In the Lens: An Interview with Bill Birkemeier

March 11th, 2010

If you’ve been to our practice, you’ve probably noticed all the beautiful nature and scenery photographs hanging on the walls.   In fact, we get compliments and questions about the photos and the artist on almost a daily basis.   Given all the interest, I decided to interview the photographer, Bill Birkemeier, who is also a patient of Clearview Eye Care.    Many of the prints in his online portfolio are hanging in our office.   You could even say Clearview Eye is a working gallery, of sorts, so feel free to stop by our office, grab a cup of coffee and walk the “gallery.”

How would you describe your style of photography?

Well I like the challenge of getting good images of most anything whether it be family snapshots or sweeping vistas, but I most like taking photos of nature and natural landscapes.  I suppose that’s partly because living on the Outer Banks, good subjects are easy to find all the time.

What is your favorite subject to photo?

I like taking photos of birds, they’re ready subjects and very challenging of photographer and equipment.  I take thousands of images of birds and every once in a while I get a good one – the feathers are in focus, the bird has a great expression (and a glint in the eye), the light is right and the composition is interesting.  It doesn’t happen often, but its fun when it does (like hitting a great drive in golf!).  I particularly like black skimmers.  They’re like barnstorming pilots in flight – they charge into the shallow water zooming along, lower beak skimming the water ready to catch an unsuspecting fish – then circling around to do it again.  We’ve watched their acrobatic flights for hours – there’s so much action, birds flying, fish jumping.  There’s a nice skimmer photo in my 2010 calendar and there’s one on my web site.  In the photo I’ve attached is of an immature skimmer in flight with fish jumping all around.  If you look close you can also the wake of the beak streaming out behind.

Of all your prints, do you have one that is your favorite?  Why?


This question is easy.  When I got my first digital SLR and was trying to figure it out, I spent a Saturday morning photographing a pot of shells that sits on our front porc
h.  I used the hose to keep them wet and experimented with different mixes of daylight and flash.  I took a lot of photos, but one image really turned out great.  A good image should draw you in and this one with its colors, texture and shadows one does just that.  It prints well as a 5×7 or a 20×30.  I have a copy on my wall at work and a larger one at home and we have yet to tire of it.  You have one on your shop wall. We’ve also printed it as a greeting card.

Interestingly, since this photo was taken, the shells have bleached out so its become a once in a lifetime image.

In your opinion, what makes the Outer Banks such a great place for the art of photography?

You can catch a sunrise over water in the morning and watch a spectacular over water sunset that evening. Birds galore, dramatic skies, big waves, storms, big vistas, boats, and lighthouses are all great subjects.  Even the classic scenes change during the year – for example when we had a dusting of snow, I was out taking photos I’ve taken before – but the snow provided a fresh look.  Its just a wonderful place to be.

How can people learn more about your portfolio or purchase prints?

Your shop is a great gallery with many of my favorite shots.  Its nice to hear that people are enjoying them.  My website www.inthelens.com has many more images (and not all from the Outer Banks).  We also have a great 2010 calendar and wonderful card and card set which showcase some of my best images.  If you see something you like, send me an email at bill@inthelens.com

Corneal Topography: Why it’s Important

March 4th, 2010

Corneal topography provides the most detailed information possible about the curvature of the cornea.  Using a very sophisticated computer and software, thousands of measurement scans are taken and analyzed in just seconds.  Then, the topographer generates a color map from the data.

The map is interpreted just like any other topography map.  The cool shades of blue and green represent flatter areas of the cornea, while the warmer shades of orange and red represent steeper areas.  This corneal map allows the physician to formulate a “3-D” perspective of the cornea’s shape.    In the following “normal” topography, you can see that the color gradient is very gradual over the whole surface of the cornea.   This patient’s eye is very round, like a basketball, and has very little astigmatism.

Why is topography important?

It helps your optometrist formulate a complete assessment of your astigmatism.   This is important in the fitting of contact lenses.  At Clearview Eye Care, we perform topography on every one of our contact lens patients.   It can aid in the selection of the appropriate contact lenses.

Patients with astigmatism may not be good candidates for certain contact lenses, and they may achieve better vision with special contacts based on the shape indicated in the topography readings.    The following patient has significant astigmatism.  Compare this picture to the “normal” topography above and you’ll see that there is a difference in the curvature of the eye, especially in the 12 o’clock to 6 o’clock meridian:

Corneal topography is also important because it can detetct irregularities in the cornea due to a disease called keratoconus.   This condition is a progressive thinning of the cornea which causes a cone-like steeping on the surface of the eye.     Corneal topography is the best way to help diagnose and map out the severity of keratoconus.  It’s also the best way to monitor progression or worsening of the condition.   Look at the following topography of a patient with keratoconus:

Keratoconus is a whole topic in itself that we’ll get to soon in another blog post, but you can see there is a big difference between this topography map and the “normal” one above.   As always, if you have any questions or comments, feel free to post them or email them our way.

Lasik Consult: An Interview with Dr. Steve Scoper

March 4th, 2010

For several years, I’ve had the opportunity to work with one of Hampton Road’s premier refractive surgeons, Dr. Steve Scoper,  in the care of many patients.   I recently interviewed Dr. Scoper in order to share some very useful information to patients wanting to learn more about Lasik refractive surgery.

Tell us a little about your educational and training background with respect to the cornea and refractive surgery?

My name is Steve Scoper, M.D. and I am the cataract and refractive surgeon at Virginia Eye Consultants in Norfolk, Va.  I attended medical school at the University of Mississippi Medical Center, and my ophthalmology residency at Tulane Medical Center in New Orleans, La.  Upon completion of my residency, I pursued advanced training through a Fellowship in Cornea, External Disease, and Keratorefractive Surgery at the Dean A. McGee Eye Institute at the University of Oklahoma Health Sciences Center.

Is every patient a good candidate for Lasik?

Not every patient is a good candidate for Lasik eye surgery.  Therefore, it is important to discuss Lasik with your optometrist who will educate you on the Lasik procedure and tell you if they feel you are potentially a good candidate.  If you are a good candidate, they will refer you to our center to receive further testing to determine your candidacy.

How has Lasik refractive surgery changed to benefit patients over the last 10 years?

Lasik surgery is one of the most sought after elective surgery procedures providing patients with an improved quality of vision.  In the last ten years, Lasik technology has continuously advanced to address previous post-operative issues such as glare and haloes.  At Virginia Eye Consultants, we provide only All-Laser Lasik surgery.  We utilize the Intralase technology which creates a precise corneal flap while improving the safety of the procedure.  Our Allegretto laser platform provides patients with a customized procedure resulting in excellent quality of vision.

What is a popular misconception about Lasik that you encounter in your practice?

One popular misconception that is often encountered in a Lasik practice would be the need for reading glasses after the surgery.  Patients often seek Lasik eye surgery to improve their distance vision and to reduce their dependency on glasses or contact lenses.  However after the age of 40, a condition called presbyopia occurs in which our eyes lose their ability to focus on objects up close.  When presbyopia occurs, the optometrist can prescribe reading glasses to help address your near vision needs.

Does Lasik surgery hurt during or after the procedure?

Overall, patients are quite comfortable during and after the Lasik surgery procedure.  Prior to the surgery, patients are given sedatives to relax them and topical anaesthetics are used during the procedure to control pain.  Postoperatively, patients are given antibiotic drops, anti-inflammatory drops, tear substitutes and eye shields to prevent eye rubbing.

How long of a recovery can be expected after Lasik Surgery?

Typically, patients recover quickly after Lasik surgery with many returning to work the very next day with great vision.  After the surgery, patients are given post-operative instructions which include what drops are required, how often to use them, and information on what is normal and abnormal after the surgery.  The full recovery period takes between 6-12 months after the surgery, followed by yearly comprehensive vision.

What can patients do to help ensure optimal vision following surgery?

To ensure optimal vision, patients need to make sure that they follow all post-operative instructions and examinations to ensure proper healing.  The typical post-operative schedule would be one day, one week, one month, three months and six month visits.  At each of these visits, your optometrist will monitor your progress and check your vision and ocular surface.  If you are in need of a touch-up procedure (enhancement), this is included in the initial cost of your procedure.  Approximately 5%-10% of our patients will require an enhancement due to individual healing factors.

If someone is interested in Lasik, what is the next step?

The first step for LASIK surgery will be to see your optometrist who will be able to tell you if they feel that you’re a good candidate for surgery.  Optometrists play an integral role with LASIK surgery by providing patient education, setting realistic expectations, pre-operative care and post-operative care.  If you are a potential good candidate, your optometrist will refer you to get a Lasik screening.  During the screening, patients are educated about the Lasik procedure and told whether or not they are a great candidate.

CEC’s Mad March to 2000–His/Her Sunglasses Giveaway

March 2nd, 2010

Mad March to 2000–His & Her Sunglasses Giveaway

We’re on a mission to have the largest fan page of any eye care practice on Facebook!

Help us reach 2000 fans by March 31, 2010 and we’ll chose one winner to receive a pair of His AND Her Sunglasses (Coach, Enni Marco, or Lacoste for the women and Michael Kors, Enni Marco, or Nike for the men).

We’ll only select a winner if 2000 fans are reached by March 31st, so become a fan and invite your facebook friends to become a fan as well 

Medication Side Effects Review: Amiodarone

March 1st, 2010

Amiodarone

Last week, a patient requested that I bring up this medication for my next ‘Medications Review.’  Amiodarone is given to treat cardiac arrhythmia, often when other medications have proved ineffective in controlling the condition.

Patients taking amiodarone are advised to have annual, and sometimes more frequent eye exams, because of several side effects the medication may have on the eyes.

For example, amiodarone may cause “vortex keratopathy.”   This side effect is seen as a swirling pattern of white deposits in the cornea.   This finding may or may not effect vision, and has been shown to resolve when the medication is stopped.

Another potential side effect is cataracts, which may cause a blurriness in vision as well as glare or halo effects when looking at lights.

Some patients taking amiodarone also experience changes in their perception of color.    This may be the result of the drug’s effect on the optic nerve.

Frequent eye examinations will allow your optometrist to diagnose these side effects and communicate with your primary care physician.   From there, the severity of the ocular side effects can be weighed against the cardiac benefits of taking amiodarone.    If you are someone you know is taking amiodarone for arrhythmia, please see your optometrist and let them know you are taking this medication.    As always, please feel free to send any questions or comments to doctor@clearvieweye.net

Vitamin & Nutrition Corner: Lutein

February 21st, 2010

Lutein:  A Vital Antioxidant for Eye Health

After speaking last month about Vitamin A’s antioxidant protection in Macular Degeneration, Lutein is a great follow-up.   Lutein is a type of carotenoid, which is a natural pigment in vegetables and fruits.  Just like beta-carotene and Vitamin A, Lutein serves as a powerful antioxidant within your eyes and protects against the free-radical damage of aging and the sun.   In fact, Lutein has become a star within eye care’s discussion of nutrition in the management of Macular Degeneration.

The macula area of the retina is responsible for your fine, central vision.   And it’s interesting that of the 600 naturally occurring types of carotenoids, only two are found concentrated in the macula area of your retina:   Lutein and Zeaxanthin.   Intake of Lutein has been shown to increase the density of pigment cells within the macula, thus protecting vision in patients with Macular Degeneration.

Should you still be interested in Lutein if you don’t have Macular Degeneration? Yes!  Think blue light.  The high energy wavelengths of blue light, within the visible spectrum of light, can cause oxidative damage to your cells.   Lutein acts as a natural filter of blue wavelengths of light (not to be confused with ultraviolet or UV light).   Some studies say Lutein may be able to filter up to 90% of these harmful light rays, but keep in mind that 73% of all statistics are made up.   But the point is Lutein can help protect the macula area of your retina, and thus protect fine central vision whether or not you have Macular Degeneration.

Last month, I made special note of the side effects of vitamin overdose.  But Lutein is water-soluble.   Unlike Vitamin A, which is fat-soluble, excess Lutein will be excreted in urine and not build up in your tissues.  Excessive intake is not an issue with Lutein.   The recommended daily dose of Lutein is 6-20 mg.    Spinach is the greatest natural source of Lutein, and a large serving may constitute up to 15-20mg of Lutein.

How much Lutein:

  • The recommended dose is between 6-20 mg per day.

Where to get Lutein:

  • Leafy green vegetables such as spinach, kale, and leafy lettuce
  • spinach, eggs, corn
  • Synthetic vitamin supplements

Benefits of Lutein:

  • Filtering of blue light to protect macula area of retina against oxidative damage from visible light
  • Protect the macula in patients with Macular Degeneration
  • Increase the pigment density in the macula and possibly improve vision
  • May help fight certain types of cataracts
  • May promote favorable results on the thickening of artery walls in atherosclerosis
  • Possibly improve skin hydration

Study Suggests a Link between Alzheimer’s and Untreated Poor Vision in Elderly

February 21st, 2010

A University of Michigan study, soon to be published in the American Journal of Epidemiology, states that “elderly people with visual disorders that are left untreated are significantly more likely to develop Alzheimer’s disease — the most common form of dementia.”

This is interesting because poor vision was typically seen as a symptom of Alzheimer’s rather than a contributing factor to the development of the disease.   The researchers state that older Americans who seek regular eye care are “64% less likely to develop dementia.”

Why?  Proper vision care and proper management of eye diseases help ensure better vision.   And better vision  is a “requirement for many of the activities that previously have been found to lower the risk of Alzheimer’s disease. These include reading, playing board games, other mentally stimulating activities, social networking, as well as physical activity such as walking and routine exercising.”  A visual disorder may interfere with normal mobility and may also hinder a person’s ability to participate in these activities.

If you want to learn more about Alzheimer’s, in general, there was an excellent 4-part series on HBO called the Alzheimer Project.   You can view the documentary for free by clicking on the link below.

Study Finds that Bifocals May Slow Progression of Nearsightedness in Children

February 16th, 2010

Last month, I touched on a recent study that showed a drastic increase in the number of people with myopia (nearsightedness) over the last 30 years in the U.S.    Not only is the number of people with myopia a public health concern, but so is the progression or worsening of myopia experienced by some children throughout their developing years.

In my practice, it is pretty common to see children that need increasingly stronger and stronger prescriptions, and this process can be concerning and frustrating to both the child and parents.

That is why I’m very interested in a recent study published in The Archives of Ophthalmology that demonstrated the use of bifocals with prisms (and bifocals without prisms) significantly slowed the progression of myopia in children.

In the new study, researchers studied 135 Chinese Canadian children who were diagnosed with progressive myopia, meaning myopia that had worsened significantly over the previous year. The children, whose average age was 10, were assigned to wear either single-vision lenses, bifocals or bifocals with prism, a type of correction that is ground into lenses to help the eyes work together and enhance near vision.

After two years, researchers found the progression of myopia was most rapid among those who wore single-vision lenses. The slowest rate of progression was among children who wore prismatic bifocals — a 58% difference in the rate of progression compared to children wearing single-vision lenses. There was a 38% difference in the rate of progression between users of standard bifocals and users of single-vision lenses.

Ask Dr. Beach: Visual ‘Floaters’

February 9th, 2010

Ask Dr. Beach:  “What are these floaters or spots I’ve had in my vision?”

Floating spots or strands within your vision, also known as “floaters,” are a pretty common occurrence and in some cases can be pretty annoying.   Despite the annoyance, floaters are not cause for concern.   However, exceptions do exist and caution should exercised so as to not mistake floaters for other more serious ocular health risks.

Most often, you may see floaters as clear, translucent, or hazy strands or dots in your vision.

They may be more noticeable when looking at bright lights or white backgrounds.    These floaters are actually shadows cast on your retina by strands within a portion of your eye called the vitreous.   The vitreous is a gel-like sphere that helps the eye maintain its shape, but over time the gel material starts to dissolve.  As a result particles will be cast throughout the vitreous, and it’s these particles that cast the shadows onto the retina.  While annoying, this is a normal aging process within the eye.   However, caution should be used if simple floaters present more pronounced or if accompanied by other symptoms, such as flashes of light.

One important aspect of the vitreous is that it is attached to your retina at several places.  Over time, the same process that causes floaters also causes the vitreous to sink in on itself.   Once the weight of the sinking vitreous becomes too great, it will detach from the retina.   This is called a Posterior Vitreous Detachment and will cause more pronounced, darker and much more noticeable spots or floaters in the central part of your vision.   The tugging force on the retina created by the detaching vitreous may even cause a person to experience flashes of light in their vision.

In a small percentage of cases, the tugging force placed on the retina by a Posterior Vitreous Detachment can cause a retinal tear or detachment.  This is considered a medical emergency and warrants immediate attention to determine whether laser or retinal surgery will be required to prevent permanent vision loss.

Overall, floaters in your vision, if few and constant are most likely harmless and should be discussed with your optometrist at your yearly exam.   If those floaters are accompanied with flashes, or if the floaters become larger and more numerous, you should see your optometrist right away to check for Posterior Vitreous Detachment or retinal tears or detachments.

Vitamin & Nutrition Corner: Vitamin A

February 2nd, 2010

An essential component to ocular health:  Vitamin A

If you ever walk by the vitamin and supplements aisle of the grocery store, you’ll notice dozens of brands specifically promoting eye health.   Which of these vitamins are important to eye health?   How much should you take?    What happens if you get too little or too much of these vitamins?   These are all great questions that I hope to answer with the ‘Vitamin & Nutrition Corner.’

First up is Vitamin A, which is a pivotal nutrient for eye health.   Vitamin A is important in the function of both the exterior and interior portions of the eye.

For example, Vitamin A plays a large role in regulating the make up of your tear or moisture film on the surface of your eye.   Vitamin A is also an antioxidant which reduces oxidative stress on the surface of your eye from environmental conditions and aging.   As a result, a deficiency of vitamin A may lead to dry, irritated eyes.

Vitamin A is also essential for your retina to function properly.  It combines with proteins in your retinal cells that are responsible for absorbing light, especially during night vision.     A lack of Vitamin A would result in diminished or delayed visual ability to adapt during low light conditions, aka night blindness.  Vitamin A also serves as an antioxidant within the retina to reduce chemical stress and it was part of the National Eye Institute’s formula of vitamins used in its landmark study on Macular Degeneration.

No discussion of Vitamin A is complete without talking about Beta-carotene, which is a precursor that is metabolized by your body into vitamin A.   Beta-carotene is found in plants with orange pigments:   carrots, apricots, canteloupe, chili peppers, and sweet potatoes.

When we discuss vitamins, it’s important to note that excessive intake of any vitamin can actually be toxic to your body.   Taking megadoses of vitamins should be avoided until it’s discussed in detail with your primary care physician.    Getting more than 6000 IU of Vitamin A on a daily basis is considered excessive.   Since Vitamin A competes with Vitamin D’s role in bone health, excessive Vitamin A may lead to osteoporosis.  Excessive Vitamin A may also cause fatigue, joint soreness, upset stomach, and irritability.   Smokers should avoid Beta-carotene as it may increase the risk of lung cancer with tobacco use.   Smokers should take vitamin supplements that substitute Lutein in place of Vitamin A.

Yet, consuming proper amounts of Vitamin A or beta-carotene is an important means of keeping your eyes and your body in great health.

How much Vitamin A:

  • The recommended dose is between 1200-5000 IU.

Where to get Vitamin A:

  • Beef and chicken liver are HUGE sources of vitamin A
  • Milk, margarine, and eggs
  • Via Beta-carotene consumption from fresh carrots, canteloupe, etc.
  • Synthetic vitamin supplements

Benefits of Vitamin A:

  • Decreased ocular dryness
  • Better antioxidant protection of the eyes against environmental and aging stress
  • Proper retinal function during night vision
  • Promotion of better macular health in patients with Macular Degeneration
  • Improved bone and teeth development
  • Better skin function, especially during wound healing
  • Improves resistance to respiratory infections
  • Promotes proper testicular and ovarian function