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Turning Back The Clock Could Mean More Car Accidents: Tips For Better Night Vision

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Our annual “fall back” time change that gives us an extra hour of sleep is welcome news for most of us. But there are some unintended consequences of darker evenings, especially for drivers. According to the National Safety Council, traffic death rates are three times greater at night than during the day.

In a special rebroadcast of the Healthy Vision with Dr. Val Jones show, I interviewed Dr. Christina Schnider, Senior Director, Professional Communications for VISTAKON® Division of Johnson & Johnson Vision Care, about common nighttime driving problems such as dry eyes, headaches, and eye fatigue. I also spoke with John Ulczycki, Group Vice President – Strategic Initiatives, for the National Safety Council, about safe driving tips. You can listen to the show here:

Most people experience a drop in visual acuity in the dark, and this can cause difficulty seeing traffic signs, pedestrians and roadside objects. The primary reason why it’s difficult to see at night is that our pupils dilate to let in as much light as possible. The trade off with large pupils is that visual acuity suffers. It’s normal for the average person’s visual acuity to drop from 20/20 to 20/40 in low light conditions.

Because of vision challenges, driving in low-light conditions can fatigue the eyes and head and neck muscles as the driver strains to see the environment more clearly. Dry eyes can occur from reduced blink rates and motor vehicle heating and cooling systems. Glasses wearers may have a reduced field of vision which further complicates driving in the dark. In fact, in a recent survey one -in-three drivers reported that they didn’t see well at night.

Dr. Schnider and Mr. Ulczycki suggest that night time driving may be safer (and more comfortable) with these tips:

1.  Update your eyeglass or contact lens prescription(s). Since darkness reduces visual acuity, wearing lenses that correct your vision to 20/20 in normal light conditions is extra important. Old glasses or contacts with outdated vision correction power can make driving in the dark more hazardous. If you experience significant challenges seeing at night, you may have a condition called “nighttime myopia” and should visit your eye doctor for advice.

2. Avoid driving long distances in low-light conditions. Since we already know that driving in the dark can cause eye fatigue, dry eyes, and reduced visual acuity, it’s best to minimize the time you spend behind the wheel during dark hours. Whenever possible, plan your travel so that the majority of your driving time occurs during daylight hours.

3. Take frequent breaks. Even though it’s tempting to push through your fatigue and finish driving those last miles to your destination, it’s safer to give yourself (and your eyes) a break. Stopping for gas or at a rest area may improve your alertness and visual fatigue. Remember that impaired drivers are more likely to be on the road at night, so vigilance on your part may prevent an accident.

4. Decrease your night-time driving speed. If you do need to drive in the dark, doing so more slowly may prevent accidents. Traveling at a slower speed can improve reaction time under lower-visibility conditions.

5. Check your headlights. It is estimated that 50% of all motor vehicle headlights are not optimally aligned. Potholes and bumps in the road can jolt the lights out of alignment. It’s important not to look directly at oncoming headlights. This can temporarily blind you as your pupils adjust to a quick change in lighting conditions.

For more safety tips, please listen to the full Healthy Vision podcast.

*Val Jones, M.D. is a paid consultant for Johnson & Johnson Vision Care, Inc.*

Six Bad Things That Can Happen If You Don’t Wear (And Care For) Your Contact Lenses Appropriately

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Photograph: Richard Austin/Rex Features

I have been wearing contact lenses for about twenty five years. Overall, I’ve been very happy with them, and have found that they have improved my vision as well as my self-esteem. As a very nearsighted person, my glasses have the proverbial “Coke bottle” lenses. Even though I’ve chosen “ultra-thin” lenses, the refractory nature of the plastic causes my eyes to appear unusually small, giving me the appearance of a juvenile badger (they have pretty small eyes for the size of their heads – check out the photo).

Needless to say, I prefer wearing contact lenses – but I must confess that I’ve been somewhat non-compliant in wearing them according to my eye doctor’s instructions. I’ve learned a few things from my mistakes, and from interviewing optometrists Jason Pingel and Christi Clausson about other patients who have been naughty. I will summarize six of the most common mistakes that contact lens wearers make, and explain what the potential harms can be. You can listen to the full podcast of this interesting interview, here:

  1. Wearing Your Contact Lenses For Too Long – this was my biggest personal mistake. It’s tempting to wear your contact lenses beyond the recommended replacement schedule in order to save money, or for simple convenience. My contacts felt so comfortable that I’d wear them (don’t gasp in horror) for months at a time, even sleeping in them at night. But after a while my eyes started hurting when I took my contacts out, which just perpetuated the cycle of over-wear. In effect, I was depriving my corneas of oxygen for long enough to kill some of the superficial cells, so when I took my lenses out it was like removing a bandage from a wound. My corneas were sensitive to light, touch, and even the wind. This medical condition is called “superficial punctate keratitis” and although it’s reversible with eye rest, it is quite uncomfortable. If you wear your contacts for too long, this could happen to you.
  2. Using Tap Water To Re-Wet Your Lenses – Sometimes when a piece of lint gets in your eye or your eyes are feeling dry you may be tempted to rinse your lenses with some tap water. Although that seems harmless enough, tap water is not safe for use with contact lenses. Tap water is not sterile, and it can contain bacteria or even protozoa that can cause serious damage to your eye. Just as you would never drink salt water, you should never expose your contacts to tap water. The risk of eye discomfort, alteration of the lens, pH imbalances, or even infection is not worth the risk.
  3. Not Washing Your Contact Lens Case Regularly – At least a third of contact lens wearers report cleaning their cases monthly or less often. Obviously, mold spores and bacteria are not good for the eyes, so if you aren’t cleaning your lens case frequently you are putting yourself at risk for eye infection and allergies. Lens cases should be rubbed and rinsed with sterile solution recommended by your eye care provider, dried with a lint free towel or and allowed to air dry with both the case and cap(s) down before re-use.
  4. Not Changing your Contact Lens Solution – Dr. Pingel told me that many of his patients admit to “topping off” their contact lens solution or storing them in the same solution from the day prior. This increases the risk of bacterial growth in the solution and lens case. The way I think of it – it’s like having a surgeon simply wipe off her instruments on her gown between patients. It’s much safer for her to dispose of the instruments or have them sterilized before the next use, right? The same goes for contact lenses and their solution.
  5. Not Washing Your Hands Before Touching Your Eyes Or Lenses – Our hands are exposed to hundreds of different bacterial strains, molds, dirt, and chemicals every day. Not washing your hands with mild soap and water prior to touching your contacts is like touching your eyeball to a door knob. Why take the risk of introducing chemicals or bacteria into your delicate eye area? It’s very important to wash your hands carefully before insertion and removal of contact lenses so as not to increase your risk of infection, allergy, or chemical burns of the eye.
  6. Not Sharing Your Contact Lenses With Others (Or Buying Them Without A Prescription) – While that might sound like an uncommon practice, it actually becomes an issue around Halloween time. With cosmetic lenses that can make your eyes look like anything from a cat to a zombie, it is tempting to share lenses with friends. However, you should not purchase or wear cosmetic lenses without an examination by an eye doctor and a prescription to ensure they fit safely and comfortably. Delicate corneal skin can be scratched, irritated, or even infected by unclean or ill-fitting lenses. No one wants their real eyes to look scary, right? So please don’t buy lenses without a prescription or share your lenses with others.

For more information about safe wear and care of contact lenses, I highly recommend that you check out the Healthy Vision & Contact Lenses e-brochure. It is a terrific summary of all the most important do’s and don’ts of contact lens wear and care – perfect for double-checking on your safe use behaviors, or teaching your kids/teens about how to care for their lenses. Or you can use my blog post and podcast to badger them (pun intended), if that’s more convenient.

Disclosure: Dr. Val Jones is a paid consultant for VISTAKON® Division of Johnson & Johnson Vision Care, Inc.

Ultraviolet Radiation Damage Can Have Long Term Consequences For Your Eyes

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If you were invited to be part of a nuclear radiation clean up crew, I bet you’d want to wear protective gear. Not just the white hazmat bunny suit, but the gloves, goggles, mask and booties as well, right?  But when it comes to ultraviolet radiation exposure, we often put on “half a suit” as it were. We cover our skin with sunscreen (maybe) but we don’t regularly protect our eyes. I’m not sure why we forget this step, but it’s time to get serious about eye protection.

In a recent interview with dermatologist, Dr. Jeanine Downey, and optometrist, Dr. Stephen Cohen, we discussed the long term damage that UV radiation can cause to the skin and eyes. I hope you’ll listen to our entire conversation here:

Sun damage of the skin has a familiar appearance – dark spots, wrinkles, thinning, and enlarged pores.  UV radiation causes visible damage to the eyes as well – yellowish corneas (the “whites” of the eyes), scars (called pterygia), and crow’s feet. Over time, eyelid skin can become cancerous from sun exposure, while eyeballs develop cataracts and macular degeneration (which can lead to blindness). The risk of these diseases and conditions can be greatly reduced with sun protection measures. And it’s not that hard to do…

Some quick tips to protect your eyes:

1. Wear a wide-brimmed hat to protect your face and eyes from the sun.

2. Wear wrap-around sunglasses that absorb at least 99 to100 percent of both UVA and UVB rays for maximum eye protection.

3. If you wear contact lenses, ask your eye doctor about whether or not your lenses have UV protection. ACUVUE® OASYS® Brand Contact Lenses offers the highest level of UV blocking available, blocking at least 90 percent of UV-A rays and 99 percent of UV-B rays. Although UV-blocking contact lenses provide important additional protection for wearers, they do not completely cover the eye and surrounding area, and should not be considered as a substitute for UV-blocking sunglasses. For maximum protection, UV-blocking contact lenses should be worn in conjunction with high-quality, wrap-around, UV-blocking sunglasses and a wide-brimmed hat.

4. Remember that UV rays are more intense when reflected from water and snowy surfaces. Just because it’s the winter time doesn’t mean you don’t need to wear your sunglasses.

So next time you reach for your sunscreen, please remember to take your hat and sunglasses with you too! Fortunately, bunny suits and booties are still optional for UV radiation protection. ;-)

Disclosure: Dr. Val Jones is a paid consultant for VISTAKON® Division of Johnson & Johnson Vision Care, Inc.

Daylight Savings Means More Driving In The Dark: Tips To Avoid Motor Vehicle Accidents

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Did you know that your 20/20 vision may drop to 20/40 when you’re driving in the dark? That’s because your pupils dilate to try to let in more light, and in so doing, they sacrifice their ability to focus clearly. Night-time driving can be dangerous for many additional reasons, and I had the opportunity to interview two experts about these risks, and how we can reduce our chances of being in harm’s way when we turn our clocks back on November 6th.

Optometrist, Dr. Christina Schneider, Senior Director, Medical Affairs for VISTAKON® Division of Johnson & Johnson Vision Care, spoke with me about common nighttime driving problems such as dry eyes, headaches, and eye fatigue – and what to do about them. We also discussed the risks of driving with an under corrected or uncorrected vision problem, and some of the available options and treatments available to improve our night vision

I also spoke with John Ulczycki, Group Vice President – Strategic Initiatives, for the National Safety Council, about safe driving tips. Please listen to the conversation here:

Traffic safety experts report that fatal motor vehicle accidents are three times more common at night. So how can we improve our nighttime driving safety? John’s tips include: Read more »

Tips For Improving Your Sports Performance: Take Your Vision Beyond 20/20

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World-Champion Sprinter, Allyson Felix

Until recently, I hadn’t given much thought to what it actually means to have 20/20 vision. Like most people, I assumed that 20/20 vision was just a synonym for “perfect” eyesight. But when I recently spoke with optometrist Graham Erickson, a sports vision specialist, I realized that there is an entire medical field devoted to optimizing vision for athletes – so that they can see better than 20/20, perhaps even 20/8! In fact, 20/20 vision just means that you can see an object 20 feet away as well as the “average” person.

In my interview with Dr. Erickson, I learned that some professional baseball players have vision that is two times better than average, allowing them to judge pitches further away by seeing how the baseball’s stitches and seams turn in mid-air. This kind of vision is not necessarily something that you’re born with – it can come with training and good vision-correcting lenses. There are exercises that professional do to improve their contrast sensitivity, peripheral visual acuity, and reaction times. And we regular folks (weekend warriors, kids, and aspiring athletes) can also “pump up our peepers” with exercises that we can do at home. Please listen in to the full Healthy Vision segment to find out how to do these exercises:

I also learned that different athletes (such as basketball players, archers, and offensive linemen) have unique visual demands, and they train for those demands quite differently. While a basketball player may focus on improving his “court vision” (dividing his attention between guarding “his man” and being aware of what’s going on in the periphery), an archer may rely almost exclusively on her central vision,
while an offensive lineman may need to split his attention between central near vision (controlling his man) and peripheral vision to pick up shifts by the defense. Since it’s estimated that 80% of the information we take in (while playing sports) comes from our eyes, even slightly blurry vision can dramatically affect performance.

Even though there is a lot that athletes can do to improve their visual skills, very few competitive athletes get annual comprehensive eye exams. In my latest Healthy Vision episode, NBA star Tyreke Evans* offered a call-to-action to his peers regarding regular check ups, and World-Champion female sprinter Allyson Felix spoke to me about the role that good vision has had in her success.

Sacramento Kings' Tyreke Evans

In summary, I learned from Dr. Erickson and Allyson Felix, that eye fitness is a critical part of competitive sports, but unfortunately something we often don’t think about. There are new training programs that help to develop peripheral vision skills that may reduce the risk of being blind sided in football or hockey games, and can therefore reduce concussion risk. Athletes should seek out an eye care professional who specializes in sports vision in order to optimize their visual potential. The American Optometric Association’s Sports Vision Section offers a doctor locator to help patients find sports vision experts in their area. Please check out the website here (or their Facebook page)  for more information.

*You can find out more about Tyreke Evans and the importance of eye exams at facebook.com/vspvisioncare.

-Val Jones, M.D. is a paid consultant for Johnson & Johnson Vision Care, Inc.-

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Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

***

Click here for a musical take on over-testing.

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Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

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