General health and fitness

Medications—prescription and non-prescription

Chronic diseases

Allergies/sensitivities

Age

Gender

Family history

Race, ethnicity, and demographic characteristics that are associated with increased risk (eg, African Americans, Hispanics, and Pima Indians are at increased risk for diabetes and retinopathy)

Income

Access to healthcare

Educational background

Access to information

Medical history

Environment (including everything from climate and geographic locale that may result in heightened ultraviolet radiation [UVR] exposure to indoor lighting that may produce eyestrain)

…As Well as Just About Everything YOU DO, Including:

Occupation

Workplace environment

Computer use

Sports and recreational activities

Diet and nutrition

Exercise

Smoking (or choosing not to smoke)

Alcohol consumption

Clothing choices

Eyewear choices

DOMIANO EYE CARE:  570-451-2020  * 570-288-2020

There are two kinds of tears: constant (or basal) tears, which are complicated, and reflex tears, which are simpler.  We will deal with the complicated ones as we discuss dry eye treatments.

Constant tears are the kind your eyes are constantly producing without your being aware of it and which keep most people’s eyes reasonably well coated throughout the day and night. They are complex. Reflex tears are simpler and more watery, the type that your eyes produce in large quantities if you get grit in your eyes.  We will deal with the Complex tears.

Regarding constant tears, there are four [4] basic tear components you should know about: oily stuff, watery stuff, sticky stuff, and other stuff.

A.  Oily stuff (lipids)

Did you ever hear that oil floats on water?  That’s true.  The lipid layer is oily stuff that sits on top of your tears. It is made by your meibomian glands, glands sitting in both your lower and upper eyelids. The purpose of the lipids is that they keep the watery part of your tears from evaporating. If you think about it, that’s a good thing. Suppose you’ve got lots of tears, but no lipids, well, your tears will evaporate and your eyes get dry. Fine, your eyes will (well, for most of you anyway) just keep making more tears, but what happens if your tears are evaporating faster than you can make new ones? Big problem. That is the problem, or rather one of the problems, that a lot of us have. In fact, if you don’t seem to have a problem with the watery stuff but still have classic “dry eye” symptoms, this is almost certainly a big part of your problem.

The main reason you might not have enough oily stuff (lipids) is that those meibomian glands, the things that make it, get clogged. The oil is supposed to be nice and warm and runny, but sometimes it can get thick and gets stuck. This can often be improved, but may well be chronic requiring regular treatment. Lid therapy – particularly heat treatment – helps deal with this by first kind of melting the stuff that’s thickened up, then gently squeezing it out. Some oral antibiotics such as doxycycline can sometimes help too. Some nutritional supplements such as flaxseed oil may be useful as well.

B.  Watery stuff (aqueous)

This is the main part of your tears. It’s secreted by the lacrimal glands. You either make enough, or you don’t. If you don’t, this is a problem – the closest thing to true “dry eye” that there is. If you don’t have enough tears of your own, usually you’ll be told to add some fake tears (artificial tear supplements) or, if you’re so dry that you’re adding tears all day long, you’ll probably be given tiny little plugs in the little holes your tears drain out through, so that you can trap the tears you have in your eyes as long as possible. If those work really well, some people burn the holes shut so they don’t have to worry about the plugs falling out (cautery). And if that’s not enough, well, first you need to make sure you haven’t got any of the Other Problems or that if you have, you’re treating them. And if that’s not enough, and you’re completely miserable, there are always more types of treatments to look into.

Now, if you don’t have enough of this watery stuff, AND you don’t have enough lipids to help you keep the small amount of watery stuff your lacrimal glands can be persuaded to actually produce from evaporating as fast as it’s made, then you’ve got an Even Bigger Problem, and you need to address both problems separately.

C.  Sticky stuff (mucins)

The mucin layer is to make your eyes wet.  “But if I have tears in my eyes, doesn’t that, well, by definition, sort of mean that they are wet?”  No. For example: Look at your car when it’s drizzling outside. Could you swear that the entire surface is coated with water? Look carefully. No?  Many things don’t actually stay 100% wet across their entire surface for very long at all.  Porous things that soak up water, fine, but smooth things, well, that’s a little harder.  So the watery stuff (aqueous) sits on top of the sticky stuff (mucin), which serves to glue down the watery stuff as long as possible. Where mucin goes aqueous will follow. Where mucin doesn’t go, well, that’s going to be dry. And unprotected, because that’s the other job of the mucins, standing between your corneas and a world of bacteria.

D.  Other stuff

There’s all kinds of other stuff in your natural tears, like Substance P and lyposomes and other goodies that nourish the surface of the eye (the epithelium) and kill bugs. It’s good stuff. The more of it, the better. In fact, unless you are truly and totally dry (meaning you haven’t got anywhere near enough Watery Stuff), we think maybe the fewer of those fake tears you use, the better, because they might just wash all this good stuff out of your tears.

The Dry Eye Center at Domiano Eye Care:  www.domianoeyecare.com

The tear film is a layer of substances secreted by glands around the eyes and intended to keep the eye surfaces constantly lubricated.

Here are some of the main reasons we have tears:

1) Tears protect the eye. Whilst we hate to state the obvious, they keep your eyes wet. But why would you want wet eyes? First, they’re more comfortable that way – especially if you expect to be able to blink. Second, your corneas are built to expect a wet surface and they’d get really unhappy without it. In fact, if your eyes get too dry you will develop erosions, abrasions and even ulcers and scarring on your eyes. Some of you have experienced that and you know exactly how unpleasant it is.

2) Tears provide all kinds of proteins and nutrients for the eye. You could say they nourish the eye. That is a Good Thing. You want as much of that nourishment as you can get.

3) Tears refract light. That’s a fancy way of saying that they do the same kind of thing that your glasses do – they help bend the light on its way to the back of your eye (the retina) so that you can see nice and sharp images. So, if you don’t have the tears you need, you might not be seeing nice, sharp images… and vice versa.

Do you have dry eyes? We have solutions!  www.domianoeyecare.com

1) A painful, life-changing chronic disease.

2) One of many misnomers (which include dry eye, dry eyes, chronic dry eye, and dry eye disease) for ocular surface disease.

3) A convenient but inaccurate catchall term for all the deficiencies and abnormalities of the “pre-ocular tear film”.

Dr. Michele Domiano is the leader in Northeast Pennsylvania for the diagnosis and treatment of Dry Eye Syndrome.  www.domianoeyecare.com

What is dry eye?
Dry eye describes eyes that do not  produce enough tears.  The natural tears that your eyes produce are  composed of three layers:

• The outer oily layer, which prevents or slows evaporation of the  tear film;
• The middle watery layer; which moisturizes and nourishes the  front surface of the eye;
• The inner mucus layer, which helps maintain a stable tear film.

Dry eye may occur because the volume of tears produced is inadequate  (we all produce fewer tears as we get older, and in some cases this can  lead to dry eye symptoms). It may result because the composition of the  tears has changed so that they are unstable and evaporate more quickly.

What causes dry eye?
Dry eye symptoms can result from the  normal aging process. Exposure to environmental conditions, as well as  medications, such as antihistamines, oral contraceptives or  anti-depressants, can contribute to the symptoms of dry eye. Or, dry eye  can result from chemical or thermal burns to the eye. Dry eye may also  be symptomatic of general health problems or other diseases. For  example, people with arthritis are more prone to dry eye.

Will dry eye harm my eyes?
If untreated, it can. Excessive  dry eye can damage tissue and possibly scar the cornea at the front of  your eye, impairing vision. Dry eye can make contact lens wear more  difficult since tears may be inadequate to keep the lenses wet and  lubricated. This can lead to irritation and a greater chance of eye  infection. Therefore, it is important to follow the recommended  treatment plan.

How is it diagnosed?
During the examination, you will be  asked about your general health, use of medications, and work and home  environments to determine factors, which may be contributing to dry eye  symptoms. This information will help decide whether to perform specific  dry eye tests.

To test for dry eye, diagnostic instruments that allow a highly  magnified view of your eyes or small strips of paper or thread and  special dyes to assess the quantity and quality of the tears may also be  used.

How is it treated?
Dry eye cannot be cured, but your eyes’  sensitivity can be lessened and measures taken so your eyes remain  healthy. The most frequent method of treatment is the use of artificial  tears or tear substitutes. For more severe dry eye, ointment can be  used, especially at bedtime. In some cases, small plugs may be inserted  in the corner of the eyelids to slow drainage and loss of tears.

To keep dry eye symptoms in check, you and Dr. Domiano need to work together. If you have increased dryness or redness that is not  relieved by the prescribed treatment, let us know as soon as possible.

Most parents load their children up with spf 50 or spf 100 sunscreen before spending time out in the sun, but seven out of 10 parents are forgetting an important step in protecting their kids from the sun’s rays.

Protecting your child’s eyes with sunglasses when out in the sun is a crucial part of preventing permanent damage.

Ultraviolet damage from UVA and UVB rays can lead to a number of health issues for your eyes, including cataracts, macular degeneration and eye skin cancer.

The majority of UV damage that happens to human beings happens before our 18th birthday.

So now is the time to start protecting your child’s eyes with some shades.  In fact, real cool
shades.

1.      Soreness of the eyes

2       Mild tearing or dryness

3.      Blurring of vision

4.      Soreness of the back of the neck

5.      Doubling of vision

6.      Light sensitivity

7.      Difficulty focusing on images

8.      Tightness of the temples or back of the head

9.      Combinations of all of the above

** Headache is the most common symptom. It is usually mild, located in both temples, not pounding, and often relieved by stopping the visual task.

          Call us to see how Dr. Domiano can help relieve your symptoms:  451-2020 or 288-2020.

     The term eye strain is frequently used by people to describe a group of symptoms which are related to use of the eyes.  Eye strain is a symptom, not an eye disease.  Eye strain occurs when your eyes get tired from intense use, such as driving a car for extended periods, reading, or working at the computer.  If you have any eye discomfort caused by looking at something for a long time, you can call it eye strain.

     Although eye strain can be annoying, it usually is not serious and goes away once you rest your eyes. In some cases, signs and symptoms of eye strain are a sign of an underlying eye condition that needs treatment.  Although you may not be able to change the nature of your job or all the factors that can cause eye strain, you can take steps to reduce eye strain.  Contact us to discuss your options.

A.   Eyeglasses

B.   Contact Lenses

C.   Orthokeratology

D.   Laser and other refractive surgery procedures

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A.  Eyeglasses

     Eyeglasses are a common form of correction for persons with astigmatism and we see this everyday at Domiano Eye Care.

     Eyeglasses are the primary choice of correction for persons with astigmatism. They will contain a special cylindrical lens prescription to compensate for the astigmatism. This provides for additional lens power in only specific meridians of the lens. An example of a prescription for astigmatism for one eye would be -1.00 -1.25 X 180. The middle number (-1.25) is the lens power for correction of the astigmatism. The “X 180″ designates the placement (axis) of the lens power. The first number (-1.00) indicates that this prescription also includes a correction for nearsightedness in addition to astigmatism.

     Generally, a single vision lens is prescribed to provide clear vision at all distances. However, for patients over about age 40 who have the condition called presbyopia, a bifocal or progressive addition lens may be needed. These provide different lens powers to see clearly in the distance and to focus effectively for near vision work.

     A wide variety of lens types and frame designs are now available for patients of all ages. Eyeglasses are no longer just a medical device that provides needed vision correction. Eyeglass frames are available in a many shapes, sizes, colors and materials that not only allow for correction of vision, but also enhance appearance.

B.  Contact Lenses

     For some individuals, contact lenses can offer better vision than eyeglasses. They may provide clearer vision and a wider field of view. However, since contact lenses are worn directly on the eyes, they require regular cleaning and care to safeguard eye health.

     Soft contact lenses conform to the shape of the eye, therefore standard soft lenses may not be effective in correcting astigmatism. However, special toric soft contact lenses are available to provide a correction for many types of astigmatism. Because rigid gas permeable contact lenses maintain their regular shape while on the cornea, they offer an effective way to compensate for the corneas irregular shape and improve vision for persons with astigmatism and other refractive errors.

C.   Ortho-K

     Orthokeratology (Ortho-K) involves the fitting of a series of rigid contact lenses to reshape the cornea, the front outer cover of the eye. The contact lenses are worn for limited periods, such as overnight, and then removed. Persons with moderate amounts of astigmatism may be able to temporarily obtain clear vision without lenses for most of their daily activities. Orthokeratology does not permanently improve vision and if you stop wearing the retainer lenses, your vision may return to its original condition.

D.   Laser

     Astigmatism can also be corrected by reshaping the cornea using a highly focused laser beam of light. Two commonly used procedures are photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK).

     PRK removes tissue from the superficial and inner layers of the cornea. LASIK does not remove tissue from the surface of the cornea, but only from its inner layer. To do this, a section of outer corneal surface is cut and folded back to expose the inner tissue. Then a laser is used to remove the precise amount of tissue needed and the flap of outer tissue is placed back in position to heal. Both procedures allow light to focus on the retina by altering the shape of the cornea. Dr. Domiano does not perform surgery but does co-manage the pre and post-operative care.

　As you can see individuals with astigmatism have a wide range of options to correct their vision problem. In consultation with Dr. Domiano, you can select the treatment that best meets your visual and lifestyle needs.

 Domiano Eye Care:  Your Boutique for  Forward  Fashion Eyewear

     Visual acuity - As part of the testing, you’ll be asked to read letters on a distance chart. This test measures visual acuity, which is written as a fraction such as 20/40. The top number is the standard distance at which testing is done, twenty feet. The bottom number is the smallest letter size you were able to read. A person with 20/40 visual acuity would have to get within 20 feet of a letter that should be seen at forty feet in order to see it clearly. Normal distance visual acuity is 20/20.

     Keratometry - A keratometer is the primary instrument used to measure the curvature of the cornea. By focusing a circle of light on the cornea and measuring its reflection, it is possible to determine the exact curvature of the cornea’s surface. This measurement is particularly critical in determining the proper fit for contact lenses. A more sophisticated procedure called corneal topography may be performed in some cases to provide even more detail of the shape of the cornea.

     Refraction - Using an instrument called a phoropter, Dr. Domiano places a series of lenses in front of your eyes and measures how they focus light. This is performed using a hand held lighted instrument called a retinoscope or an automated instrument that automatically evaluates the focusing power of the eye. The power is then refined by patient’s responses to determine the lenses that allow the clearest vision.

     Using the information obtained from these tests, Dr. Domiano can determine if you have astigmatism. These findings, combined with those of other tests performed, will allow Dr. Domiano to determine the power of any lens correction needed to provide clear, comfortable vision, and discuss options for treatment.