DP EyeCare Update: Corneal topography

Q: I have heard that many kids get more nearsighted as they grow, but my 17 year old seems to have more astigmatism every year. Is this common and what causes this?

A: You are correct in that far too many children are becoming very nearsighted at a faster rate than ever before. Fortunately, new techniques in “myopia control” can slow or stop that progression. The same cannot be said about astigmatism.

First, astigmatism is simply one of the top three types of blurry vision, and generally is caused by the shape of the eye. Specifically the front layer, called the cornea is not round like a basketball, but rather shaped like the side of a football. That “bent” surface bends the light entering the eye causing a type of blurred vision.

My concern for your son would hinge upon knowing the shape of his corneas. Measuring and mapping the corneal shape is called “corneal topography”, or CT. In our practice we use CT imaging for every contact lens wearer to be sure the eye surface is not swelling and the health is normal. We also use CT for any young patient with progressive astigmatism to diagnose the cause of this uncommon development.

I said “young” patient, because diseases of the cornea that can cause vision distortion generally begin early in life…..teenage years, in particular. So, anyone under 30 with progressive or rapid changing astigmatism should first have CT imaging done. Frankly, we worry most about corneal dystrophies like keratoconus. This usually begins early in life ( almost never over age 50 ) and makes our cornea become thinner and more pointed, or “cone-shaped”. Accurate diagnosis is so essential, because early intervention can virtually stop the progression and protect clear sight. Untreated keratoconus can cause irreversible vision distortion, with only very difficult surgery options and more tenuous outcomes.

Today, if caught early, medication treatments and special “scleral” contact lenses can stop progression and keep clear sight for your whole life……without any surgery. Because this is a “young person’s disease”, we often encounter skepticism from parents about CT imaging for something as common as astigmatism. Keratoconus is certainly not well known in the general public, and poorly understood. The new treatments are proving to be not perfect , but very good…..and in my opinion, far better than any corneal surgeries.

Be sure your eye doctor is using CT imaging for your son, and not just prescribing stronger glasses every year. Not every practice has the technology to perform CT imaging, so you may need a referral. Nonetheless, step one is to rule out any corneal dystrophy that could be driving this progressive vision change for your son.

Q: I think I had a mild case of Coronavirus back in the spring, so since I am immune now, why get should I get the vaccine now?

A: I am not a virologist, but the experts tell us that “natural immunity” from actually having the virus is pretty good….but likely not as good as the vaccine. It’s a long story, but this is an entirely new kind of vaccine. All our previous vaccines have used a weakened form of the actual virus to trigger our immune system to produce antibodies to fight the infection. It appears that antibodies are not the best way to fight this virus in the long run, so our body uses a different method called “ T cell immunity”. This type is longer lasting than antibodies, and much harder to measure in people. Other viral studies found T cell immunity still present six years after the vaccination! But so far, we do not really know how long this protection will last.

This Covid-19 vaccine has proven in the excellent studies so far to prevent any symptomatic disease in about 95% of the people. It has been able to prevent serious, hospitalization type, disease in 100% of the people being vaccinated. This is a terrific development, because previous virus research had laid groundwork and the financial barriers were erased….allowing record speed for quality vaccine development.

People are asking if getting the vaccine prevents you from transmitting the virus to others. The answer is we really do not know yet. One small study found no measurable virus in the noses of people after the first shot in 2/3 of the people. This is not conclusive, but hints at protection. The experts tell us that the best way to be sure you are carrying Covid to others is to still wear your mask.

We all need to continue to mask up to protect others. Until we have about 70% of the population vaccinated, this virus may continue to infect and kill the most vulnerable of our family and friends. So again, it appears that even if you had a real case of Covid earlier you should get the highly effective vaccine as soon as you can. Caution: If you have ever had a serious reaction to any vaccine, you should ask your physician before being vaccinated for Covid. By “serious” we do not mean a sore arm, or slightly elevated temperature for a day, or even feeling tired for a day. Those would be normal reactions to the types of vaccines we have used up until now. The most dangerous reaction for any vaccine is having trouble breathing in that first hour after the shot. While treatable if done quickly, this “ anaphylaxis” response can be life threatening, so waiting 15-30 minutes after your shot is the standard precaution for any and every vaccine.

As a side note, it turns out that the CDC has found 86 times LESS regular flu this year so far, compared to last year! Again, we cannot say for sure it is just the masks, but likely that is the extra protection we are getting by masking up. Be safe, be smart, be healthy!

Q: I have heard many suggestions about the proper thing to do when you or your child develops “pink eye”. How contagious is it really, and what should we do?

A: This is such a misunderstood condition that even the name “pink eye” is confusing to most people. As eye physicians, we actually consider “pink eye” to be a virus-induced infection of the eye. Generally, viral infections of the eye are fairly common, and far outnumber eye infections caused by any bacteria. This is very much like the common cold, or the flu, and why antibiotics actually do no good to cure such problems.

As we all by now, viruses can be very contagious! Eye viruses are transmitted by touch…not through the air. Commonly others catch the viral infection by shaking hands with a patient who recently rubbed their eye, or by sharing a hand towel at home. Fortunately, we do have a simple and painless in-office test that can tell us if a particular patient’s “pink eye” is the highly contagious type, or less so. With a tiny sample of your tears, we can identify this in 10 minutes.

Treatments are also much better now. You have likely heard all sorts of remedies, but we now have two new techniques to cure viral “pink eye” quickly. This is critical especially because untreated viral eye infections, can take two weeks to run their natural course….and can leave permanent scarring in the cornea. Correct treatment can clear the eye/s in a day or two and allow the patient to return to work or school safely.

Both treatments are still a considered “off label”….meaning we utilize medications that were first intended for another disease or a different problem. In the office we can eradicate the active virus on the eye and under the lids with a strong ophthalmic antiseptic solution. This method typically allows the patient to return to normal activities in two days, instead of two weeks! The other technique is prescribing a medication first indicated for the herpes virus, but it turns out that it is also highly effective on these very contagious “pink eye” infections. Our experience has been that our patients using this eye drop medicine are clear and comfortable in 3-4 days.

In conclusion, we advise people that if you have a red or pink eye, you could try a topical eye lubricant or eye rinse the first day. But if the appearance is still there, or worsened, on day two you need to see your eye doctor. And I do mean your eye doctor….where we have the eye microscopes to examine your eyes accurately, and where we keep the topical eye antiseptics for treatment. A special warning: if you have any change in your vision in the affected eye/s or any real pain in the eye/s, call your eye doctor immediately. In those cases, delay can result in vision loss or permanent scarring of the cornea.