Sunday, July 17, 2022

Does eating Carrots improve Night Vision?

A lot of us have heard that eating carrots can improve our vision, especially night vision. Have you ever wondered if this is true, can eating carrots really help us see better at night?

In today's article, I'll cover whether eating carrots can really improve your night vision and whether eating too many carrots can be harmful, So stay with me till the end of this post. I will review some other nutrient-dense foods that can help improve or maintain healthy vision.

The idea that eating carrots can improve night vision really started to become popular during the second world war. In the early 1940s, the British ministry of food started a propaganda campaign stating that the key to the British pilot's success in shooting down the German bombers at night was due to their superb night vision from the carrot-rich diet they ate.

And the ministry encouraged civilians to consume more British-grown carrots. In fact, this rumor spread so far across the pacific ocean, that a new article was published in Time magazine on 22 December 1941, entitled "science: rabbit for owl eyes".

Stated that the Royal aviation force may soon be eating Arizona carrots in preference to all other carrots on earth. Arizona's 3 to 4000 acres of carrots may be the answer to every aviation command's problem of preventing night blindness in its flyers.

So was this true? Were the RAF pilots really able to beat their German opponents in the sky because they ate more carrots? Most students of history would point out that the RAF's success in that era probably had much more to do with the invention of onboard radar systems than carrots.

In fact, rumor has it that the British Royal Air Force may have pushed the carrot message as a cover-up for the use of onboard radar technology by telling the public that carrots were the key to their success. During wartime, blackouts occurred often in London and other areas in the UK, and food shortages were quite common.

But there was a surplus of domestic carrots and the British ministry of food wanted to encourage the consumption of carrots, by advertising them as a healthy nutritious food source that would also help improve night vision.

Can eating Carrots help improve your Night Vision?

Is the notion that eating carrots can help improve night vision fact or fiction? The answer to this question may surprise you. Eating carrots can in fact sometimes improve night vision, but only under certain conditions. Let me explain:


The key nutrient in carrots that is important for maintaining eye health is beta-carotene, which can be converted into vitamin A in our body.

Vitamin A is the molecule that transmits the signal of stimulation from light in our eyes to the brain, allowing us to see both during the day and at night. This important step occurs in the retina which is the layer of nerve tissue in our eyes.

There are two types of cells in the retina that contain vitamin A, Rod cells which are responsible for vision at night and in dim light situations, and cone cells which are responsible for vision during the day and in well-lit situations.

Vitamin A is also essential for maintaining the health of the cornea, which is the clear windshield of our eyes. Our body cannot produce vitamin A on its own and has to rely on external sources such as dietary intake in order to obtain this essential nutrient.

Dietary sources of vitamin A can be divided into two groups, preformed vitamin A and provitamin A carotenoids. Preformed vitamin A is found in foods of animal origin such as milk, yogurt, liver, and fish oils.

And Provitamin A is found in vegetable sources such as carrots, pumpkins, sweet potatoes, and spinach. Because provitamin A needs to be converted into a biologically useable form of vitamin A in our body through enzymatic conversion.

Provitamin A obtained from plant sources is an inefficient dietary source of vitamin A. When compared to preformed vitamin A.

Additionally, vitamin A is a fat-soluble molecule, both digestion, and absorption of vitamin A require lipids or fat. so people who eat diets with critically low-fat content, and people with certain medical conditions such as pancreatic or liver diseases, may have difficulty with absorption of vitamin A.

It is estimated that globally about 30% of children younger than five years of age are vitamin A deficient. And vitamin A deficiency is the single most important cause of childhood blindness in developing countries.

In the US, we are very lucky, as vitamin A deficiency affects less than 1% of the population, and it mainly affects people with a history of digestive diseases such as inflammatory bowel disease like Crohn's disease, and liver disease like cirrhosis, etc.

Therefore there is no need for most of us in the US to run to the store to buy a large number of carrots. So can eating carrots help improve your night vision or not?

The answer depends on whether or not you are vitamin A deficient. In a setting where people suffer from vitamin A deficiency, studies have shown that supplements of vitamin A or beta-carotene actually do improve night vision.

If you are suffering from vitamin A deficiency, exactly how many carrots do you need to eat to help improve night vision?

Most of the studies have looked into the benefits of beta-carotene from plant sources. Which are the sole source of vitamin A in many developing countries.

A randomized control study published in 2005 in the American Journal of clinical nutrition studied the benefits of vitamin A supplementation from different food sources in pregnant women with night blindness.

The study concluded that the daily consumption of 4.5 ounces of cooked carrots for six weeks improved night vision in the pregnant women studied.

As I mentioned before, if you live in the US or other developed countries, eating more carrots is likely to improve your night vision unless you suffer from vitamin A deficiency due to various digestive diseases or dietary restrictions.

That being said, carrots are very healthy and they are high in antioxidants. so if you want to go ahead and eat more carrots that should be fine for most people.

Can eating too many Carrots be harmful?

One thing to mention about vitamin A is a fat-soluble vitamin. It is possible to have too much vitamin A in your body. This is known as vitamin A toxicity.

However, it is very unlikely for you to develop vitamin A toxicity solely from eating carrots. The conversion of beta-carotene from carrots to active vitamin A in our body is quite inefficient.

The ratio is estimated to be 12:1 by weight, meaning it takes 12 times more beta-carotene to make an equivalent amount of bioavailable vitamin A. This means eating extra carrots is very unlikely to cause vitamin A toxicity.

Most cases of vitamin A toxicity are actually due to supplements. Some people have even experienced their skin turning orange after taking a large number of beta-carotene supplements. it's a real condition called carotenemia.

Please also be careful when taking a large amount of vitamin A supplements in the preformed vitamin A form. For example, vitamin A supplements come in capsule form with lipid carriers.

Taking too much of those vitamin A supplements can cause toxicity, and symptoms such as abdominal pain, nausea, skin rash, increased intracranial pressure, and increased risk of fractures.

As I mentioned above, here is a list of foods that are important for maintaining eye health:

Dark leafy greens such as kale and spinach contain important xanthophylls, such as lutein and zeaxanthin. They are important to maintain the health of the retina.

Fruits and vegetables are high in vitamin C and other antioxidants such as oranges and broccoli are important for combating oxidative stress in our eyes and body.

Foods high in omega-3 oil such as wild-caught fish and seaweed are important for preventing dry eyes. 

Saturday, July 16, 2022

Eye Floaters No more with Pineapple Treatment?

Have you ever experienced floaters in your vision? Did someone tell you that eating pineapples can get rid of them? I am here to bring you the latest information on eye health and medicine.

If you have noticed some tiny grey or black strings that are floating around in your vision, you are not alone. Those small floating objects you are seeing in your vision are commonly called floaters or posterior vitreous detachment as the scientific term.

In fact, floaters are so common, that I see multiple patients every day in my clinic who come in because they have developed symptomatic floaters.

In today's article, we will discuss the nature of floaters, whether eating pineapples is really an effective treatment for floaters, what the confirmed effective treatment options for floaters are, and when you should be concerned about floaters.

What are Floaters?

Floaters are basically clumps of collagen fibers formed in the jell-O-like material called vitreous gel, which fills the cavity in our eyes. the vitreous gel is composed of 99% water, and 0.5% collagen fibers and the remaining 0.5% is mucopolysaccharides and hyaluronic acid.

The vitreous gel is usually clear and transparent. However, due to aging and mechanical factors such as trauma to the eyes, vitreous gel can undergo a process called syneresis, which is the contraction of the gel accompanied by the separation of liquids from the gel.

As the volume of the vitreous gel shrinks, the collagen fibers embedded in the vitreous gel break and form free-floating clumps of collagen, known as floaters.

The collagen fiber clumps move with the eyes, and when they are near the center of your vision, you can see them as grey structures such as bubbles, strings, cobwebs, or dark spots.

Floaters are very common among people over the age of 50 and become more common as we age. It is reported that the prevalence of floaters is over 87% among people over 80.

However, it doesn't mean floaters do not affect people younger than 50, I frequently see patients in their 20s, 30s, and 40s with symptomatic floaters. In fact, over 30% of the general population has floaters.

Can eating Pineapple Cure Floaters?

Can you really get rid of floaters by eating pineapple? You may have seen some pineapple eating challenge videos on the internet, or heard about people who reported seeing less floaters after eating pineapple for a few months. How did this all come about?

It all started with a study conducted in Taiwan and published in 2019 in a journal called the Journal of American science, not to be confused with the more well-known American journal of science.

In this article, they reported that 388 participants were divided into two experimental groups:
  1. 190 participants ate two pieces of pineapple after lunch every day for three months, and the study reported a 70% reduction of floaters in this group.
  2. 198 participants were divided into three groups and ate different amounts of pineapple. One, two, or three slices of pineapple after lunch for three months, and the study reported a dose-dependent reduction of floaters ranging between 55% and 70% in this experiment.

Pineapple Cure for Floaters

So did these researchers discover a miracle cure for floaters in 2019? When I read the title of this article, just like you, I was really hoping that this pineapple treatment for floaters could be true.


But after reading this study, I have many questions. This study was published in 2019. but since then, there have been no studies that were able to replicate those results reported in any major or minor scientific journals.

Usually, when there is a new ground-breaking scientific finding that could potentially affect a third of the global population, that is something a lot of researchers would be interested in studying, and yet there have been no studies by any other groups confirming these findings.

Let's dive a little deeper into this study. The study's authors hypothesized that bromelain, which is a group of enzymes found in pineapple, breaks down the collagen fibers in the floaters and dissolve them.

One important thing to note is that many parts of our eyes are made out of collagen fibers, besides the ones in the vitreous gel that form floaters. Collagen fibers also form parts of the cornea the clear windshield of the eye, the sclera, the white wall of the eye, and the lens capsule, the thin membrane that wraps around the lens inside of the eye.

All of those structures and more are made out of collagen. if bromelain from eating pineapple can dissolve the collagen fibers in the floaters. Why would it not affect the collagen fibers in the rest of the eye?

By this logic, if bromelain can break down collagen fibers that form floaters it would break down collagen fibers that support the normal structure of the eye, and the whole eyeball would melt.

Another question that I had is that the study's authors reported a cure rate of up to 70% of floaters in a matter of three months by eating a few slices of pineapple every day.

You might expect therefore people who eat a lot of pineapples would have a lot fewer floaters. However, in countries with high consumption rates of pineapple such as Brazil and the Philippines to the best of my knowledge. Do not have a dramatically lower prevalence of floaters.

So if pineapple really cures most floaters, I wonder why we are not seeing significantly less floaters in those regions. I have always been interested in natural remedies that are effective in treating common eye diseases, and I actually also have a master's degree in nutrition. So I really wanted this study to be true.

Unfortunately, after reading this study, I am sorry to report that most likely, more rigorous future data will likely not show eating pineapple can cure floaters. Also please keep in mind, that the natural progression of floaters is that they often get better spontaneously without any intervention.

Because the clump of collagen fibers that form the floaters tend to settle away from the center of vision over time. This is one reason why regardless of pineapple, many people notice the resolution of floaters over a period of a few months.

That said, pineapple is a delicious fruit, so if you have floaters and want to try eating some pineapple every day and see if that helps your floaters, that's probably fine for most people. But do keep in mind that pineapple is high in sugar content, and is very acidic.

So for people with diabetes or other medical problems, I would recommend that you speak with your doctor before eating large amounts of pineapple.

Effective Treatment Options for Floaters

Now we have talked about whether pineapple can really cure floaters. Let's talk about the confirmed effective treatment options for floaters. As I mentioned before, naturally, many floaters tend to get better on their own without any intervention.

For the majority of people who develop floaters, the symptoms become less bothersome after a few months. For floaters that are persistent over months, and especially if the location of the floater is central, and obstructing the vision, limiting what you can see and do, your eye surgeon can perform a laser procedure called YAG laser vitreolysis in the office to treat floaters that are very well formed and with certain anatomical characteristics.

In rare cases, a surgical procedure called pars plana vitrectomy can be performed in the operating room to remove the whole vitreous gel and replace it with a clear fluid to remove all of the floaters. Both the YAG laser procedure and the vitrectomy surgical procedure have risks, so please discuss them with your eye surgeon.

If you are interested in having those procedures to improve any persistent and severe floaters.

When to Worry about Floaters?

So when should you be worried if you are seeing floaters? Floaters are one of the most common eye diseases that can affect your vision. For the vast majority of cases, eye doctors recommend people who experience new symptomatic floaters get a full dilated eye exam, to rule out any tears or detachment of the retina.

There are three symptoms you should definitely watch out for, and they are common symptoms of tears or detachment of the retina
  1. Seeing flashing lights in the peripheral vision that is continuous and painless
  2. Seeing a curtain or a shadow-like image that starts gradually to block part of the vision.
  3. All of a sudden started developing a significant number of floaters, like looking through a snow globe.

While those symptoms are not inclusive if you do see any of those three symptoms. You need to contact your eye doctor right away and get a full dilated eye exam.

Saturday, March 26, 2022

Best Omega 3 Fish Oil for Dry Eyes

I am here to bring the latest information on eye health and medicine. I also have a master's degree in nutrition. So today's topic is very dear to me.

In today's article, you'll learn why you should take omega-3 fish oil supplements for dry eyes. How to pick the best omega-3 oil you? and also my top three recommended oil supplements for treating dry eyes.

Why you should take Omega-3 Fish oil supplements if you have Dry Eyes

The tears on the surface of our eyes have 3 different layers. The lipid layer, the aqueous layer, and the mucin layer. The lipid layer of the tear film is the outermost layer and its function is to prevent the liquid portion of the tears from evaporating too fast.

It contains mainly meibum oil which is produced by the oil glands in our eyelids called meibomian glands. Therefore if the meibomian glands are not working properly due to inflammation or clogging or if the meibum oil is too thick or has abnormal composition, the lipid layer of the tear film may either contain too little oil or poor quality of the oil, and it will not function properly.

This results in your eyes getting dry due to rapid evaporation of the tears. This condition is called meibomian glands dysfunction, and it is one of the most common causes of dry eye disease.

Numerous studies have shown that omega-3 oil supplements can decrease inflammation of the meibomian glands, improving meibum oil flow into the tear film as well as improving the quality of meibum oil. That is why omega-3 oil supplements are commonly recommended by eye doctors for treating dry eye disease.

How do you Pick the Best Omega-3 Fish Oil Supplement for you?

When we go to a pharmacy or even a grocery store, the number of choices for omega-3 fish oil supplements available over-the-counter can be overwhelming. So how do you pick the best omega-3 fish oil supplement for you?

Omega-3 oil supplements, just like other dietary supplements, are not regulated by the FDA. So the quality and composition can vary greatly among different products. Let's talk about some key things to look for in good quality omega-3 fish oil supplements.


Most of the key information you are looking for to differentiate different types of omega-3 fish oil supplements is listed on the supplement facts label, which is typically located at the back of the package.

The first thing you should look at is the types of fatty acids contained in the supplements. You are looking for the amount of omega-3 fatty acids, and specifically, the amount of EPA and DHA contained in the product.

Omega-3 fatty acids are a group of polyunsaturated fatty acids. There are three primary omega-3 fatty acids in our diet, ALA, EPA, and DHA. Among these three types of omega-3 fatty acids, EPA and DHA have significantly more anti-inflammatory properties than ALA.

While ALA can be converted into EPA and DHA in our body, only 5 to 10% of dietary ALA is converted into EPA and DHA. You want to pay attention to the amount of EPA and DHA contained in each serving of the product.

Studies have shown that daily supplementation of 2000 mg of combined EPA and DHA is effective in treating dry eye disease. However, the amount of omega-3 fatty acids needed to treat dry eye disease can not simply be obtained by just eating fish due to the number of toxins contained in fish such as mercury and lead.

The amount of fish that you would need to consume daily to treat dry eye disease could pose a significant risk of mercury poisoning.

The second thing you are looking for is the form of EPA and DHA that the product contains. Significantly, you are looking for the triglyceride form of EPA and DHA and not the ethyl ester form.

Studies have shown that the triglyceride form of omega-3 oil can have up to 70% better absorption than the ethyl ester form. For example, in this type of fish oil supplement, you can easily get it from a big-box store.

Omega-3 fatty acids contained in this product are in ethyl ester form. omega-3 fatty acids in natural unprocessed fish oil are in the triglyceride form in order to remove toxins such as mercury and lead from the raw fish oil.

It is often processed with ethyl alcohol which converts the omega-3 fatty acids into the ethyl ester form. But it needs to be converted back into the natural triglyceride form to improve the absorption in our body. So in summary, it is important to pick omega-3 oil supplements that contain adequate amounts of EPA and DHA that are in the triglyceride form.

The third thing to look out for is the source of the fish oil used in your omega-3 supplement. Both farm-raised and wild-caught fish can be used to make omega-3 fish oil. But oil from wild-caught fish typically contains a higher concentration of the desired omega-3 fatty acids EPA and DHA.

Fish oil sourced from farm-raised fish is typically much cheaper. So why can't you just take more servings of the cheaper supplements to get the same amount of omega-3 fatty acids?

Fish that are farm-raised and fed with grain typically contain a higher concentration of omega 6 and other fatty acids which may be harmful or pro-inflammatory. Let's say supplement A contains 2400mg of fish oil, 600mg of which are EPA and DHA.

You would need to take almost 3.5 servings of supplement A to get the recommended 2000mg of EPA and DHA along with 6300mg of the less healthy and possibly harmful other oils and the calories from those oils.

In addition, the fish oil obtained from fish that are farm-raised and fed with grain may possibly contain pollutants and chemicals that may not be found in wild-caught fish. Not all manufacturers will specify the type of fish they used to source their fish oil on the package.

So you may need to do a little bit of research on your own to find out the source of the fish used in a given product.

Best 3 Omega-3 oil Supplements that I recommend for my Patients

1. Nordic Natural Ultimate Omega

Number one nordic naturals ultimate omega liquid form. I recommend this product because each serving contains 1460 mg of EPA, 1010 mg of DHA, both are in the triglyceride form.

The fish source is wild-caught deep-sea fish from sustainable sources according to the company. And the toxins levels in this product are significantly below the maximum allowance set by the different regulatory agencies.

I usually prefer liquid omega-3 oil supplements over capsules, because various materials can be used to manufacture the capsular shell, and some can decrease the absorption of omega-3 fatty acids in our body such as methacrylic acid copolymer.

2. PRN Dry Eye Omega Benefits

Number two PRN dry eye omega benefits liquid form. This is actually the supplement that I personally take. I would have listed this product as number one if weren't for the slightly higher price with the PRN products.

For a 10 oz bottle, this one typically costs about $108, and the nordic natural product costs about $72 for an 8-ounce bottle. So it's about $1.80 per oz difference. I really like the PRN dry eye omega benefits because each serving contains 1680 mg of a triglyceride form of EPA and 560 mg of a triglyceride form of DHA.

Also, PRN has stated that they are committed to using sustainable sources for their fish oil. And that they maintain strict testing criteria for purity and toxins.

3. PRN Omega-V Benefits

Number three PRN omega-v benefits. This is one for my vegetarian and vegan readers or those with dietary restrictions. This is a vegan product that still contains a high concentration of triglyceride form of EPA and DHA.

The source of omega-3 fatty acids in this product is algae, which is the main food source for many fish. Each serving contains 330 mg EPA and 670 mg of DHA.

There are limited choices in high-quality omega-3 oil supplements for vegetarians and vegans, or people who limit their consumption of fish or fish products, and this supplement can provide them with a good amount of high-quality omega-3 fatty acids.

Oil from algae is thought to be significantly better than flaxseed oil as a source of omega-3 fatty acids. The main form of omega-3 fatty acids contained in flaxseed oil is ALA.

As I mentioned before the conversation of ALA to the effective forms of omega-3 fatty acids EPA and DHA are less than 5 to 10% in our body. This makes flaxseed oil a much less effective source of omega-3 fatty acids.

Please remember to always consult with your doctor before taking any high dose of omega-3 oil supplements, to make sure that they are safe and right for you. 

Tuesday, March 22, 2022

What Eye Drops should I avoid for Dry Eye Disease?

In this piece of article, I'll show you three different over-the-counter eye drops that I would not use to treat dry eye disease. I will tell you about one lesser know eye drop you may also want to look out for.

4 Eye Drops Not Recommended

1. Soothe lubricant eye drops

soothe maximum hydration lubricant eye drops by Bausch & Lomb. The main reason I do not recommend this eye drop is the preservative they use in it. The preservative contained in this eye drop is benzalkonium chloride or BAK.


There are three different types of preservatives that are commonly used in drops. Detergent type, Oxidative type, and Ionic buffering systems.

The detergent type of preservative is the most toxic type to the surface of the eye, and BAK is the most toxic of the detergent type preservatives. BAK is also commonly used in many different types of medication eye drops such as antibiotic eye drops. Where its toxicity can actually be an advantage for short-term use.

BAK can interfere with the connections between the cells on the surface of the eye and reduce the number of cells on the outer layer of the eye called epithelial cells.

Therefore it can be quite harmful to the eye surface when used frequently or over a long period of time. If you really like the family of soothing eye drops, you would be better off using the soothe XP lubricant eye drops from the same company as they contain polyquad as the preservative.

Although polyquad is also a detergent type of preservative. It is less toxic than BAK. Because the cells on the surface of the eye tend to repel polyquad making it less toxic to the eye surface. Even better among the soothe family of the eye drops are the preservative-free eye drops.

2. Clear Eyes Drops

Clear eyes natural tears eye drops by prestige consumer healthcare. There are two reasons that I do not recommend using clear eyes natural tears for treating dry eyes.

The first is that this eye drop also uses benzalkonium chloride or BAK as its preservative and there is no preservative-free version of this eye drop.

The second reason is that this eye drop contains polyvinyl alcohol or PVA which is a demulcent that lowers the viscosity or thickness of the eye drop. PVA is found in many older types of artificial tear eye drops.

There are more effective newer compounds that are available as a demulcent in eye drops such as propylene glycol and polyethylene glycol which are used in some newer artificial tears eye drops.

3. Visine Eye Drops

Visine dry eye relief, Visine red-eye hydrating comfort, and Visine red-eye total comfort by Johnson & Johnson. Visine red-eye hydrating comfort and Visine red-eye total comfort contain tetrahydrozoline to reduce eye redness.

Tetrahydrozoline is a chemical that temporarily constricts the blood vessels on the eye surface to reduce the appearance of eye redness. Frequent and long-term use of tetrahydrozoline can cause rebound dilation of the blood vessels on the eye surface when the eye drop is discontinued.

This means the eye will appear red if the eye drop is discontinued. Now unlike Visine red-eye total comfort, some other Visine eye drops like Visine dry eye relief do not contain tetrahydrozoline.

However, all three Visine eye drops I mentioned use BAK as their preservative, and as always, I recommend avoiding long-term use of any over-the-counter eye drops that contain BAK due to its toxicity to the surface of the eye.

If you really would like to choose an eye drop from the Visine family to treat dry eyes. You would be better off choosing Visine dry relief tired eye lubricant eye drops or Visine dry eye relief all-day comfort, as the preservative used in those two drops is polyquad which is less toxic than BAK.

4. Rohto Cooling Eye Drops

It is less well known than the other over-the-counter eye drops. Rohto cooling Digi eye contains both tetrahydrozoline and BAK which as we already talked about can be toxic to your eyes.

Saturday, March 5, 2022

Best Active Ingredients of Eye Drops for Dry Eyes

In today's article, I would like to talk to you about the science behind the ingredients in artificial tears. These are the over-the-counter eye drops for treating dry eye disease. This post will help you to understand the differences between different dry eye drop ingredients and will help you choose the artificial tears that work best for you.


Without further ado, let's talk about the ingredients in artificial tears. The ingredients of artificial tears can be categorized into three groups:
  • Active Ingredients
  • Inactive Ingredients
  • Preservatives

1. Active Ingredients

The active ingredients are the agents that have been approved by the FDA to be used in artificial tears to provide lubrication to the eye. There are three main categories of active ingredients in artificial tears.
  • Astringent
  • Demulcent
  • Emollient


The most commonly used ophthalmic astringent is zinc sulfate. Two common brands of dry eye drops that contain zinc sulfate are Clear eyes drop made by prestige consumer healthcare and Visine made by johnson & johnson.

Zinc sulfate can help reduce the burning and itching sensation from exposure to the pollutants in the air by reducing the mucus on the surface of the eye. So it can help reduce some allergy symptoms but zinc sulfate is not very effective in lubricating the eye compared to other active ingredients. So it is not a top active ingredient in artificial tears that I recommend for my patients to treat their dry eye disease.


The second group of active ingredients is called demulcent. This is the main ingredient in artificial tears which determines the consistency and thickness of the drop. Demulcents are typically mucoprotective agents. They reduce inflammation and irritation of the mucus membrane of the eyes and hold moisture to lubricate the surface of the eye.

They act on both the aqueous and the mucin layers of the tear film. There are a few common demulcents used by different brands of artificial tears. Carboxymethyl cellulose sodium (CMC) is the main demulcent used in the Refresh brand artificial tears made by Allergan. Systane brand of artificial tears made by Alcon typically contains polyethylene glycol or propylene glycol as their demulcent.

The other commonly used demulcent agent is hydroxypropyl methylcellulose (HPMC). It is the demulcent used in GenTeal brand artificial tears made by Alcon. Variation in the concentration of the demulcent such as CMC affects the consistency and the viscosity of the artificial tears.

For example, Refresh Optive gel drop contains 1.0% CMC which is double the concentration of CMC in the regular refresh optive eye drop. This allows the gel drop to provide a longer-lasting lubricating effect.

However, the higher concentration of the demulcent used increases the thickness of the artificial tears. This will require more blinking action by the eyelid to spread the demulcent polymer over the surface of the eye. Therefore if you use a gel eye drop you may notice it takes a little bit longer and more blinks to clear your vision after you put in the eye drop.


The third category of active ingredients is emollient. An emollient is usually fat or oil providing a long-lasting lubricating effect, and the eye drop which contains emollients tend to be thicker and take longer to clear up. So the liquid formulations of artificial tears typically do not contain a large number of emollients.

For example, mineral oil is a commonly used emollient and is intended to replace and thicken the lipid layer of the tear film in order to improve the stability of the tears and slow down the evaporation of the tears.

More commonly emollients are found in ointment formulations of artificial tears such as Refresh PM and Systane Nightime eye ointments. These formulations are more frequently used before bedtime and reserved for moderate to severe dry eye disease.

Some newer liquid formulations of artificial tears target all three layers of the tear film including the lipid layer, which often contain a small amount of emollient to provide a longer-lasting lubricating effect to the eye.

Artificial tears which contain emollients are a little bit thicker. So after you put in the drop make sure you blink a few times to spread out the eye drop across the surface of the eye. You may notice the vision is a little bit blurry and it may take a few blinks to clear up your vision. If you want to know what eye drops should not use for dry eyes. Click here

Monday, January 31, 2022

RLE Surgery - A Permanent Solution to Reading Glasses

So you want to get rid of reading glasses forever? that's the topic of today's article. I am here to bring you the latest information on eye health and medicine. The worsening of reading vision as we age is called presbyopia.

With the recent FDA approval of the vuity eye drop which is a temporary treatment for presbyopia. A lot of my patients have been asking me about ways to eliminate reading glasses permanently.

Refractive Lens Exchange Surgery (RLE)

In today's article, I will discuss a surgical option that can treat presbyopia permanently. This type of presbyopia eye surgery is known as refractive lens exchange surgery or RLE.


I will go over how RLE works? Who are candidates for RLE surgery? What to expect before and on the day of refractive lens exchange surgery? what is the recovery process and what are the risks of this type of surgery? Make sure you read the entire article to learn about both the benefits and risks of RLE surgery?

How Does Refractive Lens Exchange Surgery Work?

So how does RLE surgery work? RLE surgery corrects presbyopia by replacing the stiff and aging natural lens in our eyes with an advanced intraocular lens implant or IOL.

When we are young we are able to see objects at different distances due to the flexibility of our natural lens. Our natural lens becomes more curved when the eye muscles contract called "Ciliary body muscles" and our eyes become more nearsighted.

This enables us to see objects that are close to us clearly. In our early 40s, our lenses gradually lose their flexibility and no longer change shape as our eye muscles contract causing presbyopia. Although there is no currently available treatment to restore the elasticity of our natural lens.

Refractive lens exchange surgery treats presbyopia by removing the rigid lens and replacing it with an advanced IOL to give us a clearer range of vision including distance, intermediate, and near vision.

Who is a Good Candidate for RLE Surgery?

So how do you know if you are a good candidate for RLE surgery? In general, people who are over the age of 40 and have developed significant presbyopia or difficulty reading, may want to be evaluated by an eye surgeon for RLE surgery.

In order to be a candidate for RLE surgery, you need to have a healthy eye, free of significant eye diseases. For example, people who have glaucoma, macular degeneration, significant diabetic eye disease, a history of retinal detachment, eye inflammation, or any significant disease of the cornea, are not good candidates for RLE surgery.

People who are extremely nearsighted or farsighted with an abnormal length of the eye are also typically not good candidates for RLE surgery.

For example, in people who are extremely nearsighted with a glasses prescription over minus 15 diopters, the length of the eyeball is extremely long and this increases the risk of developing retinal detachment including RLE surgery.

What to Expect before RLE Surgery?

Retinal detachment with any kind of intraocular surgery including RLE surgery. So what can you expect during your evaluation for RLE?

In order to determine if you are a candidate for RLE surgery, you will need to have a full eye exam by your eye surgeon and complete extensive testing and measurements of your eyes.

Typically a full RLE surgery evaluation will involve measuring the curvature and length of the eye, a full eye exam with pupil dilation, examining the health of the optic nerve and retina inside of the eye. Also, the strength of the glasses prescription for both distance and near vision is recorded during the exam.

After the examination and testing, if you are a candidate for RLE surgery, your eye surgeon and you will pick the best advanced intraocular lens implant for your eyes. There are two main types of advanced IOLs that are currently available in the US for presbyopia correction.
  • Multifocal IOL (MFIOL)
  • Extended depth of focus (EDOF) IOL
The choice of IOL for each candidate is made based on that individual's functional vision needs as well as any vision requirements for their profession and lifestyle.

What to expect on surgery day and vision recovery after surgery?

What should you expect on the day of RLE surgery and how do you care for your eyes after surgery?

RLE surgery is typically done for both eyes either separately or occasionally at the same. It is an outpatient procedure that takes about 15 minutes for each eye and you will go home the same day.

During the surgery, patients are typically not under general anesthesia. They will receive IV or local sedatives to stay conscious but in a very relaxed state. The surgery itself is painless and patients will be using different types of eye drops with a tapered schedule in the weeks of the following surgery.

Strenuous activities should be avoided during the first week after surgery. In general, your vision will be blurry on the day of surgery. With a successful RLE surgery, your vision should be much clearer the day after surgery and you should be able to resume most of your vision tasks the day after surgery such as:
  • Watching television
  • Driving
  • Reading or light reading
You may feel very mild irritation or foreign body sensation in your eyes and may have some light sensitivity for about a week after surgery.

The majority of vision recovery occurs during the first week after surgery. But it is not unusual for you to experience small fluctuations in your vision during the first month after surgery.

Although mild irritation and vision fluctuation are expected shortly after surgery, significant eye pain and sudden significant vision change are unusual and can be signs of potentially serious complications. If you experience those or any other concerning symptoms, you should contact your eye surgeon right away.

For RLE patients, their vision stabilizes about one month after surgery. However, a small percentage of patients may take a few months to fully recover their vision after RLE surgery. Usually, patients will be following up with their eye surgeon or eye doctor a few times during the postoperative period.

The surgical steps of RLE surgery are basically the same as cataract surgery, and it can be done with a conventional manual method or with assistance from a femtosecond laser.

What are the Risks of Refractive Lens Exchange (RLE) Surgery?

Please remember, there are risks with any surgery including RLE surgery. With RLE surgery there is a small chance of infection, bleeding, increased eye pressure, glares at night, and potentially other risks that you should discuss with your eye surgeon.

Most of the complications from RLE surgery are treatable with additional medications or procedures. Although it is rare, the risk of vision loss is not zero with RLE surgery or any intraocular surgery.

The goal of RLE surgery is to reduce the need for reading glasses and to help you eliminate reading glasses for most of your vision needs. Most RLE patients do not need reading glasses after surgery.

However, people who spend a lot of time doing prolonged close-up work. for example, threading needles or reading very small print up close for hours at a time may still want to wear reading glasses for those tasks in order to reduce eye strain.

Therefore it is important for you to have an individualized exam and consultation with your eye surgeon to determine if RLE surgery is the right treatment for you. 

Sunday, January 30, 2022

Are Floaters in Eyes Normal? - When they are Serious in Eyes

Hey guys! today we are going to be talking about floaters if you have had flutters before you know that they can be a little bit of a nuisance as they kind of float around your visual field. Sometimes they can be a sign of something more substantial like a retinal tear or a retinal detachment.

So we are going to talk about what floaters are? When they are normal and when do you need to worry about them? So I am Dr. Ruman from the website and today we will discuss floaters.

What are Eye Floaters?

Floaters are a super common symptom that probably most everybody will experience at some point in the course of their life. but what exactly are they? When you see floaters what do they look like?


Floaters are just a little kind of grayish or black strands or little floating almost kind of mosquito-looking objects that are floating in your visual field.

You have probably noticed that they are more commonly seen when you are looking at something that has not very much detail like a blue sky or a white. You know a piece of paper or white background on your computer and what those floaters actually are little condensations in the vitreous gel in the back of our eyes.


What is the Vitreous Gel?

So this is our handy eye model and this is a cross-section of the eyeball. So in the cross-section where the cornea exists, the front surface of the eye directly behind that is the iris the colored part of the eye the lens and then this entire space is a huge open cavity. That's occupied by this substance called the vitreous gel.

At what age does Vitreous Detachment Occur?

The vitreous gel is very formed when we are in our teens and 20s kind of early in life. It's really solid almost like jello and it barely moves at all. So that's why in those years we really don't see floaters because the vitreous is just very firm but as we start to age in our 30s and 40s and definitely 50s, 60s and beyond. All of those collagen bonds that make up the vitreous gel start to break down and the vitreous starts to liquefy you will get these little clumps that form in the vitreous little condensations.

That is going to be suspended you know intermittently throughout the vitreous and so what we actually see as floaters is a shadow cast on the retina. When the light comes through the eye hits, that little condensation and then casts a shadow on the retina.

We are not actually seeing the condensations ourselves because they are in the eye. They are too close to our retina for us to perceive them. we can see that shadow that's cast on the retina and that's why you notice them more when it's a white lighting setting.

Are Floaters in Eyes Normal?

If you are in a dark room, you know there is something else for your brain to look at. If you are looking at a complex image, you are not going to see those floaters as much as you will. If you are looking at that bright blue sky.  If you are having those kinds of occasional floaters that start in your 30s and 40s, they are usually not worrisome.

But occasionally as the vitreous gel starts to liquefy it will actually pull away from some of its attachments in the back of the eye. The vitreous is attached very firm to three different locations in the back of the eye. It's attached to the optic nerve which is right here and as the nerve comes into the back of the eye.

We can see that in the above cross-section a little circle, it's attached to the retinal blood vessels and it's attached to the very far periphery of the retina. Where the retinas kind of stretched out to their thinnest point and so as that vitreous is starting to pull away.

It can pull a little piece of tissue off the optic nerve and you actually see this little ring-shaped area of tissue we call a Weiss ring so this is called a posterior vitreous detachment. 

What is a posterior vitreous detachment?

A posterior vitreous detachment is a normal process of aging and it just means that vitreous gel is going to be pulling away from the back connections to the optic nerve and to the retina patients will typically say when they present with this.

You know I have had floaters for many years but all of a sudden I just had really a big floater and it was in the shape of a ring or some semblance of a ring. Because we can actually see that little piece of tissue that's been pulled off from the optic nerve.

What Causes a Posterior Vitreous Detachment?

So the reason that we make a big deal about this is that 10 to 15 percent of people who have a posterior detachment will have a retinal tear associated with that and the reason for that is as we are talking about earlier the retina is one of the things that the vitreous is very closely adherent to and so as the vitreous is pulling away from the retina.

If it pulls a little tear in the retina that can lead to a retinal detachment which of course you know we don't want to happen. So if that were to happen we could, of course, treat that but we want to get you in and get you seen as soon as possible.

If you are at risk for that the symptoms that people have if they are about to experience a retinal tear or they are experiencing a retina tear are that they will have these peripheral arc-like flashes of light and the flashes are typically split. Second a lot of times people wonder if they are even seeing if they feel like maybe a camera flash or you know something a reflection.

You know of off light or something was what they were seeing and they realized oh my God this is actually happening inside of my eye. The reason that we see that flash is that as the vitreous is tugging on the retina that traction on the retina is going to be perceived by us as a flash.

Most people will describe them out, in the temporal periphery but occasionally you can see them nasally as well. But they are almost always going to be in an arc shape split second and people describe them as kind of a white or silver flash.

The other thing that people frequently see with a retinal tear is a whole bunch of little tiny floaters. So I call them pepper dot floaters. Because people say it feels like somebody took a pepper shaker and just shook it in front of the eye and instead of a couple little you know big amoebas floating around.

When we have got hundreds of little tiny dots the reason that this is a symptom is that the retina is tearing. It will release the pigment from underneath the retina that pigment then scatters throughout the vitreous and we can see that. We will see all those little pepper dot floaters so our front desk knows that if somebody calls with flashes or pepper dot floaters.

Floaters are coming immediately but in general, we tell anybody who's having a new onset floater especially if it's large that they should come in because like I said you know 10 to 15 of people who have a posterior vitreous detachment are going to develop a tear.

So what will happen at your visit when you come in is we will get you in. we will get the eye dilated we are going to look all the way around the edges of that retina to make sure that there's not a tear.

If there is not a tear but I can see that somebody has developed a posterior vitreous detachment then I just give them those warnings that we were just talking about if you are having flashes of light.

If you are having pepper dot floaters come back and see me sooner and then I always follow up with them about two to three weeks after that initial visit. because this posterior vitreous pulling away from the retina is kind of a process in evolution.

So the highest risk for a tear is going to be in those first few weeks afterward we bring them back and check them all over again and make sure that the retina looks okay.

If there is a tear then the next step is to immediately get you to a retina specialist to treat that tear. So the tear itself can never be put back to place but what they can do is that the tear is way out here in the peripheral retina.


They will use a laser to spot weld around that tear so that the two layers the retina and the choroid kind of you know spot weld together. they shrink together so that no fluid is allowed to come up underneath that retina which causes a rental detachment. This procedure is an outpatient procedure.

The retina docks are wonderful. they do these all day long. It takes a couple of weeks for that laser to really settle in so they tell patients to kind of take it easy for about a week or two after the procedure but the wonderful thing about this treatment is that it does not affect the vision and people preserve you know it preserves their vision for folks which is excellent.

When Floaters are Serious in Eyes?

If there were actually a retinal detachment that's a little big procedure and we can certainly talk about that in a different article but we definitely want to make sure that anybody with flashes or pepper dot floaters comes in immediately okay.

So let's summarize floaters a lot of floaters are just a normal process of aging so if you have noticed that occasionally you see a little mosquito flying through your field of vision. that's okay and if that comes and goes we are really not worried about those.

What's not okay is that if all of a sudden you notice these peripheral flashes of light or you have a whole bunch of new floaters especially if they are hundreds of little black pepper dot floaters.

At what point should you Call the Doctor?

You know patients are always kind of confused or wondering like when should I call my ophthalmologist and I always tell them If you are worried you call. we only have two eyeballs and so we really want to make sure that if there is something that needs to be seen.

We get you to see up again if you have a posterior vitreous detachment. there is an 85 to 90 percent chance you are going to be fine and nothing is going to happen at all. But considering almost all of us are going to get a posterior vitreous detachment 10 to 15 percent of all comers and this is a pretty big number.

So we want to make sure that you are seeing so never feel bad about calling our front desk and just front desks in general can kind of help evaluate that and give you some guidance but in general, we only have two eyes so if you are worried about them please come into us. So guys on floaters I hope you found this article helpful.