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Kids and Eye Exams

Did you know that 80% of all learning in a child’s first 12 years is through their visual system? While most parents recognize the value of routine visits to the dentist, they often underestimate the importance of testing their children’s eyes. Studies find that 1 in 4 children, ages 5 to 12, have an undiagnosed vision problem that can affect their educational performance. Additionally it often affects other areas such as personality, behavior, and sport performance. Children are sometimes mislabeled as “slow learners” when impaired vision prevents a child from seeing clearly. Even if your child doesn’t complain about not seeing well, you should not assume that there are no visual disorders. Your children have no reason to believe that you see any differently than they do.

According to the American Optometric Association (AOA), infants should have their first comprehensive eye exam at six months of age and then at age 3 and right before they enter kindergarten. For school-aged children, eye exams should be performed every two years if no vision correction is required, but annually if they wear eyeglasses or contact lenses.

To make sure your kids have the chance of learning in school, call 1-866-865-2020 to schedule an appointment today with any of our Board Certified Optometrists for a comprehensive eye exam to make sure your kids have the chance of learning in school.

SLT For Glaucoma Treatment

Are you tired of taking expensive drops for your glaucoma? Selective Laser Trabeculoplasty (SLT) may be the answer.

SLT is a fast, effective & painless ‘cold’ laser treatment that is used to lower intraocular pressure (IOP) in glaucoma patients. It may reduce the need and the expense of eye drop medication. The outpatient procedure is so safe that it can be used on patients where traditional glaucoma therapy has not been successful, and it can even be repeated, if needed. SLT is FDA approved and covered by Medicare.

SLT is sometimes the first-line treatment for open-angle glaucoma because it has few side effects, and it eliminates the compliance issues that drops have. It can save the patient a lot of money as glaucoma eyedrop medications can be very expensive.

SLT has been used in the US and around the world for about 20 years. Patients with open-angle glaucoma are a candidate. It works to lower the IOP by opening up the drainage tissue.

SLT usually last between 1 and 5 years. The good news is that it can be performed again without complication. It is still important for people with glaucoma to continue to monitor their pressure and see the eye doctor on a regular basis.

Some patients may need to continue with drops  to keep their IOP as low as possible, but they may benefit by only needing one drop instead of two. The most important thing is keep your eye pressure low with any means possible.

If you have glaucoma, come in for a second opinion and see if SLT can help you. Click here or call 1-866-865-2020 for an appointment today.

Your Dry Eye Coach – Dr. Richard Hector

dry eye advice

It always bothers me when a patient says “Well, you are the expert, tell me what I need to do”. The truth is every patient knows more about how they feel, what parts work and what needs help, than I will ever know. As much as I try, I cannot feel or see how someone else is feeling or what their vision is like. I try and take a thorough history, because as most doctors will tell you, the hardest thing is jumping in too soon after a few observations only to have your patient tell you, no, that is not it at all. I learned long ago that what worked very well for one patient, could fail miserably for the next. It is very true that we are all individuals and need to be treated as such and I like the role of trusted adviser. Let me work with you to improve your vision and reduce the discomfort you are suffering with professional dry eye treatment.

I participated in a local call in show on SNN Local News 6 right here in Sarasota; on a recent show, a listener prefaced their question with the words “please do not laugh” but exactly how do dry eyes feel? My response was to ask them to not laugh, because dry eyes often water all the time, and I went on to explain why this can happen. So when someone tells me “you are the expert, tell me what I need to do” I sit back and remind them that it is their body, their eyes, and you are the expert of your body. You have to tell me what bothers you about how your body is working, or not working, and how it feels, good and bad, and I will be happy to give you the best advice I can on how to help you see better and feel better.

As a good coach I remind patients that your eyes are part of the rest of your body. How you treat your body plays a big role on how well your eyes will work. How good is your over all nutrition? Do you get enough rest/sleep? You may brush your teeth 2-3 times a day, but how often do you cleanse your eye lids? That simple act of applying a warm compress to your closed eye lids for 2-3 minutes, 1-2 times a day, keeps the tear glands open and working properly. These are the tear glands that protect your eyes, and help your eyes focus clearly. During your exam I can tell if they are receiving enough care and attention. Then as your “Dry Eye/Vision Coach” I will tell you are doing well and to keep up the good work. Or, you need to work harder on your compresses and/or nutrition and you need to do this every single day. So every time you are at the sink to wash your hands and face or brush your teeth, take 2 more minutes and apply a good warm compress to your eye lids. Your eyes will thank you by allowing you to see better and feel better for the rest of the day.

-by Richard Hector, MD

Floaters – Are they dangerous?

What are Floaters?

What is that speck that I see? This is one of the most frequent questions that we get every day. They are commonly called floaters. Floaters are tiny clumps of debris or gel that are suspended within the clear jelly-like fluid that fills the inside cavity of the eye. They can take on different shapes. They are often described as floating dots, specks, or thread-like cobwebs. The appearance of floaters is most often is part of the natural aging process.  They are not generally sight threatening nor require treatment.

How do we get floaters?

As we mature, the vitreous gel shrinks and pulls away from the retina, forming floaters in the process. Although annoying, most are not usually sight threatening and do not generally require treatment. But the sudden appearance of new floaters can be a signal to have an eye exam as soon as possible as it may be an early symptom of a retinal detachment.

Often they will fade with time, but if not, most people get used to them. The brain has a way of ignoring them after a while. But when they first appear, they can be quite annoying.

Only with a comprehensive medical eye exam can it be determine whether they are harmless or the beginning of a more serious problem. To schedule an eye exam, call 1-866-865-2020 or click here: online contact form.

Glaucoma: The Silent Thief of Sight

Glaucoma is a disease of the eye whereby there can be buildup of fluid within the eye causing increased pressure. When this occurs there is a risk of damage to the optic nerve, a part of the eye that is necessary for good vision.

Because glaucoma is without visual symptoms until serious damage has occurred, people can go for years without even knowing that they have it. Unfortunately this undetected condition can cause vision loss if left untreated.

The only way to diagnose glaucoma is with a thorough eye examination. That is the reason that we recommend that everyone have a comprehensive eye examination at least every 2 years, even people that do not wear any type of eyewear.

Patients who are looking for glaucoma treatment  can visit our clinic for quality eyecare services and advanced eye surgery.

5 REASONS TO HAVE AN EYE EXAM……even if you don’t wear eyeglasses.

1) Eye Exams Save Sight

Some sight-threatening eye diseases do not have early warning signs, and many can only be detected during a dilated eye exam.

2) Eye Exams Detect Other Health Problems Too

Many general health problems are often first detected during a routine comprehensive eye exam, because the eye is the only place where blood vessels can be viewed without a surgical procedure.

3) Good Vision Increases Safety

Poor vision can have an adverse effect on many life issues, such as depression, increased car accidents, drug-related errors, and falls. Falls are among the leading causes of death of people 65 and older.

4) Vision Affects a Child’s Success in Life

80% of all learning is through the visual system, and decreased vision can significantly affect childrens’ grades, athletic performance and even social interaction.

5) Changing Eyecare Technology

Sight-saving technology is changing at an astonishing rate. Conditions once considered untreatable are now able to be corrected with cutting-edge technology.

Click here to make an appointment with one of our award winning eye doctors.

Things You Might Not Know About Dry Eyes

1. Do you need another reason to quit smoking? Add Dry Eye Disease to the list. Recent studies have shown even second hand smoke is very harsh on the surface of the eye. There are a lot of toxic chemicals in cigarette smoke that can break down your protective tear film and the surface corneal tissue. If you are around a lot of cigarette smoke, you need to increase the use of artificial tears. Cigarette smoking is also known to be a strong contributor to the acceleration of macular degeneration. Outside of family history, it is the most common denominator in those patients with this serious eye disease.

2. While I am spoiling your fun, alcohol is also not dry eye friendly, as it can dehydrate you. This is good to remember when you are traveling in a commercial aircraft where the atmosphere is already dryer than any desert. Drink plenty of water instead.

3. Now, for a little update on makeup and dry eye issues: Water proof eye make-up, mascara, shadow, etc., has a much higher discomfort and sometimes toxic reaction to the sensitive skin of dry eye sufferers. Also keep your makeup fresh, disposing old bottles after 2-3 months. Thoroughly clean off your make up every night.

4. Contact lenses are not just an aggravating factor, but can also cause dry eye damage to the cornea. Daily disposable lenses are the safest for dry eye patients. Never wear your contacts if your eyes are red and uncomfortable.

5. Up until now we have recommended avoiding too much caffeine as it is a mild diuretic. More recent studies have shown a reduced risk of dry eye in coffee drinkers and that caffeine can stimulate tear production. A little caffeine also shortens ophthalmic migraine symptoms. Treating a patient’s dry eye condition has also been shown to reduce the frequency of their migraine attacks.

6. Be aware that children can also suffer from dry eyes, secondary to congenital endocrine, autoimmune and inflammatory disorders. If your child has persistent complaints of painful, irritated eyes, don’t just treat them with artificial tears and ignore it… Bring it to the attention of your pediatrician and eyecare professional.

7. And yes, those simple carbs that are bad for the waistline are also bad for your eyes. They compete with the complex carbs needed by ocular tissue and aggravate your dry eye symptoms.

Do you need any more evidence that Dry Eye Disease is a very complex problem that needs something more than an artificial tear once or twice a day?

– By Richard Hector, MD

True or False: Tanning Booths Won’t Cause Skin Cancer.

Tanning Beds Won’t Cause Skin Cancer – True or False

FALSE – According to, just ONE tanning booth visit, 1) will increase your risk of melanoma by 20% 2) will increase your risk of basal cell carcinoma by 29% and 3) will increase your risk of squamous cell carcinoma by a whopping 67% . A spokesperson for The Skin Cancer Foundation pointed out that there seems to be a cultural disconnect between the risk of skin cancer and the desire for a ‘healthy glow.’ Since physical appearance may mean more than long-range health effects, a new study suggests that pointing out the negative cosmetic effect of tanning, such as age spots and wrinkling, may have more impact than the fear of skin cancer.


Beware of Similar Looking Bottles

Take few minutes right now and separate your artificial tear/eyedrop bottles from ALL other similar containers. There has been a recent increase in patients reaching for their eyedrops, or what they thought was eyedrops, but instead placing a drop of nail cleaner, ear wax remover, super glue or whiteout into their eye. Some of these solutions can be easily rinsed out, but some cannot and are very dangerous, such as super glue.

If you do inadvertently put the wrong liquid into your eyes, immediately rinse the eye with lots of plain water or saline solution. This is one of those times where the old eye cups would be useful. When you are done rinsing, use a thicker artificial tear solution, such as a gel, to re-lubricate your eyes. If you have persistent pain, redness or blurred vision, by all means call the office. There is a doctor on call 24/7 who can advise you if immediate attention is needed.

If something more toxic, such as drain cleaner, battery acid, ammonia based cleaning products, dry wall or concrete dust, gets into your eyes, a trip to the emergency room or eye clinic nearest to you is recommended. A full 20 minutes of continuous, thorough rinsing and pH testing are needed to completely remove these products. BUT before you go to the emergency room, do an immediate rinse wherever you are. I do not care if you rinse with a garden hose… one patient used a can of 7-Up (that is all she had to help her son after the car battery exploded in his face). The faster your eyes are washed out and the toxic solution diluted the better. Even a 5 minute ride to the hospital can be more than enough time for potentially blinding damage to occur if these solutions are present full strength. It is common to be concerned if the word acid is in a description of the fluid, but solutions with the opposite pH called bases, such as ammonia, can cause much more rapid and severe damage to your eyes.

By Richard Hector, MD

Dr. Mali’s Top 5 Predictions for 2018

This is an article by Dr. Joshua Mali published by Ophthalmology Times.

1). Aflibercept and ranibizumab utilization will continue to soar to new heights in 2018.

The success of aflibercept (Eylea, Regeneron Pharmaceuticals) and ranibizumab (Lucentis, Genentech/Roche) injections will definitely continue in 2018. Regeneron just recently reported fourth-quarter 2017 sales of its flagship product, aflibercept, of $975 million, up 13.6% year over year. I anticipate sales will continue to flourish with aflibercept given its strong efficacy data and excellent long-term safety profile.

In 2017, ranibizumab became the first anti-VEGF therapy approved to treat patients with myopic choroidal neovascularization (mCNV) in the United States, in addition to receiving FDA approval for the treatment of all forms of diabetic retinopathy. The combination of these two new indications, as well as the availability of the ranibizumab 0.5-mg prefilled syringe, makes ranibizumab primed to continue its growth momentum in 2018. Overall, as the prevalence of exudative age-related macular degeneration (AMD), retinal vein occlusion, and diabetic macular edema continues to climb worldwide, these will be the two heavyweights in the anti-VEGF market in 2018.

2). The ForeseeHome device will be the new standard of care in AMD monitoring.

Described in one of my previous articles as one of the 5 greatest ophthalmic innovations of the 21stcentury, telemedicine represents a new frontier of our field focusing on two main principles: prevention and early disease detection. This philosophy is probably best illustrated in a disease like AMD, and the ForeseeHome device (Notal Vision) is the flagship telemedicine technology in ophthalmology today. The ability to immediately detect the initial conversion in a patient from dry to wet AMD is absolutely critical and basically determines a patient’s visual prognosis in addition to making our current therapies even more effective. Top that off with the recent Medicare coverage approval for the device and I believe ForeseeHome utilization will accelerate this year and become the new standard of care in AMD monitoring.

 3). Bromenfac will take a significant leading share of the topical NSAID market.

Bromfenac ophthalmic solution 0.075% (BromSite, Sun Ophthalmics) is a non-steroidal anti-inflammatory drug (NSAID) indicated for the treatment of postoperative inflammation and prevention of ocular pain in patients undergoing cataract surgery. Bromfenac is the active molecule that is designed for improved corneal penetration given the bromine component which allows for enhanced lipophilicity and ocular tissue penetration. However, the key feature of this medication is the delivery system (DuraSite) that allows the delivery vehicle to be more viscous and mucoadhesive—thus increasing retention time on the ocular surface and allowing for a higher intraocular concentration of bromfenac. I strongly believe that bromfenac, with its delivery vehicle, is able to create a much higher intraocular concentration (as compared with other topical NSAIDs)—thus resulting in a more efficacious response and will lead to increased utilization in the ophthalmology community in 2018.

4). Voretigene neparvovec-rzyl will be a successful pioneer for gene therapies. 

Voretigene neparvovec-rzyl (“voretigene,” Luxturna, Spark Therapeutics) is the first gene therapy for a genetic disease, first and only pharmacologic treatment for an inherited retinal disease (IRD), and first adeno-associated virus (AAV) vector gene therapy approved in the United States. With all these first-in-class titles, there will be new challenges ahead for this innovative advance in medicine. Drug cost reimbursement, insurance coverage, distribution, and marketing/education will be the critical topics that will require creative solutions.

However, I believe voretigene is more than ready for the battle and it will be very successful in pioneering this new frontier. The company has already put into motion an organized structural model to address these pivotal issues and they have the skills to deliver this exciting new treatment to patients across our country. They will be making history and writing the blueprint for which the entire class of gene therapies will utilize in the future.

5). Healthcare law reform will start to take shape.     

While complete healthcare reform has taken a backseat to other legislative priorities, I still strongly believe comprehensive healthcare reform will make significant progress in 2018. While it remains to be seen if complete repeal of the Affordable Care Act (ACA) or adjustment to existing healthcare law will be accomplished and signed into law this year, President Trump and Congress will be working diligently on a solution for healthcare reform.

In addition, the private sector may also be able to provide some assistance in developing healthcare solutions.

For example, it was recently announced that Amazon, Berkshire Hathaway, and JPMorgan Chase & Co. are partnering on ways to address healthcare for their U.S. employees, with the aim of improving employee satisfaction and reducing costs.

Additionally, former CMS administrator Andy Slavitt has launched a new bipartisan nonprofit organization called the United States of Care to ensure access to quality, affordable health care for all Americans regardless of health status, social need or income.

Ultimately, it will take the efforts of all of us as Americans with different backgrounds and skills to solve this issue. I also have some ideas on how to develop our healthcare policy that will be satisfactory to all sides-patients, physicians, hospitals, pharmaceutical companies, insurance companies, and our government. So, if President Trump, any of our politicians from Congress, or members of these private sector initiatives are reading this article, feel free to call me. That being said, we must have stabilization of the United States healthcare system in order to allow all of us as physicians/ophthalmologists to continue to provide the best healthcare delivery for our patients.

2018 will definitely be a very exciting year for both ophthalmology and healthcare as a whole. As I have done in the past, I look forward to keeping you updated throughout the year!

Joshua Mali, MD, is a board-certified ophthalmologist and award-winning vitreoretinal surgeon at The Eye Associates, a private multispecialty ophthalmology practice in Sarasota, Florida. He can be reached at 941-923-2020. Dr. Mali’s relevant financial disclosures include the following: Regeneron (consultant, speaker, stock shareholder, research funding), Genentech/Roche (consultant, speaker), Notal Vision Inc. (consultant, speaker), and Sun Pharmaceutical Industries Inc. (consultant, speaker).