Medications and their (many) side effects... Plaquenil...

Hello everyone,

I'm writing from Delaware today, taking a mini-vacation to visit my sister, brother-in-law and their dog, Ace. We have plans to visit the pool and the shore today and tomorrow, but due to the extreme heat, we may just be there for a couple of hours each day before our skin melts off.

Anyway, I was thinking about the many, many, many ocular side effects to commonly used medications. Sometimes, I've wondered if I would have really taken a medication I was prescribed if I actually read the numerous side effects on the warning label. Similarly, you've probably seen the familiar commercials advertising new drugs that come out. The start of the commercial usually shows someone in misery and then they "talk to their doctor about" X drug, and now their life is wonderful, making flower arrangements, chasing their dog through the park and laying in a bathtub on a the side of a mountain. And in all of these, the low-voiced announcer spends at least thirty seconds mentioning pretty severe side effects while the subject of the commercial is trying to distract your ears by smiling and having a good time.

Unfortunately, medications have side effects. And unfortunately, these same medications are needed by people to live better lives, regardless of the side effects. It's up to the doctor to balance the benefits vs. side effects and in most cases, the benefits win out. However, the patient should be made aware of the possible adverse reactions so that they can report to the doctor what's going on; to make a change if necessary.

If you're taking a medication, look at the warning label. Relating to the eyes, the side effects are numerous (these are generalized): blurred vision, decreased vision, double vision, eye dryness, light sensitivity, increase in intraocular pressure, conjunctivitis, color vision changes, and eye inflammation, among others.

Plaquenil is a medication used to treat lupus and rheumatoid arthritis. And like I mentioned before, any medication that has benefits probably has some side effects. Here are the ocular side effects of Plaquenil:

1) Ciliary body: This is the part of the eye that is responsible for focusing the lens in your eye. Disturbance of the ciliary body affects accommodation, which causes the blurred vision. This reaction is dose-related and reversible with cessation of therapy.

2) Cornea: This is the very front portion of the eye. The cornea can experience mild edema, patches of dryness and decreased corneal sensitivity. This will contribute to blurred vision, halos around lights and light sensitivity, which are reversible. Deposits of the medication can also appear in the cornea as early as three weeks following initiation of therapy.

3) Macula: The macula is the very center-most portion of the retina, which is responsible for your fine visual acuity. Edema, atrophy, and abnormal pigmentation ("bull's eye" appearance) of the macula can cause enlongated recovery times to bright lights and decreased vision.

4) Visual field defects: Due to the macular changes, blind spots may occur close to and in the exact center of your central vision. The most common symptoms due to this are difficulty reading and seeing, blurred distance vision, and missing or blacked out areas in the central vision.

The most severe is the retinopathy affecting the macular area, which is dose related and has occurred within several months to several years of daily therapy. This retinopathy may continue even after the drug is discontinued. The good news is that the retinopathy can be reversible with discontinuing Plaquenil therapy.

It's important for patient on Plaquenil to obtain a baseline eye examination and annual follow-up visits to ensure that none of these side effects take place. The testing typically includes a comprehensive eye exam with pupil dilation, as well as a macular visual field, color vision test, and retinal photography.

Although side effects are rare, patients on Plaquenil may or may not have visual symptoms so it is important to get your eyes checked out if you are taking the medication AND to also communicate with your doctor if you're having any side effects while on any medication to make your life as comfortable as possible.

Take care,
Dr. Weaver

Six months in the making...keeping it current...Groupon...thank you's!

Hello,

On July 2, 2011, Weaver Eye Care Associates will have been open six months! Whoo-hoo! And oh my, those six months have gone very quickly!

I've done various things on getting the word out about the practice. Probably the most important method is just doing my eye doctor thing and trying to provide the best customer service that I possibly can. This in turn creates a positive impression on those patients so that they hopefully tell their neighbors, friends and family.

I try to keep things current in my practice:

1) Digital visual acuity charts in the exam room = how many times have you gone to an eye doctor and tried to strain your eyes reading that faded projector screen? This should be the fun part of the exam.

2) Digital photography of the front and the back of your eyes = if there's something peculiar that should be followed, taking a picture is much better that making a drawing or writing a description. The saying "a picture is worth a thousand words" is definitely true. I have a digital camera adapter for my bio-microscope in the exam room and a digital camera conversion on my retinal camera in the back diagnostic testing room. There's no more guessing when it comes to checking things out a year later.

3) No paper charts = everything is going to be electronic at some point or another, it's just a matter of time. That's why I chose electronic medical records software from Practice Director for all of my documentation. I try to stay with the leading edge of things, because technology moves so darn fast, it's easy to lose one's balance and fall behind. I have computers in every room in the office: reception, business office, optical department, the exam room and the diagnostic testing room (okay, I don't have one in the bathroom, but that's self explanatory).

4) The latest styles of frames with good warranty = frame representatives visit my office on a regular basis to keep my frame inventory fresh and lively! New colors, styles and models of men's, women's and children's frames arrive from the various vendors, swapping out what's discontinued and out of warranty. This is done so that when you buy a frame from Weaver Eye Care Associates, you're buying a frame that's current, unlike buying online from vendors with shoddy materials and poor workmanship.

I also try to keep things current in my promotion:

1) Blog, blog, blog = I don't blog to the point where it's annoying and I only write when I have something to write about. I try to keep existing patients and (hopefully) soon-to-be patients informed with news about my new practice and anything related to the eye (see previous posts). I enjoy writing, and probably would have been a writer if I hadn't done the optometry thing. But at least I can get my writing fix while supporting the career that I love to do: optometry.

2) Facebook, Twitter, MySpace = MySpace not so much anymore, since most people these days are on Facebook and Twitter. I post links on Facebook and Twitter whenever I have a new blog post, or whenever there is just something exciting happening with the practice. Like when Kaylee was helping me set up the frame boards when I first opened, I posted pictures on Facebook documenting the event. Or as progress occurred with the build-out between September and December last year, I posted pictures of that as well.

3) Practice Website = Personally, I don't go to a business if they don't have a website. I just like to know about the place when I visit there or buy something from there. I thought it important to have a pretty comprehensive website to describe who I am, what I do and what I have to offer.

4) Groupon = Groupon seems to be the next best thing out there right now for small business and consumers. Groupon will be featuring my practice (with a pretty slick write-up, I may add) on Thursday June 30th...two days from now! I'll be checking the discussion boards on the Weaver Eye Care Associates feature page to answer any questions you may have about the deal. I don't want to reveal anything about the deal, but all I have to say is this: if you haven't visited the practice for an eye exam and glasses yet, I strongly suggest that you check out the feature. It will be the best deal around...for a long, long, long while!

I've promoted by traditional methods as well: newspapers ads, direct mail postcards, and yellow pages (coming later 2011, missed the cut for the 2010 book). I've also been trying to hand out my business cards like crazy and get to know as many people in the area as I can.

The practice will only get busier, so have many thanks to hand out! (Sorry, if this sounds like an award speech. At least I won't get cut off by an orchestra if I go to long...)

First, big thanks to the Man Upstairs for giving me the courage to do this and making all things possible.

A close second to the many current patients of the practice who was curious enough to check out the practice. I truly appreciate your business and thank you for your support.

Big thanks to my wife, Laura, for supporting me in taking the plunge with opening a brand new business and enduring this adventure together. Laura helped me out with the wall colors, carpeting and tiles, since I'm pretty useless when it comes to color coordination (yes, she picks out my shirt and tie combos as well). :) And Kaylee for keeping things interesting and entertaining at the practice.

Another big thanks to my parents and Laura's parents for their unending support, as well as watching Kaylee many, many times when I have meetings and work-related things to do.

Also, another thanks to the band-mates, Derek and Tim for giving me the time to get things settled. We're recording in the studio right now and if all goes well, the band will be doing shows soon afterwards once the mania settles down a bit.

Thanks to Kim, the lovely Weaver Eye Care Associates receptionist, for treating patients with respect, for staying on task during the slow times and the crazy times, and learning just as much as I am with insurances and all of that other "fun" stuff.

And many other thanks:

George H. Longenecker's and Sons = the fine craftmanship on the build-out and setting up the optical and reception furniture

EyeDesigns = designing the office space and the awesome craftmanship on the frame displays, dispensing desk and reception desk

Three Rivers Optical and Zeiss Lab Kentucky = for their excellent optical work and warranty on all of my eyeglass orders

ClearVision, Modern Optical, Europa International, Silhouette, Live Eyewear and Bushnell = for their wide array of stylish frames, sunglasses and clip-ons

Vision Systems Inc. = for all of their awesome equipment that I needed to open up shop

Practice Director = for the electronic medical records and practice management software, and their excellent customer service and technical support

PC Ninja = Mel for hooking up the network, computers, phone system, printers, security and back-up. Awesome work, man!

Wells Fargo = for the business loan capital to get things off the ground. (Although, you should be thanking me for all of the interest.)

And to anyone that I may have missed, thank you to all...and to all a goodnight!

Sincerely,
Dr. Weaver

Ps. Don't forget the Groupon...

UV is bad.

Hello everyone,

Summertime is upon us. The weather is warming up. I remember myself squinting for the longest time when the rainy and cloudy days of April and May gave way to the sunshine days of summer.

And with the summer is more time outdoors. Hopefully, when you spend some time out in the sun, you lather up the SPF 500 so that you skin doesn't fall off when you get older. It's also important to protect your eyes from the harmful UV rays as well.

The UV can affect the front, the inside AND the back of your eye.

The front: For those who do a lot of fishing or boating, spending numerous hours on the water can cause a lot of reflected glare from the water's surface. This can actually cause a sunburn on the cornea (similar to a welder's flash) and can be very painful. The skin around the eye is very thin and sensitive, and very prone to damage from the sun's rays.

The inside: There is a lens inside each eye and as everyone gets older, this lens can develop a cataract of varying degrees. Some studies have shown that UV radiation can accelerate the formation of cataract growth.

The back: Have you ever heard of macular degeneration? (If not, see my previous blog post.) Well, not only is getting older and smoking increase your risk of getting the disease, but so is UV exposure. Your eyes focus all the light that enters your eye onto the macula to allow you to see. So if you're getting years and years of UV light getting in there as well, it's going to cause some toxic damage to the sensitive retinal tissue in the back of your eyes.

So what should you do about all of this? Well, for starters, wear SUNGLASSES for cryin' out loud, but not just any old sunglasses. Make sure they provide 100% UV protection AND make sure they are polarized. The polarization will provide the most comfortable vision by reducing reflective glare off of road surfaces, other automobiles, snow, water, your wet dog...you get the idea.

People who wear contact lenses should have the polarized UV sunglasses to protect the eyes. However, what about those who don't wear contacts? Certain materials and certain eyeglass lens options have UV protection built-in to that feature: the ultra-thin lenses (Hi Index) do this, Transition lenses (change from dark to light to dark) do this, polycarbonate lenses (the most shatter-resistant lenses) do this. If you feel you don't need any of these features, you can get a UV coating applied to your eyeglasses to protect your eyes. Also, clip-on lenses (to convert your regular glasses to sunglasses) are typically polarized and provide 100% UV protection as well.

(NOTE: We just got the customized Cocoon Clip-On lenses in the office. Make sure to stop by the office to check them out. Only $34.95 to convert your regular glasses to kickin' suns!)

So, make sure your eyes are protected from the UV, which we all know is bad. And if you need a customized recommendation, make sure to visit your local, friendly optometrist. :)

Take care,
Dr. Weaver

My Eyes are on Fire!

Hello everyone,

Yup! It's that time of year again: allergy season! Hooray! Don't you just love the itching, coughing, congestion, sinus pressure, tearing, headache, malaise, sniffling that happens this time of year? Isn't it just wonderful?

Well, I hope that you can tell the previous paragraph was pure sarcasm. Allergies stink! I suffer from it. My wife suffers from it. And most of you suffer from it as well. I've heard from many people this year who don't get allergies who are experiencing allergy symptoms for the first time ever!

Every allergy season feels like it's the worst ever, since the memory of the previous season is difficult to remember (or it was so bad you blocked it from your mind). But this year with warm temperatures, and an insane amount of rain, this year's allergy season is longer and more robust! So it may actually be the worst ever!

If you take oral allergy medication (OTC or Rx), it's important to start taking it before the season starts. Yes, I know that advice is a little too late for this year, but getting your body ready for the influx of allergens and pollen is important to minimize your reaction to the particles floating in the air into your nostrils.

The thing with oral allergy medications is that one of their main side effects is eye dryness. So, while you're thinking that taking your allergy medication is helping your eyes, it's probably not. The dryness can exacerbate the itching, watering and redness, making you miserable.

And wearing contact lenses? Forget it! Wear them on a minimal basis during this troubling time of the year, or switch to daily disposable lenses to minimize the build-up on allergens on the lenses from day to day.

The key thing to getting eye relief is to get some medication right on the eyes...and getting the RIGHT medication on the eyes. Over-the-counter eye drops can be absolutely fine if you know which ones to use. For my patients, when I examine them and determine they are suffering from ocular allergies, my recommendation is typically Alaway (Bausch & Lomb) or Zaditor (Novartis). These drops contain both an anti-histamine AND a mast cell stabilizer. These components are the BIG GUNS when it comes to kicking butt in the allergy department. Both of these brands are used two times a day, and I usually say to use them right when the patient wakes up and at night shortly before going to bed. The drops then can be used as needed once the allergy symptoms are under control.

I'm not a fan of the Clear Eyes by Visine. It contains only naphazoline, which is a decongestant that constricts the blood vessels to reduce the redness appearance. It's helpful, and sometimes a vasoconstrictor is beneficial, but when it comes to allergies, having an anti-histamine AND a mast cell stabilizer is typically the best option, which is why I prefer Alaway and Zaditor.

Naphcon-A and Opcon-A are other drops that may work well. These drops are used four times a day. They contain naphazoline, but they also contain an anti-histamine. In this case, the decongestant works well with anti-histamine to provide allergy relief and are a good option if Alaway and Zaditor are unavailable.

There are two drainage ducts in each eye close to the nose. The ducts are pathways that drain your natural tears and any eyedrops from your eyes through your nasal passage to the back of your throat. So taking an allergy eyedrop may not only be good for your eyes, but if you're suffering from sinus congestion, allowing the allergy eyedrops to run through this drainage system may cause direct relief of the sinus symptoms as well.

Now, if all of this over-the-counter business isn't helping out, then some prescription options are in order. After a visit to your local optometrist (hint, hint), he will be able to assess the allergy situation and cater all of the options to your specific needs. Sometimes, steroid eyedrops are recommended to suppress the inflammation, which allows the anti-histamine and mast cell stabilizers to be more effective.

Although this is common sense to most people, I must leave the disclaimer that this blog post is not a substitute for an eye exam. It's just some helpful and friendly advice to get you through the allergy season this year. However, my recommendation is to see an optometrist if you are suffering from any eye problems so that the cause of your problems can be determine and treated most effectively.

Best regards,
Dr. Weaver

Golf Fore-ever! May 7, 2011 Golf Tourney Results...

Hello,

Those who know me can attest to my love for the game of golf. I've been playing the sport (yes, it's a sport) since I was five-years-old. My dad sawed off some old clubs, put them in a little golf bag and took me out to Indian Mountain Golf Course, a local 9-hole public course in Kresgeville, PA that was my "home course" for most of my life. My dad would take me out on late weekday afternoons for 4 holes, and then later 9 holes and 18 holes as I got older.

I remember taking golf lessons only a couple of times. I remember playing in the Henry Moyer Junior Golf Tournament a few times at the Mahoning Valley Country Club, and winning a few (I still have the hardware to prove it, too). I ever remember the video footage from the Blue Ridge cable news (channel 13) from their coverage, and the announcer saying about my swing "He looks like a dapper Bobby Jones," which he probably wouldn't have said if he saw the actual ball flight (video camera = nervousness = shankasaurus).

I've played competitively at the high school and college levels. My swing is a work in progress, taking information from reading books on golf (Harvey Penick) and watching the pros on TV. My swing has modified as I've grown older and wiser, because when I was younger, I just thought about hitting the ball, which is probably why I didn't play as good then as I am now. (I still shot in the 70's in high school and college, but not consistantly.) I'm a "feel" player, meaning I don't really worry about the technical stuff. I have a few things that I think about now: shorter stance, strong grip, keep the left arm straight on the takeaway, make good contact and swing down the line where I'm aiming.

If I didn't do optometry, I always wondered the result of going the professional golf route. But then I realize I probably wouldn't think it as fun as I do now, and my back probably wouldn't have held up for this long, either.

So when I do feel competitive and want to have fun, I look for local scramble golf tournaments in which to play. Yesterday (which was a gorgeous day), I played in the Rehrersburg Lion's Club Annual Golf Tournament at Green Acres Golf Course. Not only did I play in the event, but I sponsored a tee, #15:

It was my first time playing in the event, and it was well-organized! Plenty of food, soda, beer and snacks! I even got to place some Weaver Eye Care Associates pens and magnets in the goodie bags for everyone to take home, so I'm hoping that helps get the word out about the practice. Thanks to Derek DeLong, Jim Yost and my dad for making up our group for the tourney.

So, after 18 holes of club swinging, our team placed in Second!!! We were only 1 stroke behind the winners, and we account that to a bad hole on number 6. We had a bogey, which is a major no-no in a 4-person scramble. Despite that, we hung together and finished the round.

My tee shot on the Par 3 #2 landed just a few inches outside of the Pot o' Gold hole. However, I did win closest to the pin on that hole, since no one landed inside the five-foot radius circle the whole tourney. Jim and I also won some non-skill prizes from the raffle afterwards.

It was a great day, and we're all planning on playing in the tournament next year. So, thank you to Green Acres Golf Course for having a wonderful site for a scramble golf tournament. And a big THANK YOU to the Rehrersburg Lion's Club, who will use the proceeds to benefit individuals with vision care needs, the blind and the maintenance of the park in Rehrersburg. Hoping to win it next year...

Dr. Weaver

Cataracts LESS LIKELY in those who eat their veggies

Hello everyone,

When I was a young lad, my mom would ALWAYS tell me to eat my vegetables. I'm certain that I wasn't the only one who has received this constant advice. However, I was notorious for shunning whatever vegetable I was served. Whether it was green beans or a medley of corn, carrots and lima beans (ugh!), the vegetable portion always ended up as a cold pile of food at the edge of my plate, at the furthermost position from my mouth.

I guess my mom was onto something. There's a report on WebMD that says "people who eat meat may be at increased risk of developing cataracts compared to vegetarians," according to a study in the American Journal of Clinical Nutrition.

For the study, they divided the people into groups according to how much meat they ate.

Highest meat consumption: 3.5 ounces or more a day

Mid-range meat consumption: 1.7 to 3.4 ounces a day

Low-meat consumption: less than 1.7 ounces a day

Fish eaters: Those who ate fish but not meat

Vegetarians: Those who did not eat meat or fish but did eat dairy products and/or eggs

Vegans: Those who did not eat meat, fish, dairy products, or eggs.

And the results? The researchers found that "mid-range meat eaters had a decreased cataract risk of 4%, low-meat eaters 15%, fish eaters 21%, vegetarians 30%, and vegans 40%."

When I see a patient that has a cataract and I bring it to their attention, some patients ask if there's anything they could do about it. If you weren't aware, other risk factors for increasing the risk of developing cataracts include smoking, diabetes and UV exposure. Now, I would mention eat more vegetables/cut out red meats to the list.

Now that I'm older, I'm much better at eating vegetables. But lima beans are still UGH!

Dr. Weaver

Gut check! Increased waistline = higher risk of macular degeneration?

Hello everyone,

There are always an assortment of studies that you hear about in the news. Beer is good for me. Really? Caffeine increases my lifespan. Really? Sleeping more than 10 hours is bad for me. Really? Chocolate makes me strong like Superman? Okay, that last one may be believable...

And then you hear the studies that give you the opposite opinion, as well. So, how can you believe anything that you hear in the news? This brings me to the article that I just read, saying how if you have a big belly you are more likely to go blind from macular degeneration. REALLY?!

The UK's Daily Mail website said that "an expanding waistline puts men in danger of developing age-related macular degeneration (AMD)." After monitoring "changes in the waistlines of more than 21,000 men and women, aged between 40 and 69, over several years," then following the study population to determine how many cases of AMD developed, Australian researchers discovered that "even small increases in waist size seem to raise the risk of AMD by up to 75 per cent" in men. Women do not seem to be affected, however.

It is an actual study in the American Journal of Epidemiology. Their efforts were to try and show a correlation between obesity and developing macular degeneration. In my previous blog post, you should be aware that smoking is a risk factor. Increasing age, light-haired/light-skinned individuals and UV exposure are all risk factors as well.

What you also learned from the Smoking = Macular Degeneration post is that if a patient is told to have signs of macular degeneration, the patient is usually monitored and/or started on a multi-vitamin using minerals and vitamins investigated in AREDS (Age-Related Eye Disease Study) in the early stages of AMD. On a separate note, previous studies show that increased waist size is also a good predictor of having a stroke.

So what does all this mean? To me, it sounds like it all comes down to having a good diet and maintaining an active lifestyle. If you eat right and stay in shape, your body gets the correct nutrients it needs, which helps with the slimmer waistline. Your eyes get the components they need (leafy green vegetables are an eye's best friend). Exercising gets the juices flowing to burn the fat that tends to collect in the belly zone of men.

So, now that winter is behind us (hopefully), get out of hibernation mode and into active mode. Your eyes and belly will thank you for it.

Take care,
Dr. Weaver