There used to be very good contact lens care products available a few years ago that are no longer available now. It has been very frustrating for me, a contact lens practioner, because products that I have recommended to patients for years, products that worked and which patients had no problems with, have either been discontinued or are difficult to get.
Since the advent of disposable contact lenses, which require less care when used as directed, the four manufactuers of contact lens solutions: Advanced Medical Optics (AMO)(which took over the Allergan line of contact lens solutions),Alcon, Bausch and Lomb, and Ciba/Novartis, have tended to market only their multipurpose solutions (MPS): AMO's COMPLETE® MPS EasyRub™, Alcon's OPTI-FREE® Express™, OPTI-FREE® RepleniSH™ or Opti-One® Multi-Purpose Solution, B&L's ReNu® Multiplus Multi-Purpose Solution, and CIBA's AQuify® 5 Minute Multi-Purpose Solution, respectively. (Bausch and Lomb's ReNu® with MoistureLoc® Multi-Purpose Solution was taken off the market in April, 2006 when it was implicated by the CDC in cases of fungal keratitis, and AMO's COMPLETE® Moisture PLUS™ was recalled May 25th, 2007, when it was implicated by the CDC in cases of Acanthamoeba keratitis). The function of these multipurpose contact lens solutions is to clean, disinfect, and keep moist (both in and out of the eye) any of the traditional hydrogel soft contact lenses, as well as the new silicone hydrogel materials. With one day (single use) type of disposable contact lenses you don't have to use any solutions, other than the saline solution the sealed contact lens comes in. That is the primary advantage of one day disposable contact lenses. Theoretically, the wearer of a continuous wear disposable contact lens, if it didn't get dirty in the eye, could avoid using solutions, too. Exposure to infective agents in the environment (such as swimming, hot tubs, et al) while the lenses are worn could could cause these microorganisms to adhere to and multiply on a contact lens that is worn for an extended period of time, especially if one has a compromised immune system. A wearers lens handling is the source of most contamination and if your disposable contact lenses are to be taken out of the eye and reused then you must store them in some type of solution. A pure sterile saline solution could be used to store a sterile contact lens for a short time, but soft contact lenses, once they have been taken out of the sterile package in which they were shipped, are good media for growing bacteria, fungus, virus or other microbes. Solutions without disinfecting properties might be alright for a while, but if they have become contaminated from bacteria or other microbes on skin, tears, lens case, or anywhere else, these microbes can multiply in the pure saline in which the contact lens has been placed and infect the eye when the contact lens is later worn. From early on, methods of disinfecting contact lenses were developed that effectively killed pathogens. These methods included either heat, or some type of chemical for disinfection. Heat sometimes shortened the life of contact lenses and couldn't be used at all on some contact lens materials. Hydrogen peroxide was and still is a very effective disinfection method. In addition to disinfection, one or more methods of cleaning were developed to preserve contact lenses, surfactant cleaners that were rubbed on contact lens surfaces and enzyme cleaners which removed protein which had built up on contact lenses that had been worn for a period of time. So traditional contact lens care systems had separate steps and solutions, to disinfect, clean, and store contact lenses and these systems worked well.
"No Rub" Multipurpose Solutions
I always have to chuckle when I ask patients what contact lens solution they are using and their reply is, "No Rub." There never was a solution named "No Rub." But the four primary manufactuers of multipurpose solutions all prominantly printed on the outside of the boxes and bottles of their products the words "No Rub." The illusion they wanted to portray is that one can be lazy about contact lens care without risk, when in reality this is not the case. Multipurpose contact lens solutions made by the four major contact lens solution manufacturers probably work alright for most people wearing disposable contact lenses. The only contact storage products given to America's contact lens fitters as samples are the multipurpose solutions by the four manufacturers. In turn, they are usually the only contact lens storage products given to new contact lens patients. Although the manufacturer of each of these products used to tout its product as being better than the others because of its ability to keep contact lenses moist while in the eye, it turned out that the moisturizing agents in B & L's ReNu® with MoistureLoc® and AMO's COMPLETE® Moisture PLUS™ is what apparently attracted microorganisms (fungus and amoeba, respectively) causing corneal infections that led to the recall of these products. I believe Alcon was the first of the multipurpose solution makers to print "No Rub" on its boxes of OPTI-FREE® multipurpose solution, and the other three manufacturers soon started printing that on their boxes too. Personally, I have long felt that rubbing a cleaner on the contact lens surface, and then rinsing the debris off before before storing, cleans the lens better than just taking the lens out of the eye and storing in the solution without rubbing it. I am sure laboratory tests will confirm that. Rubbing is a good thing, not a bad thing, even if it takes a few seconds to do it. Lately contact lens solution makers are starting to realize the error in their ways in playing into the "No Rub" myth by admitting that rubbing helps clean contact lenses and AMO even has put rub into the brand name of its 2007 replacement product by calling it AMO COMPLETE® MPS EasyRub™. I guess rubbing is not so difficult after all. But the "No Rub" designation is not my main gripe. Besides the "No Rub" idea, there are two other things I don't like about multipurpose solutions: First, even though multipurpose solutions have cleaning and disinfecting agents in them I believe that multipurpose solutions neither clean nor disinfect as well as solutions dedicated to that purpose. Second, people can be, and many are, allergic to the agents in the multipurpose solutions that are used for disinfection and cleaning. Dr. Gary Andrasko studied the toxicity affects of various multipurpose solutions by soaking contact lenses made of the newest contact lens materials in these solutions and then placing the contact lenses on the eyes of volunteer subjects. The toxicity effect was measured by the amount of corneal staining produced by various lens/solution combinations. The results are were tabulated on a grid and published on the web at www.staininggrid.com.
The Good Ol' Days of AOSEPT®
To me, the gold standard of contact lens care systems, the one I traditionally used for people using non-disposable premium soft contact lenses, is the Ciba AOSEPT® system. A contact lens system is not just a single solution but several products and steps, used together to achieve the goal of cleaning and disinfecting contact lenses, without bothering the eye in any way. The original AOSEPT® system consists of: 1) Removing contact lenses from eyes and rubbing lens surfaces with a daily cleaner (Miraflow®), 2)rinsing cleaner off lenses with sterile non-preserved saline solution (generally Softwear® Saline), 3)placing contact lenses in a special case that has a disc (AOdisc®) at the bottom 4) filling the case up to the line with AOSEPT® solution (a 3 % hydrogen peroxide premixed with saline). The disc acts as a catalyst to neutralize the peroxide into water and oxygen. Peroxide is an effective disinfecting agent and it is passively neutralized into pure non-preserved saline solution overnight (minimum 6 hours) by the disc. In the morning the clean and disinfected contact lenses can be removed from the case and put directly in the eyes or rinsed with the non-preserved saline solution before placing in eyes. 4)Once per week a tablet of Allergan (now AMO) Ultrazyme is placed in the AOsept® case along with the AOsept® solution to remove protein. This system works 100% of the time without causing allergy problems.
BUT... Miraflow® Cleaner is no longer available in retail stores. CIBA will sell it to eyecare practitioners, but because of low demand few have it. The excellent Softwear Saline has been difficult to find. For AOsept users Ciba has been promoting Ciba Clear Care® (also known as AOSEPT® Plus), which eliminates the dedicated cleaner, and which has a "No Rub" designation. It is AOSEPT® without dedicated cleaner and saline solution. There are good reasons for all the components of the original AOSEPT® system. Although hydrogen peroxide is primarily a disinfecting agent, it has cleaning properties as well. It does not, however, clean as well as the original dedicated cleaners. Packaging Clear Care® without a rinsing saline solution, there is the danger of mistakenly getting the peroxide in the eye before it is neutralized in the lens case (Getting Clear Care® solution in the eyes may burn for hours, but it does no permanent damage). Besides warning my patient's about the need for neutralization of Clear Care®, I try to always dispense it with an additional solution for rinsing, either a non-preserved saline solution or MPS. Since I posted the original version of this article in 2006, I have had comments from contact lens patients from across the country, who agreed with my frustration with the contact lens solution manufacturers. As I have suspected, those who were using dedicated cleaners (such as Miraflow®) have said Clear Care® does not clean as well as their previous cleaners. Based on the Androsko Staining Grid (www.staininggrid.com) Clear Care may be the best multipurpose solution when used as directed, and Alcon's solutions (OPTI-FREE® Replenish and OPTI-FREE® Express) may come in a close second. Allergy and toxicity do not seem to be a problem with these products. But for cleaning of contact lenses, a dedicated cleaning solution still does the best job, even though the contact lens solution manufacturers seem to deny or ignore this fact.
A system that is very similar to AOSEPT®, using hydrogen peroxide as a disinfecting agent, and utilizing a dedicated cleaner, is AMO's Oxysept® (originally Allergan UltraCare®) System. AMO changed the name to Oxysept® in 2008.
The original Oxysept®/UltraCare® disinfecting system consisted of:
Oxysept® Disinfecting Solution - a sterile 3% hydrogen peroxide solution for lens disinfection.
Oxysept® Neutralizing Tablets - a delayed-release neutralizing tablet that is added at the beginning of the disinfection cycle, and colors the solution pink to show that the tablet has been added. This tablet allows disinfection to occur before neutralizing the solution all in one easy step (and serves the function of not only neutralizing the hydrogen peroxide, but adds the salt to produce a preservative-free sterile saline solution--it does what the combination of AOsept and the neutralizing disc did in the original CIBA AOSEPT® system).
Lens Plus® Daily Cleaner is the preservative-free daily cleaner to be rubbed on the contact lens surface before rinsing with saline.
Lens Plus® Sterile Saline Solution is for preservative free rinsing of any soft contact lens. It is in a spray can, which gives it bacteria controlling action of a preservative without having a chemical preservative in it.
Oxysept® Cup - a specially designed lens cup that must be used with this system.
Ultrazyme® enzyme cleaner - an enzyme tablet that is placed in the UltraCare™ Cup with UltraCare® Disinfecting Solution once a week to remove protein deposits on the contact lenses.
When Allergan first started selling the UltraCare™ system at least a decade ago all the components of the system were bundled in a starter kit made available to eyecare professionals, similar to Ciba's AOSept® kits available at that time. AMO, which was spun off from Allergan, does not make a bundled kit (just as Ciba stopped making an AOSept® kit). If you want to use the UltraCare™ system, you have to buy each component separately (the commerically available Oxysept® box found in stores has bundled a 12 ounce Oxysept® Disinfecting Solution with Oxysept® Neutralizing Tablets), but I recommend the Oxysept® system for people previously using the traditional AOSEPT® system, and been unable to find it. In September, 2006 AMO sold rights to Lens Plus® Sterile Saline Solution and Lens Plus® Daily Cleaner to another company, Exaeris. Exaeris is a pharamaceutical company that previously had no had eye care products. Distribution of these two former AMO components of the UltraCare™system is therefore limited. In fact neither are currently available. In speaking to representatives of Exaeris they will make the LENSPLUS® saline available first, then the LENSPLUS® cleaner. I have received numerous e-mails from people all over the world who have found the website and this article, and have expressed their frustration in finding a dedicated contact lens cleaner. If one looks hard there are still some contact lens cleaners available (see Soft Contact Lens Cleaners below). When used as directed the peroxide systems (AOSept®, ClearCare or Oxysept®) are the best systems for cleaning and disinfecting but patient's need to remember that the peroxide in these solutions must be neutralized before contact lenses containing these solutions can be put into the eye. Lenses cannot be rinsed with these solutions and then placed in the eye. Neutralization can be accomplished either by soaking the lenses for 6 hours in the special container with the Neutralizing disc in the case of AOSept® or ClearCare or with the Oxysept® Neutralizing Tablets in the case of Oxysept®. Failing to do this will cause a non-permanent burning of the eyes which may last hours.
Saline and cleaning solution of the Oxysept® system can be substituted for available Ciba AOSEPT® components (or with other manufacturer"s products):
Non-Preserved Saline Products: Non-preserved sterile saline solution should cause no problem on the eye when used with soft contact lenses, as long as it hasn't been contaminated. Unfortunately non-preserved saline solution is a good media for growing microorganisms, and to keep this from happening various presatives have been added to saline solutions to inhibit the growth of bacteria and other microorganisms. Unfortunately, many of the preservatives bother the eyes of contact wearers, causing allergic reactions and discomfort. Even Bausch and Lomb's Sensitive Eyes® Saline and Alcon Saline Solution use edetate disodium as a preservative. This preservative can bother some people. Prior to the peroxide systems, heat was used for contact lens disinfection, and at least one of the original non-preserved saline solutions initially intended for heat disinfection is still available, Alcon Unisol 4. We have also seen a store brand equivalent made by CVS pharmacy. These are 4 ounce bottles of non-preserved saline solution. Not having a preservative in sterile saline solution can cause the solution to become contaminated and become non-sterile after opening, so once it is opened it should be used immediately and the unused portion discarded within 30 days (or sooner if it has become contaminated--refrigeration can help preserve sterility). Another method of preserving saline solution without potentially harmful chemical preservatives is manufacturing the saline in a can in which it can be expelled using a gas propellent. This is what Allergan did in the production of Lens Plus® Saline. Later AMO, and then Exaeris, Inc, was been given the rights to this product. On July 2, 2007, Exaeris, Inc. filed petition for bankruptcy. Blairex Preservative Free Saline is another spray saline in a can. It can be ordered from online drugstores. Another saline solution we put under the list of non-preserved saline products is Ciba Softwear® Saline. Technically it has an ingredient in the bottle, sodium perborate, that acts like a preservative in inhibiting the growth of microorganisms. But the beauty of this product is that when the saline is poured out of the bottle and is exposed to air, the solution acts as a non-preserved saline, and never produces an allergic reaction in the eye. Ciba has been having a problem manufacturing the product but it should be available.
Soft Contact Lens Cleaners: Besides the problem of getting non-preserved saline solutions, it has also been difffult lately getting dedicated soft contact lens cleaners. I have been told by representatives of Ciba that Ciba MiraFlow® Cleaner is no longer going to be made available in retail stores. It is available to eyecare practioners by special order from Ciba. It is also avaiable from certain on-line retailers. Since AMO has sold the rights to LensPlus® Cleaner to Exaeris and since Exaeris has had no previous distribution of ophthalmic products we have yet to see any of this cleaner in stores. AMO's excellent non-preserved cleaner LC-65 is no longer made. Other soft contact cleaners are still made (Alcon OPTI-CLEAN® II Daily Cleaner, Alcon OPTI-FREE® Daily Cleaner , Alcon PLIAGEL® Cleaning Solution , Bausch and Lomb Sensitive Eyes® Cleaner), and sometimes you can find other store brand soft contact cleaners is stores, but they are rare, because all the manufactures only want to promote and sell their multipurpose solutions, which we have discussed above.
Derelection of responsibility by all contact lens solution manufacturers forces contact lens fitters and wearers to create their own systems. I still consider peroxide systems with separate dedicated cleaners the gold standard when contact lens wearers have allergies to preserved products and/or need better cleaning than multipurpose solutions provide. Either Exaeris Lens Plus® Sterile Saline Solution, Alcon or CVA Unisol 4, or Ciba Softwear® Saline Solution could be used interchangeably and either Exaeris Lens Plus® Daily Cleaner or Ciba Miraflow® or other contact lens cleaners could be used as the surfactant cleaner function in either the UltraCare® (now Oxysept) Disinfecting System or AOSEPT® system. The UltraCare® (Oxysept) Disinfecting Solution and UltraCare® (Oxysept) Neutralizing Tablets must be used with the Oxysept system. Now it is hard to find any non-preserved saline to use with the peroxide system except Unisol 4 and its equivalents. Good luck in finding ANY dedicated soft lens cleaning agent.
There is no website or organization that we know called All About Ophthalmic Lens Prescriptions and Lens Options. The closest thing to it is the website of Laramy-K Optical. Laramy-K is an optical lens laboratory that cuts lenses for dispensing opticians and eye care practitioners who dispense eyewear. Laramy-K has a great website about lenses that is useful to anyone with an interest in ophthalmic lenses. Another resource is the section on ophthalmic lenses in wikipedia.
Some of the articles and links concerning the basic optics of ophthalmic lenses, what the numbers in a lens prescription mean and lens options that can be dispensed are described below. They answer the questions most people have about prescription lenses, and talk about lens options you may not even be aware of, covering things from the basic to the more technical. Their comparison of Polycarbonate and Trivex explains why Trivex is the lens material of choice in drilled rimless frames:
DriveWear ®Lenses Polarization and Transitions (this goes to www.Drivewearlens.com site Younger Optics Drivewear site which requires Flash). Drivewear is the first polarized photochromic lens to darken behind the windshield of a car, allowing Drivewear to change from high contrast green/ yellow to copper to dark reddish brown (depending on lighting conditions) in order to enhance the driver’s vision. It is only available by custom fabrication, even with or without prescription.
Certain options of ophthalmic lenses, such as the qualities of Photochromatic Transitions® lenses, can be found in the Optical Products section of 1800MyEyeDoc.com
*Anti-Refective Coatings (AR coatings)---The benefits of AR Coatings are reviewed on wikipedia, but we have noticed some complaints from our patients over the years with AR coatings. These have involved cost, cleaning, and the fact that sometimes the coatings have peeled off the lenses. The main benefit of an AR coating is that it seems to make the lens disappear from the frame, while leaving the prescription, so that the lens bends the light as it should to improve your vision, while ridding the wearer of the awareness of the lens. When you look at or through a clear (untinted) lens, you are aware of the lens being there by light reflected off its surfaces. Even a lens that has surface finger prints, dust, dirt, and scratches, these defects of the lens surface may not be readily seen on an uncoated lens because they are generally absorbed into the reflection. So the main complaint that new wearers of AR coated lenses may have is noticing things on the lens that they didn't notice on an uncoated lens. And this brings about the problem of cleaning AR coated lenses. They take special care. In order to keep AR coated lenses from showing the finger prints, dust and dirt they must be kept cleaner than non-coated lenses. There are newer AR coatings that have special protective coatings over and under the AR coatings, that make the lenses scrach-resistant, resist dust and fingerprints, make lenses easier to keep clean and keep the AR coating from peeling off. AR coating laboratories make AR coatings available both with and without the premium features. In our office the standard AR coatings add $45.00 to the cost of a pair of lenses and the premium coatings are more, depending on their features. Vivex coating (by iCoat Company) has most of the premium features for a cost of only $10.00 more than standard AR coating. Most durable premium coatings cost more.
The American Academy of Ophthalmology evolved as part of the American Academy of Ophthalmology and Otolaryngology (AAOO), which was founded in 1896 primarily to provide continuing education to eye, ear, nose and throat doctors (EENTs).
The American Academy of Ophthalmology was incorporated as an independent organization in 1979 when the AAOO was divided into separate academies for each specialty and is the largest organization for ophthalmologists in America.
Founded in 1898, the AOA is a federation of state, student and armed forces optometric associations. Through these affiliations, the AOA serves members consisting of optometrists, students of optometry, paraoptometric assistants and technicians.
The Andrasko Staining Grid is an easy-to-use reference tool informing the eye care practitioner as to the level of biocompatibility of various contact lens/multipurpose solutions. When the corneal surface has been insulted either by an abrasion, a microorganism, or a toxic chemical, it will absorb topically applied sodium Flourescein and the extent of this absorption can be seen and graded using a slit lamp biomicroscope. The extent of the staining can be graded. Dr Andrasko soaked various brands of soft contact lens in various brands of Multipurpose contact lens solutions and then graded the corneal staining that occured on patient corneas after 2 hours. The www.staininggrid.com website goes into more detail on methodology. The results appear as a "grid" with the solutions listed across the top and the lens materials in the first column. The percentages which appear in each cell represent the average percentage of the cornea which was stained 2 hours after lens/solution insertion.
To choose a biocompatible multipurpose solution for a particular lens brand: 1) Find the lens material (if it has been tested) in the first column of the grid. 2) Follow across that row and select a solution which results in minimal corneal staining.
Note: Clicking on a percentage inside a cell of the Grid gives more information about that particular study's results.
Lens and Solution Combinations
Percentage of Average Corneal Staining Area at 2 Hours
The Association for Research in Vision and Ophthalmology (ARVO) is one of the most prestigious organizations for cutting edge research in the field of vision and ophthalmology. Their website has a list of research papers that have been presented at their annual meetings as well as a directory of their members.
Dr. Brian Boxer Wachler was the second director of the refractive surgery center at Jules Stein Eye Institute. After FDA approval in 1999, Dr. Boxer Wachler was the first in the United States to publish the use of Intacs for treating a corneal degenerative condition called keratoconus after this treatment had successfully been done in other countries. Since then, the use of Intacs has dramatically increased for this condition. More detailed information can be found at www.keratoconusinserts.com. Dr Boxer Wachler started his own Boxer Wachler Institute in Beverly Hills in 2003. In 2004 he was the first ophthalmologist in the U. S. to embrace a new treatment developed in Germany by Gregor Wollensak, MD, called C3-R, to slow or stop the progression of Keratoconus by strengthening cross-linked collagen fibers in the cornea using specially directed 30 minute exposure to the cornea of UVA radiation with riboflavin drops placed on the cornea to protect deeper layers of the eye from the ill effects of such radiation. He was the first doctor in the world to combine this treatment with Intacs.
We think of the Braille Institute as providing services for the totally blind. They are still the leading organization for services for the blind. But they are much more than that. From Child Development programs to classes in independent living skills to Low Vision Rehabilitation Services, click here to find all of their programs and services for people who are visually impaired, often offered free of charge to the recipients.
This site by the California Board of Optometry (www.optometry.ca.gov) lists all licensed optometrists in California, state laws regarding optometry including requirment for licensure and continuing education requirments for optometrists, and other facts of about the profession in California, including several downloadable documents, such as "Focus on Your Eyes - A Consumer Guide to Eye Care"(PDF).
If you don't have a health insurance plan with good drug benefits and you need prescription drugs, especially long-term, you know how expensive that can be. This is a site that is not especially for eyes, although they do have eye medications. It is an online drug store in Canada that requires your doctor's faxed Rx, (usually for 100 tablets because they ship them in the manufacturer's unopened bottle), and after filling out an on-line questionnaire, you'll find prices are usually at least a half of what U.S. drugstores charge for the same medications. If you need an anti-biotic or corticosteroid or other acute relief medication, you'll want to get it as fast as possible at your local pharmacy--not here. But if you have chronic problems such as allergies, heart disease, hypertension, anxiety, glaucoma, arthritis, thyroid disease, etc., for which you must take anti-allergy medications, chronic heart medications, blood pressure medications, anti-depressants, glaucoma drops, long term pain relievers, thyroid tablets, and other medications that you chronically need refills for and can wait a week or so to get them check out Canada Pharmacy. Besides ordering on line at http://www.canadapharmacy.com/ you can call them 24 hours a day at 1-800-891-0844. As a special to those referred by 1800MyEyeDoc.com if you mention Promo Code 1-85977 you will receive $25.00 off your initial order that totals at least $100. If you are going to need medications regularly for the rest of your life you might want to get the company's free lifetime shipping benefit, available for $50.
cataractsurgery.com
www.cataractsurgery.com is a site by Alcon that explains catararcts, cataract surgery and the benefits their intraocular lenses used in cataract surgery.
The Center for the Partially Sighted in Los Angeles, California has optometrists and counselors who specialize in low vision (vision not correctable with normal eyeglasses and contact lenses and has special devices, counseling/support groups, technology and training and special store that features low vision products.
The CLEK Study was a multi-center, observational study whose purpose was to prospectively characterize vision, corneal changes, and patient quality of life in Keratoconus and to determine the progression of changes occurring with Keratoconus over time.
Over 1,200 keratoconus patients were enrolled at 15 participating clinics across the United States, examined at enrollment (between May 1995 and June 1996) and annually through 8 years of follow-up (the last 8-year follow-up was completed in August 2004).
The Digital Atlas of Ophthalmology is a database of images drawn from the vast clinical experience of The New York Eye and Ear Infirmary specialists and their colleagues around the world.
The Digital Atlas is intended to serve as a visual reference and educational supplement for ophthalmologists, general physicians, and medical students.
DrElman.com is the website Dr John W Elman, Optometrist, created for members of VSP in 2001. It does not allow Adobe Flash Animation, GIFs, and other technological computer upgrades, but still has information about Dr. Elman's office and links with eye information. He launched 1800.MyEyeDoc.com in 2005. He is responsible for all content on both DrElman.com and 1800MyEyeDoc.com.
This is a database of ophthalmological images created by Italian eye researcher Umberto Benelli, MD, PhD, who works in the Eye Center of the University of Pisa.
This site provides information for patients and interested members of the public on a variety of common vision problems and therapies. The material on the site has been reviewed for accuracy and balance by panels of leading eye surgeons who comprise the Eye Surgery Education Council (ESEC).
The site has sections on laser vision correction (LASIK and similar procedures), cataracts, and glaucoma. Sections under development include those on new technologies for managing presbyopia, the age-related loss of the eye’s ability to focus on near objects, and children’s vision problems and their treatment.
The ESEC is an initiative established by the American Society of Cataract and Refractive Surgery (ASCRS), a professional society of ophthalmologists who specialize in these type of surgeries.
Eyesurf.info is a free optical search engine created to assist eyecare professionals research medical information, optical equipment, optical industry news, optical continuing education, designer frames, laboratories, contact lenses, schools and more. The site includes an extensive list of optical industry websites.
Eyesway is the web portal for the optical and eyewear industry realized by Mido Srl Unipersonale and ANFAO (the Italian Association of Eyewear Products Manufacturers). With such companies as Luxottica, Safilo, Marchon and others, Italy is the center of the eyewear industry. When Luxottica bought the rights to the Rayban line from Bausch and Lomb it signalled the end to any American claim that the US was a significant player and showed that the global headquarters for the optical industry is in Milan, Italy.
Eyeglass Guide
Eyeglass Guide is an interactive interview (from DrElman.com) that considers the factors to think about and the options to consider when ordering glasses. It requires Adobe Flash on your computer to view.
Eyeglass Guía (Eyeglass Guide en Espanol)
Eyeglass Guía interactiva es una entrevista (a partir de DrElman.com) considera que los factores de pensar y las opciones a considerar cuando se ordena gafas. Requiere Adobe Flash en su ordenador para ver.
Although the main emphasis on Dr. Elman's website is information specific to the eye and vision, this link is an excellent one as an up-to-date resource for general health topics. The homepage www.1uphealth.com features various health topics, current research studies, and definitions and information on over 1600 systemic diseases and descriptions of over 300 medical symptoms, such as abdominal pain, headaches, or heart palpitations, to allow users to search topics by what they are experiencing.
Google Health puts you in charge of your health information. It's safe, secure, and free.
Organize your health information all in one place
Gather your medical records from doctors, hospitals, and pharmacies
Keep your doctors up-to-date about your health
Be more informed about important health issues.
The free service integrates with other services that hospitals and doctor's offices are starting to put in place so the information can be transferred to the patient's providers, especially those who previously had not seen the patient. Google has integrated partners to supply the patient data to the doctors and hospitals. Among them are www.I-HealthRecord.org and www.NoMoreClipboard.com.
This is a great service of Google that allows you to translate a text message or even a whole website from one language to another. You can go to Google's Language translator site by clicking here and if you want to translate this or any other website from English to Spanish, for example, just type the address of the website you want to translate in the field after Translate a web page and the website will automatically be translated into any of eight languages.
Besides the websites that have been prepared by various refractive surgeons the government, specifically the FDA, has also prepared a site about LASIK surgery. If you want an impartial preview of the subject, this may be a place to begin.
iCoat Company is a leading independent laboratory in thin film optical coating technology. iCoat's anti-reflective coatings combine ion-impacted static-neutral anti-reflective technology with unparalleled scratch resistance. iCoat's mirrors (ICE mirrors) are in two groups, Flash ICE Mirrors for fashion and Solid ICE Mirrors, which are popular with sports enthusiasts, particularly those participating in activities such as golf, skiing, snowboarding, hunting, fishing and hiking. All ICE mirror coatings have anti-reflection coatings on back side of lens and antiscratch coatings on both sides.
HealthInsurance.com is a comprehensive website that compares various Health Insurance plans available for groups, families, and individuals, defines insurance terms and has links to applications for insurance. Dr Elman is an affiliate of HealthInsurance.com.
iHealthRecord (http://www.ihealthrecord.org ) is a secure and confidential interactive personal health record that patients can keep on-line, on password protected Internet servers maintained by Medem Inc., an online medical services company set up in 1999 by medical societies such as the American Medical Association, American Psychiatric Association and American Academy of Pediatrics. This service not only stores personal health information for you and your loved ones, but it provides interactive programs that help you better understand medical conditions and medications, all at no cost to you, the patient. It is paid for by subscribing doctors, hospitals and medical groups. Even if your doctor doesn't subscribe, you can create, manage and share your personal health information with your physician, or another care giver in case of an emergency. Other features of an iHealthRecord are as follows:
Secure email and Online Consultation with your doctor
Automatic email warnings if a medication that you take is recalled or has a safety notice from the FDA
Automatic education programs, written by medical societies and other national experts and sent to you, that are specific to your medications or conditions
Quarterly online reminders to keep your iHealthRecord current
The ability to access the iHealthRecord in an emergency
The ability to share your health record with family members and loved ones
All of your medical information stored in one place and accessible from anywhere and at any time
A convenient iHealthRecord wallet card that provides emergency contact information and directions to access your iHealthRecord
“We believe that electronic personal health records are an important service for physicians and patients, and a key element of the national information technology infrastructure,” Dr. James Rohack, chairman of the American Medical Association told a news conference May, 2005.
The medical groups backing the iHealthRecord, which include the American Heart Association and American Cancer Society, said it could be a first step to transforming the ponderous and mistake-prone paper-based U.S. medical records system into an efficient, digital structure.
“Ultimately, we know these systems will reduce medical errors and save lives,” said Rohack. “It doesn’t matter whether (patients) move, switch health plans or switch doctors.”
Dr. Elman does not subscribe to IHealthRecord but to a similar program, www.NoMoreClipboard.com. These and other programs are now partnered with Google Health. Since Dr Elman maintains patient records in an electronic format in his office, he can, at a patient's request, give the data to the patient, who can then transfer information to Google Health, NoMoreClipboard.com or iHealthRecord.
This Atlas of Ophthalmology is a comprehensive public online database, free of charge, edited by specialists in the field from around the world. The site has translations into multiple languages, but the link we have given is for the English version.
Established in 1966, the Jules Stein Eye Institute represents the culmination of a dream shared by ophthalmologist, businessman and philanthropist Dr. Jules Stein and his wife Doris, of creating a world-renowned center dedicated to the preservation of vision and the prevention of blindness. The Institute's comprehensive programs for the care of patients with eye disorders, research in the vision sciences, education in the field of ophthalmology and outreach to the community, coupled with its state-of-the art facilities, have brought national and international recognition to the Institute and UCLA. Besides the ophthalmology residency programs offered at the Institute it also provides continuing education for community ophthalmologists and optometrists at its weekly Wednesday Grand Rounds presentations held in the RP Auditorium. It's website gives information about its services and staff.
Keratoconus literally means a cone-shaped cornea. The cornea or window of the eye thins, resulting in progressive nearsightedness and astigmatism over time. The vast majority of patients with keratoconus can be visually corrected with special contact lenses. They may require many lens changes over a lifetime as the cornea is constantly changing. The corneal thinning may stop or progress at any age.
Studies to date support the position that there is a genetic basis for keratoconus. As such, it is the goal of the Keratoconus Genetics Research Program to study patients with keratoconus and their family members in order to identify the gene(s) that cause the inherited form of the disease. Program staff: Yaron S. Rabinowitz, M.D., Principle Investigator, Cornea Specialist/Ophthalmic Geneticist, and Diana Remba, Research Coordinator. They hope to be able to use this information to devise a cure for high-risk individuals.
There are several wonderful refractive surgeons in the Santa Monica-West Los Angeles area that we refer to and comanage patients with. Dr. Wallace is one of them. He not only is an excellent surgeon but he has a very informative and unique website. The website includes graphics on how the eye works, multimedia video of refractive procedures being done, good search tools as well as Q&A and commentary from Dr. Wallace. It has information on various options in refractive surgery, in addition to LASIK, and news on hot topics in refractive surgery, such as the various single vision and multifocal Intra Ocular Lens implants to help correct presbyopia with or without cataract surgery, and Wavefront Technology that has been incorporated into the Alcon Ladarvision eximer laser and Visex StarS3 eximer laser and the new Wavelight Allegretto eximer laser, which Dr. Wallace has in his office. With the Allegretto Dr. Wallace has been able to achieve 20/20 vision without lenses on 99% of the patient's who previously needed lenses to see that well, while eliminating halos and glare that often accompanied earlier refractive surgeries. Using the new technology he is able to offer to patients a 20/20 guarantee.
This site translates phrases and websites from one language to another (such as English into Spanish and many other languages) and is useful when explaining health problems to people in different languages. The Google translater offers more for free, and this site by Systran will translate short phrases of up to 150 words for free, but offers more complicated translation services for a fee.
Laramy-K is an optical lens laboratory that cuts lenses for dispensing opticians and eye care practitioners who dispense eyewear. They have an informative website that can answer questions, in simple terms, about the differences of various types of lenses and lens materials. The website describes the basic categories of eyeglass lenses (single vision, bifocals, trifocals, blended and progressive multifocal lenses) and the options that are available to wearers in these type of lenses. The site includes a discussion of the concept of lens power in diopters , what the three components of a lens Rx (Sphere, Cylinder and Axis) mean, as well as a less used lens component called prism; the difference between polycarbonate and the new Trivex (Trilogy) material (the latter may be the best for drilled rimless frames), the advantages of A-R (Anti-Reflection coatings) the concept and advantage of aspheric lenses, and other options that people may want to consider when having a pair of glasses made.
This article, written by Darryl Meister, ABOM, technical marketing director of SOLA International, tells the history, advantages, and limits posed by various PAL designs and helps explain why, although many people prefer and do better with PALs than traditional bifocals and trifocals, there other people who prefer the optics and/or price of the traditional lined bifocals and trifocals, while others do better with separate single vision lenses for distance, near and intermediate tasks.
Dr. Robert Maloney started the refractive surgery center at Jules Stein Eye Institute and started his Maloney Vision Institute in Westwood after several years. He has always been on the cutting edge of new refractive surgery procedures and is one of the best refractive surgeons in the country.
Although expensive health insurance plans cover vision services and materials, most major medical plans, such as those that self-employed and small companies tend to have, do not cover glasses, contact lenses, or even routine exams. Medical Savings Accounts (MSAs) and Health Savings Accounts (HSAs) can be created along with a high deductible medical insurance (to cover the major catastrophic health expenses) which allows these people to create a plan that allows them to put money in a special Medical Savings Account or Health Savings Account. The money put in and taken out of the MSA or HSA is not taxed, and can be used for those medical expenses you chose, such as eyeglasses, contact lenses, LASIK surgery, or cosmetic surgery that traditional medical plans would not allow, as well as other doctor visits. There may be minimum amounts that must be put into the accounts, there are monthly fees, and penalties if the money is not used for a qualified medical expense, but contributions into the account earn interest tax free and the unused balance rolls over every year throughout your life. The title link goes to PDF file of IRS Publication 969, defining MSAs. I find that more useful and readable information may be available on the websites of certain brokers who specialize in HSAs and MSAs such as this one from C. Dean Richard: http://www.msainfo.net/
The National Eye Institute (NEI) was established by Congress in 1968 to protect and prolong the vision of the American people. As one of the Federal government's National Institutes of Health (NIH), the NEI conducts and supports research that helps prevent and treat eye diseases and other disorders of vision. This research leads to sight-saving treatments, reduces visual impairment and blindness, and improves the quality of life for people of all ages. NEI-supported research has advanced our knowledge of how the visual system functions in health and disease.
Vision research is supported by the NEI through approximately 1600 research grants and training awards made to scientists at more than 250 medical centers, hospitals, universities, and other institutions across the country and around the world. The NEI also conducts laboratory and patient-oriented research at its own facilities located on the NIH campus in Bethesda, Maryland. Their website is a wonderful resource for information about eye diseases and the many things the NEI does: www.nei.nih.gov.
NIH is one of the agencies of the Public Health Services which, in turn, is part of the U.S. Department of Health and Human Services. Comprised of 27 separate components, mainly Institutes and Centers, NIH has in excess of 75 buildings on more than 300 acres in Bethesda, Maryland. From a total of about $300 in 1887, NIH has been appropriated nearly $23.4 billion for 2002. The NIH mission is to uncover new knowledge that will lead to better health for everyone. NIH works toward that mission by:
Conducting research in its own laboratories; supporting the research of non-Federal scientists in universities, medical schools, hospitals, and research institutions throughout the country and abroad; helping in the training of research investigators; and fostering communication of medical information.
The National Keratoconus Foundation (NKCF) is an outreach program of the non-profit organization Discovery Eye Foundation http://www.discoveryeye.org/. The NKCF provides information and support to persons diagnosed with keratoconus. The NKCF publishes a newsletter, distributes patient information booklets, provides physician referrals, helps start local support groups and maintains this website for patient information and discussion.
The United States National Institute of Health (NIH) supports the National Library of Medicine (NLM)--the largest medical library in the world. PubMed, a service of the National Library of Medicine, provides access to over 12 million MEDLINE citations back to the mid-1960's and additional life science journals. PubMed includes links to many sites providing full text articles and other related resources.
NoMoreClipBoard.com like i-Health Record is an online Patient Health Record company that integrates with Google Health to provide online secure storage of patient medical records that can be downloaded and sent to patient's new doctor's before appointment is made so that the normal forms handed to the patient on a clipboard do not have to be repeated when patient visits a new doctor. The storage of records online is free to the patient. Dr Elman's subscribes to this service.
This service not only stores personal health information for you and your loved ones, but it provides interactive programs that help you better understand medical conditions and medications, all at no cost to you, the patient. It is paid for by subscribing doctors, hospitals and medical groups. Even if your doctor doesn't subscribe, you can create, manage and share your personal health information with your physician, or another care giver in case of an emergency. Other features of patient online storage are as follows:
Secure email and Online Consultation with your doctor
Automatic email warnings if a medication that you take is recalled or has a safety notice from the FDA
Automatic education programs, written by medical societies and other national experts and sent to you, that are specific to your medications or conditions
The ability to access the NoMoreClipboard.com or Google Health in an emergency
The ability to share your health record with family members and loved ones
All of your medical information stored in one place and accessible from anywhere and at any time
“We believe that electronic personal health records are an important service for physicians and patients, and a key element of the national information technology infrastructure,” Dr. James Rohack, chairman of the American Medical Association told a news conference May, 2005.
The medical groups that back online medical records include the American Heart Association and American Cancer Society, said it could be a first step to transforming the ponderous and mistake-prone paper-based U.S. medical records system into an efficient, digital structure.
“Ultimately, we know these systems will reduce medical errors and save lives,” said Rohack. “It doesn’t matter whether (patients) move, switch health plans or switch doctors.”
This website is part of the Occupational Outlook Handbook provided by the U.S. Department of Labor Bureau of Labor Statistics. It discusses the profession of optometry in the United States and defines the role of optometrists.
The goal of Palm4Eyes.com is to provide useful handheld-device (PDA) software for eye care professionals, as well as a helpful online resource. It is especially an excellent resource for its pictures on external eye diseases.
The Retina-Vitreous Associates Medical Group is an ophthalmological medical group located in the Good Samaritan Hospital medical building in Los Angeles that specializes in diseases of the retina and vitreous. They are always on the cutting edge of medical research in their specialties for diseases such as Age Related Macular Degeneration and repair of diabetic retinopathy and provide an annual educational seminar for eye doctors at Good Samaritan Hospital.
RxList.com contains a great search tool for information on various medications, including brand names, generics, modes of action and different drug classes. The site is owned and operated by RxList LLC a California limited liability company located in San Francisco. RxList was founded and is maintained by Neil Sandow, Pharm.D. a licensed California Pharmacist, who has been publishing on the Internet since 1994.
Over twenty years ago, a dozen senior citizens had a dream that people over 65 would enjoy easy access to the health care coverage and personal care services they needed to remain independent. That's why they formed Senior Care Action Network, now known as SCAN Health Plan (www.scanhealthplan.com). It is available in four southern California counties: Los Angeles, Orange, Riverside and San Bernardino. Many of the other HMO plans for seniors have cut their benefits and have not told their members about it. If you, or your parents or grandparents are eligible for Medicare and are unhappy with the deal you've got, check out this non-profit organization. As part of the full line of health benefits they offer is vision benefits though VSP, prescription benefits, physical therapy, skilled nursing, chiropractic, hospital, diagnostic lab tests, and mental health inpatient services. For Los Angeles County there is no premium for Medicare eligible patients to sign up for this program. One problem for eligible members in the west Los Angeles--Santa Monica--Palisades--Malibu area is that there is no participating hospital in this area. Because the local hospitals are not participating, the local doctors are also not participating. The closest participating hospitals to the west Los Angeles area are in Torrance, downtown Los Angeles or the San Fernando Valley. Hopefully westside provider participation will occur in the future and the many seniors in the Santa Monica area can enjoy the benefits of this organization. Dr. Elman is trying to reach parties on both sides (SCAN and hospital providers) to facilitate this. If you can help call SCAN or Dr. Elman. SCAN Health Plan headquarters is in Long Beach, CA and their phone number is (800) 915-7556.
Sjögren's ("SHOW-grins") syndrome is a chronic disease in which white blood cells attack the moisture-producing glands. The hallmark symptoms are dry eyes and dry mouth, but it is a systemic disease, affecting many organs and may cause fatigue. It is one of the most prevalent autoimmune disorders, striking as many as four million Americans. The Sjögren's Syndrome Foundation promises to make a difference in the lives of people with Sjögren's and their families by offering: Information and support, Public awareness, Education for medical professionals, Advocacy for increased research. I also recommend checking out http://www.theocularsurface.com.
Patients come to the Boston Foundation for Sight, desperate for relief from devastating corneal disorders such as Stevens-Johnson syndrome, keratoconus, distorted corneal transplants, corneal degenerations and dystrophies, corneal scars, disabling dry eye disorders and eyelid abnormalities that cause severe eye damage. Dr. Perry Rosenthal of the Boston Sight Foundation has developed a unique scleral rigid gas permeable contact lens that must be made and fit at their facility in Boston, MA.
This site at www.theocularsurface.com is geared for ocular professionals and is the most complete source for information about dry eye problems, their treatment and shows the latest research about ocular surface disease.
In 1978 Jeffrey P. Gilbard, MD, while still in medical school,received project grant funding from the National Eye Institute to develop an eye drop for dry eye that really worked. This research led him to develop several eye drops plus a nutritional supplement containing omega-3 fatty acid, all to aid dry eye problems. All of the products are branded TheraTear and are produced by the company that Dr. Gilbard founded, Advanced Vision Research. Besides being the CEO of the company he founded Dr. Gilbard is a Clinical Assistant Professor of Ophthalmology at Harvard Medical School, and Director of the Dry Eye and Ocular Surface Disease Clinic at the New England Eye Center in Boston, and a speaker on dry eye problems, touting his success with TheraTear.
Éste es un gran servicio de Google que permita que usted traduzca un mensaje del texto o aún un website entero a partir de una lengua a otra. Usted puede ir al sitio del traductor de la lengua de Google chascando aquí y si usted desea traducir esto o algún otro website de inglés al español, por ejemplo, tipo justo la dirección del website que usted desea traducir en el campo después de que traduzca un Web page y el website será traducido automáticamente a cualesquiera de ocho idiomas.
There are reasons that people may want refractive surgery to correct myopia, but are not candidates for LASIK surgery. These include higher powers, thin corneas, or suspicious corneas. Vision of the implantable Visian ICL might be better than LASIK or PRK. Visit www.visianinfo.com for more information.
An Internet Resource for Research in Human and Animal Vision
This website is a master list of websites and organizations having to do with vision and the psychophysiology of vision. It has links to universities around the world that have programs having to do with vision. It has online demonstrations of visual effects of motion, 3-D, and optical illusions. You could spend all day on this sight and still not see everything, yet it is very well organized and up-to-date. Highly recommended.
VSP is the largest vision provider group in the United States. It started in 1955 with a dream to provide high-quality, cost-effective eye care benefits, a group of optometrists in Oakland, California form the first prepaid, not-for-profit vision benefit. It is now available in every state in America, and continues to be cutting edge in trying to benefit member patients and member providers with education and innovative programs.
NoMoreClipBoard.com like i-Health Record is an online Patient Health Record company that integrates with Google Health to provide online secure storage of patient medical records that can be downloaded and sent to patient's new doctor's before appointment is made so that the normal forms handed to the patient on a clipboard do not have to be repeated when patient visits a new doctor. The storage of records online is free to the patient. Dr Elman's subscribes to this service. 
