Picture one of those typical doctor intake forms. Would you check a box beside any of these?

• Red, scaly, crusty eyelids
• Flaky debris along the lashes
• Frequent and recurring styes or inturned eyelashes
• Chronic redness, itching, watering, or irritation

If you answered yes to any of the above, you likely have blepharitis.  Blepharitis simply translates as inflammation of the eyelid skin, but it's commonly associated with conditions like ocular rosacea and dry eye syndrome. And it's extremely common - studies suggest as many 47% of all patients that are seen by an eye doctor have some degree of blepharitis.

Blepharitis caused by Demodex colonies have a classic appearance of cylindrical dandruff or collarettes along the base of the lash root. via

For decades the go-to treatment recommendation for chronic blepharitis was eyelid hygiene with baby shampoo. The concept? The most common causes for blepharitis are skin bacteria like Staphylococcus epidermis and Staphylococcus aureus or eyelid mites Demodex brevis and Demodex folliculorum. These strains of bacteria are found naturally on human skin, and Demodex mites are also extremely common: studies confirm 70% of 18 year olds have Demodex mites living on their facial skin and over 84% of healthy adults over 60 have mites.  Both skin bacteria and Demodex colonies thrive when there are more dry skin flakes and skin oils hanging around the eyelid surface, growing rapidly and often causing chronic irritation as their populations explode.  It's a dangerous feedback circle: the more the body inflames in response to bacterial growth or Demodex infestation, the more it sheds the surface layers of skin, giving bacteria and mites more of what they love to live on. 

Microscopic view of demodex mites at the base of hair and eyelash follicles via

Getting rid of dry skin and abundant skin oils is essential to minimizing the habitat for bacteria or Demodex, so doctors historically turned to baby shampoo as a "no tears" way to clean the sensitive eyelid area.  The issue with baby shampoo is that the detergents and preservatives found within can actually promote skin irritation. Preservatives in baby shampoo like quaternium-15 chemically release formaldehyde, a known skin and eye irritant.  Some research suggests that baby shampoo can interact with the eyelid's natural oil expression (meibum), turning it into a pro-inflammatory soap-like expression that is irritating to the eye and eyelid, a process called saponification. 

A Better Alternative?
OCuSOFT lid cleansing products have the cleansing power to knock out skin bacteria and Demodex colonies, but are far more gentle and less irritating to the delicate eyelid skin than baby shampoo. Studies assessing ocular irritation on OCuSOFT products found that OCuSOFT Lid Scrub Plus was "practically non-irritating" to the ocular surface if not rinsed off in 1 hour based on Draize score data. Baby shampoo was rated category 3 or "mild irritation" on LVET (low volume eye test) Draize testing. OCuSOFT products are graded as 16 x milder than baby shampoo for eye irritation!




Not only were OCuSOFT products found to be more comfortable to the eye than baby shampoo, they also have significantly better bacterial kill rates. Studies on skin wound cleansing scored Johnson and Johnson Baby Shampoo as non-antibacterial at 24 hours against Staph. aureus at "cell-safe" levels, and additionally scored it with a high cytotoxicity index score (meaning it was considered highly irritating and damaging to healthy cells as well). OCuSOFT Plus lid scrubs have exceptional kill rates against common skin bacteria that are known causes of blepharitis, including Staph. epidermis, Staph. aureus, and even MRSA. 



Our recommendation? For chronic blepharitis put down the baby shampoo and reach for a specific eyelid hygiene product. In my personal practice I recommend daily use of OCuSOFT Lid Scrub Plus for bacterial-based blepharitis until the eyelid inflammation is controlled, and then recommend use of daily lid cleansing products like OCuSOFT Original pads or foam longterm to help promote a skin environment that would be inhospitable to bacteria or Demodex infestation. Eyelid hygiene is part of my patients' everyday routine for clear vision and healthy eyes; you can't take a night off from caring for your eyes and delicate eyelid skin and expect your eyes to perform at their best level. OCuSOFT is gentle enough to be used as a daily cleanser for even sensitive skin types, and its strong enough to neutralize skin bacteria and help prevent chronic conditions like blepharitis and recurrent styes. 

Wanting to learn more about all the products in OCuSOFT's line of lid cleansers? Head here

OCuSOFT is a platinum sponsor for Eyedolatry but all opinions are my own.

Designer Gazal Trabrizipour and her husband Saeed are the dynamic duo behind Gazal Eyewear. You can follow their personal story - designing eyewear, outfitting their new flagship optical, and jetsetting around the world to trade shows with behind the scenes looks at the insider's world of optical design on their instagram account @gazal_eyewear

While the designs are created by Tabrizipour in Georgia, the material sourcing and manufacturing for her frames happens in Japan, the go-to manufacturing hub for high quality and light weight titanium metals. “We use a lot of titanium because the weight of the frames and durability compared to other metals makes a remarkable difference.  I am very focused on the intricate details of each frame design so it is important to utilize the skillset of Japanese manufacturing to bring these details to life.”

Their latest photoshoot featuring Amy Roiland (@afashionnerd) was a collaboration introduced to Trabrizipour by Maarten Weidema. " It was great seeing Amy in all of our designs, she is the first model outside of my husband and I that has been part of the Gazal Eyewear collection."

The flagship Gazal boutique optical store will open later this year in Roswell, Georgia, but already the design aesthetic that has made Gazal Eyewear a success is on display. Exam rooms look sleek with sliding black doors embossed in gold, and the main optical space creates a pure luxury feel with recessed display shelves and uniform white walls and ceilings that let the frames take center stage.

The average American spends more than 10.5 hours a day on digital devices like computers and smart phones, so is it any wonder our eyes are tired at the end of the day?  We're actively using them to look at small print from a lit screen for over 60% of our waking hours!

If you are a contact lens wearer, you may have noticed that your eyes feel more tired when you wear contact lenses than when you wear your glasses.  This is not in your head - it's a scientific fact. Because contact lenses physically sit on your eye, the amount of work and energy your eye muscles use to focus on near objects (like computers and cell phones) is greater than when you wear glasses that sit a few millimeters off your face.  In eyecare lingo we call this accommodative demand: the amount of work muscles have to do to focus up close. But happy contact lens wear is not lost; meet Biofinity Energys.  

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Biofinity Energys is a new monthly disposal contact lens designed with aspheric optics to reduce the accommodative demand on eyes as they focus on near work.  Their proprietary Digital Zone Optics design is not a multifocal so there are no rings, halos, or glare side effects and there is no specific "reading power" in the contact lens.  Instead the power profile of the contact lens changes to match the curvature changes of the eye, ensuring your eye gets an even power grid across the entire contact lens.  That's a lot to digest and even eyecare professionals can get a bit lost in understanding what's happening in this lens, but it all starts with understanding what aspheric optics really means.

Demystifying Aspheric Optics
Let's start with some basic optics.  Our cornea is curved, so when light enters the eye it immediately gets distorted or bent by the fact it passed through a curved plane.  The result is the object you're looking at also looks curved (even if it's not).  This is called spherical aberration - the distortion to vision that occurs simply as a result of the fact our eye is a curved sphere and not flat.

Our cornea is a curved surface, so when light enters, it also gets bent and curved.  The result is an imperfect image entering our eye - one that is bent just like our corneal shape.  This is spherical aberration. via

When we are born, our body is set up to help negate this inherent visual distortion caused by the cornea by offsetting it with the curvature of the lens.  The cornea has what's called positive asphericity (it's more curved in the center, and flatter in the periphery), and the lens at birth and through childhood has negative asphericity.  But the lens is one of the few body parts that never stops growing, adding layers and thickening with every year of life.  At some point in adulthood, the lens changes over from negating corneal asphericity to becoming an added source of positive asphericity itself (much more thick in the center than in the periphery).  That's why adults usually feel like they see more glare and halos (especially with high demand visual tasks like night driving) than they used to.  The lens is thicker, and it's now adding to the distortions that are created by the cornea!

Knowing that we have spherical aberration-caused visual distortions inherent to the eye itself, CooperVision has mapped out the "average" cornea and designed a contact lens to negate the spherical aberrations that are naturally present.  The power profile of the contact lens will change gradually from the central cornea to the peripheral cornea to match the bend and curvature change of the average corneal shape.  The result is a lens that's designed to correct your vision perfectly at each point of the contact lens -- not just a -4.00 throughout the whole lens like most contact lens designs, but a -4.00 right in the center and then maybe a -3.93 right outside, and a -3.87 out at the periphery for example. The goal is that your eye gets only the correction it needs at each point in space, and not more correction than necessary, which would increase the amount of work your eye has to do when looking at something up close like a cell phone or computer (the accommodative demand).

A spherical contact lens will match the optics of our spherical cornea, giving everything a curved or bent shape; aspheric contact lenses are designed to prevent this curved distortion and keep the true dimensions and shape of the objects we are looking at. via

This is the concept behind Biofinity Energys -- there's no bifocal; there's no reading power.  Just a lens designed to match the average cornea's bend to negate any optical distortions that would make the eyes have to work harder to see. 

If you are an astute reader, you may have noticed there are some potential shortcomings of this design.  It does assume an "average" cornea, so if your cornea is far from average then you may not get any visual benefit, or potentially even feel like vision is worse (though you'd have to be pretty far off from average for this).  Some people will notice a vision difference (presumably those that are very average), and some people may notice nothing at all with an aspheric lens design. CooperVision reports from their own study that 8 out of 10 digital device users (using devices at least 4 hours a day, 5 days a week) report Biofinity Energys made their eyes feel less tired.

What About Astigmatism?

Some doctors have tried to use aspheric contact lenses to mask low amounts of astigmatism, There is data to support this! A 2004 study comparing aspheric contact lenses to spherical contact lenses (in this case CooperVision's Frequency 55 lenses) found that aspheric optic designs can mask 66% of the astigmatism in patients with an average astigmatism amount of 0.69D.  If your patient has -0.75D of astigmatism or more, they'll likely need a toric lens for statistically significant improved visual correction, but for low astigmatism amounts there is evidence you can mask over half of it with an aspheric design. Spherical lenses only masked 21% of low amounts of astigmatism in the same study.



Who Is This Lens For?

The key to fitting success with Biofinity Energys is to understand what the lens does and what the lens doesn't do.  It won't give a reading boost to people needing reading glasses.  There is no reading power anywhere in this contact lens.  But if you have teens, millennials, or even pre-presbyopes that aren't needing reading glasses yet but are feeling end of day eye strain and fatigue, this lens is a perfect recommendation.  Patients usually won't see any differently reading letters on a chart, but how their eyes feel when they adjust to look up close - that's what the difference will be if they are having issues with eye fatigue in their previous contact lens brand.

When I fit Biofinity Energys, this is what I tell my patients:

"Mr. Jones, you told me your eyes were feeling really tired at the end of the day. There's a new contact lens design I want you to try that can relieve some of the strain on your eyes when you're looking at computers or your phone.  Most people don't notice that they see any differently, but how your eyes feel at the end of the day -- that's what this lens can improve.  I can keep your vision clear and sharp like what you're experiencing in your lenses right now, but just help them work less as you go through your day."

The Details:

Biofinity Energys
Replacement Schedule: Monthly
Dk/t: 160
Material: Comfilcon A (silicone hydrogel, same material as Biofinity)
Base Curve: 8.6
Power Ranges: +8.00 to -12.00D (0.50D steps after +/- 6.00D)

I'd love to hear your feedback on the lens! Please comment below if you've tried it out or what your patients are saying!

Want to learn more? Check out my podcast with CooperVision's Dr. Michele Andrews!

A young pediatric patient with significant preseptal cellulitis.  Often this appearance is brought on by a hordeolum (stye). via

Loving Tim Gunn's new eyewear this season - gone are the aging rimless frames, replaced with a much more youthful black zyl.  But he's still the thoughtful, constructively critical Tim we all know and love. via

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Morning talk shows and nightly news segments are abuzz with the promise all Americans over 40 are desperate to hear: "Say So Long To Reading Glasses" and "The End of Reading Glasses" blaze headlines. But before you open your wallet and throw your progressives and drug store reading glasses out the window, let's talk the real science behind what the newly FDA approved presbyopic refractive surgeries can truly accomplish and what they can't.  Many are finding success with these treatments, but only after they have clear expectations for what is possible, what isn't, and what the risks include.

What is Presbyopia?  Around age 40, our eyes begin having difficulty focusing up close.  Looking at books, cell phones, and computers gets more and more difficult with every passing year. This is a completely normal change associated with the aging eye, and no humans are immune.  There is a popular misconception that presbyopia is a weakening of the muscles of the eye, but in fact the muscles are just as strong as they've ever been.  This is why eye exercises or the idea of avoiding glasses wear to "use your eyes" unfortunately won't work.

The lens inside the eye changes shape as the eye muscles contract and release when we change focus, but with time all those layers it accumulates as it grows from year to year add up, and the muscles struggle to get it to adjust its shape. via

The reason we lose our ability to focus at close ranges is because of the lens, a structure of the eye that sits right behind the iris.  The lens changes shape to focus vision near and far, and the muscles of the eye control this movement.  From the day we are born, the lens lays down layers like a tree trunk -- it's one of the only body parts that never stops growing.  Year after year the lens is layering and thickening, and around age 40 it has gotten so thick that it is very difficult for your eye muscles to move and adjust its' shape.  And it just keeps getting thicker every year after, eventually to the point that the muscles can barely move it at all and you would need reading glasses to focus clearly on nearly all close objects.  With today's science we can't thin down the lens to restore flexibility, and if we remove the lens we don't have any artificial lens implants yet that can truly mimic the flexibility of the original.  The presbyopic refractive procedures on the market at this time do not affect the lens at all, but instead try to improve near vision through changing the corneal surface of the eye.  This is important to understand because both the KAMRA and Raindrop procedures available can't give you 20 year old vision again.  The vision will be different from that provided by young, naturally flexible lenses, but if you are prepared for what they can achieve, you may still find success!

The KAMRA Inlay
FDA Approved: April 2015
What It Is: The KAMRA Inlay is a solid dark ring implanted in the cornea in the center of the visual axis (the middle of the pupil) to create a pinhole effect.  The device itself is just 3.8 mm in diameter with a 1.6 mm pinhole in the center for vision.  Due to the optics of a pinhole, objects will appear clear at a range of distances when viewed through such a small "window" because the pinhole blocks light rays that would be entering the eye off angle (which would make things appear blurry). It's the same way a pinhole camera works if you are wanting to learn more. The inlay itself has 84,000 small holes to allow oxygen and nutrient exchange through the inlay to the corneal tissue underneath.

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Who is a Candidate: Age 45 to 60 years old requiring reading glasses between +1.00 and +2.50 in strength.
Who is Not a Candidate: People with cataracts, corneal degenerative conditions (like keratoconus), uncontrolled diabetes, glaucoma, immune system disorders, a history of corneal infections or scarring or dry eye are not candidates.

The Procedure: Only one eye (the nondominant eye) will have the KAMRA inlay placed into the cornea with an outpatient laser procedure, leaving the dominant eye to have clear distance vision. The eye with the inlay will have a range of both distance and near vision, and the untreated eye will only see distance.
The inlay can be removed if there are complications or if vision isn't acceptable, but it is possible that scarring will have occurred where the inlay was placed and vision may be permanently damaged even after removal of the inlay.
The procedure is often coupled with LASIK or PRK to achieve prescription-free distance correction. The inlay eye is ideally left undercorrected at distance by -0.50 to -0.75 D at the time of surgery to improve near function.

FDA Approved: June 2016

This year's Small Business Saturday had me thinking: optometry is full of independent practitioners but for many years we've been providing eyewear designed by large corporations.  Don't get me wrong, I am a fashion world junkie as much as the rest.  But while we can be wowed by designer names on the side of our glasses, we often aren't getting much in the way of true design.  Many large fashion house designers outsource their optical divisions to larger corporations, and that's where you see entities like Luxottica retailing everything from Oakley to Tory Burch and Michael Kors.  Where can you find truly crafted eyewear?  Until recently there was very little going on in America, and the top independent eyewear craftsmen were designing in France, Italy, and Japan.  But in the past few years we've seen a Renaissance in American eyewear design, and in honor of Small Business Saturday, we're featuring 6 reasons that you should shop small for your eyewear this year too!

Were your glasses made by hand? I challenge you to try on a custom crafted pair of eyewear and feel the difference true design and quality can make.  Wonder why your glasses always push dents on your nose or pinch behind your ears?  You don't have to hate your glasses; you just need to invest in quality, thoughtful eyewear design. Photo above via State Optical

Article One Eyewear: Based in Flint, Michigan, Article One originated as an idea to give back. Designer Wes Stoody was inspired to create an eyewear line that combined luxury craftsmanship with a cause. Every frame purchased donates money to Helen Keller International, a non-profit fighting blindness from vitamin A deficiency in impoverished nations.  To date over 15,000 lives have been touched by their mission.  Right now Article One frames are handcrafted in Northern Italy, but Stoody dreams of bringing production to craftsmen in his hometown of Flint in the future.  You can hear more of his story here.

A bonus for you  Sign up for the Article One newsletter and you'll have a chance to earn a free pair of Article One eyewear and 50% off future orders. This promotion is only open to eyecare providers.

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Bevel This Kansas City based eyewear company is the brainchild of opticians Richard Mewha and Rick Nelson, and their mission statement is a bit unusual.  "Neither wants the brand to be the coolest or hottest or most recognizable" states their website, but the focus is on the simple perfection of minimalist ideals: great fit, clean lines, quality materials. Their titanium and acetate frames are designed in America and hand crafted in Japan with a focus on bold colors like the chartreuse used in their graphic brand logo and marketing campaigns.