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About Nazir Brelvi, OD: Dr. Nazir Brelvi is an Optometric Physician in a busy private practice in Flanders, New Jersey. He graduated from SUNY: State College of Optometry, Manhattan and has traveled extensively in India, Africa, Europe and South America.
Concerned for the vision care of children, Dr. Brelvi founded KidSEE 20/20, an innovative vision care program that allows children 10 and under to receive a thorough eye exam for a nominal fee. |
Nazir Brelvi, OD |
Editor’s note: The following questions and answers are only a small sample of the large number of questions sent to 'Ask The Expert'. Due to time constraints and the number of similar questions, a representative sample of the submitted questions were answered.
Regards,
Lisa Turner
Online Editor
A Big Hello to Lisa and the rest of the crew for giving me the privilege of answering these very interesting queries from their listening audience.
So, without much further ado, let’s get to the first one.
1. Are the "No Rub" contact cleaning solutions as effective as scrubbing them with my fingers?
Dr. Brelvi: Most of the current No-Rub formulations do have advanced surfactants that are able to remove most deposits from the contact lens surfaces. However, it is always better to scrub them with your fingers at least once a week or so to remove stubborn deposits left behind by eye make-up, lotions, generic protein, etc.: Most of the current No-Rub formulations do have advanced surfactants that are able to remove most deposits from the contact lens surfaces. However, it is always better to scrub them with your fingers at least once a week or so to remove stubborn deposits left behind by eye make-up, lotions, generic protein, etc.
2. Sometimes I find a "gummy" deposit in the corners of my eyes. What is this and should I call my eye doctor?
Dr. Brelvi: The "gummy" deposit one finds in the corners of the eyes after being outdoors is a kind of mucus discharge. This is produced by the eyes to "flush-out" various allergens (pet dander, tree pollen, dust debris etc) that tend to accumulate in them during the course of the day.
As long as the rest of the eye appears clear and "white", simply rinse out your eyes with cool water or buffered saline and you should be fine.
3. I've heard that contacts magnify the sun's rays and can cause more damage to my eyes. Is this true?
Dr. Brelvi: No. Contacts are just like wearing a pair of glasses except they are on the eye. They do not "magnify" the sun’s rays and are definitely not a cause for concern.
4. My father underwent lasik surgery and had problems with the recovery process. Does this mean I will react the same way?
Dr. Brelvi: Not necessarily. However, since Lasik is a surgical procedure, several complications can and do occur. It would be best to seek advice from your dad’s eye surgeon as to what these "problems" were that your dad encountered; and if they were merely generic ones or have some sort of "genetic" component. 5. I'm 25 and thinking about getting lasik surgery. I'm worried that because I'm young and the procedure is rather new that I may have irreversible effects in the future. What are the pros and cons of opting for the surgery at my age? In my opinion, being 25 is a perfect age to get it done. At this age, your refractive error tends to be fairly stable as you have stopped "growing" and being still "young" the healing process and consequent recovery from the surgery is quite robust. Also, depending on what your "correction" is, you can enjoy a good twenty years or so of excellent "eyeglass-free" vision before entering presbyopia, when reading glasses will be needed.
6. What causes a detached retna? Is this a hereditary condition? Dr. Brelvi: Without getting too much into detail of the eye anatomy, the retina is the portion of the eye that makes you see. It can be compared to the "film" in a camera. A detached retina is when a small rip in it begins to "peel it away" from the back wall of the eyeball. This causes it to lose its connections with the rest of the optic nerve and brain, essentially leaving you "blind" in that portion of the eye. Such detachments can occur spontaneously in high nearsighted individuals or result from an abrupt blow or blunt trauma directly to the eye or face region as in boxing, getting hit with a ball, etc. High degrees of nearsightedness do run in families and may be considered hereditary.
7. I'm on the computer all day and I have noticed that after a few hours of working, sometimes it is hard to focus and my eyes get dry. Why does this happen and what can I do to prevent this? Dr. Brelvi: Computers and the workplace environment have been implicated in a variety of vision syndromes including dry eye, focusing dysfunctions, eyestrain, blurred vision and headaches. Consequently, the prescribed therapies range from the insertion of punctual plugs in naso-lacrimal ducts to ergonomically designed work stations with advanced lighting fixtures. Many clinicians also prescribe various anti-glare coatings on eyewear and gradient tints with UV protection. If you are reporting focusing difficulties and dry eyes after a few hours of working, maybe you have some uncorrected refractive error or accommodative infacility that is resulting in such binocular stress. Basically, the best thing to do is to consult your primary eyecare physician and get a thorough evaluation of your symptoms.
Dr. Brelvi: Lasik surgery is really not a "new" procedure but has been around for a good fifteen years or so. In fact, the newer techniques utilized by most modern-day eye surgeons have almost eliminated many of the "horror" stories that one hears about: perforations of the cornea, peeling away of the corneal surface or even exploded eyeballs or being involved in a car accident.
8. Do UVB and UVA sun rays damage my eyes the same way they damage my skin?
Dr. Brelvi: Sunlight is essentially radiation emanating from the sun, which is a huge nuclear furnace. The earth’s magnetic field and atmosphere filters this radiation and thankfully blocks off most of the harmful rays by the time it reaches us.
Like the skin, your cornea and sclera (white of the eye) need to be additionally protected from the high energy UVA, UVB and UVC radiation as they tend to destroy living cells.
UV rays have also been implicated in producing cataracts in all animal species including humans. Thus, it is always advisable to wear dark protective sunglasses while venturing out between 10 am and 4 pm when such radiation is at its worst.
9. My children swim in our pool all summer and open their eyes while under water. Does chlorine have any lasting effects on their eye sight?
Dr. Brelvi: The short answer is no. However, chlorine is not the only thing floating around in your pool water. Various sight-threatening organisms tend to linger in your children’s eyes after they exit the pool. The best thing to do is to thoroughly irrigate or wash off their eyes once they are done swimming with sterile saline or copious amounts of cool water from an indoor faucet.
10. I have been to my own Dr. to see about floaters in the eyes. All he told me was to not pay any attention to them and I will quit seeing them as much. I notice sometimes they are worse than at other times. Could diet and exercise have any thing to do with these things? Could I do something to make them go away?
Dr. Brelvi: Great question. 98% of the time, floaters in the eyes are relatively benign and do not lead to any sight-threatening conditions. These so-called floaters are usually cellular debris left over when the eye was forming in the womb, together with various "scavenger" cells that help keep the vitreous free of infection and miscellaneous cellular metabolites. Such "floaters" tend to be more obvious when relaxing at the beach with eyelids closed or when exiting a dimly-lit room into the brighter outside.However, a medical history of diabetes, hypertension or even high degrees of myopia should give you pause and lead to a more thorough evaluation via a dilated fundus exam by your primary eyecare physician. A dramatic increase in floaters may signal a small leak or break in a retinal blood vessel and does need to be addressed right away.
Unfortunately, there is not much one can do to make them go away as they are pretty much a normal ingredient of all eyeballs.
11. I've heard of programs that "teach" people to improve their vision through what I picture to be some type of focusing exercises. What are your thoughts on this? Is this a new technique that is gaining favor within the medical community or more of an unlikely to be and/or unproven to be effective treatment?
Dr. Brelvi: Eye exercises or vision therapy (VT) has been around for decades and occupy a special niche in Optometry with numerous practitioners on either side of the divide. Some wax eloquent on the benefits of VT, especially in school-age children, while others denigrate it as "voodoo optometry".
I, personally, have seen remarkable results with "patching" therapies in young children that are amblyopic (lazy eyed) or afflicted with various attentional deficits being trained on computer-based models. As is often the case with any medical intervention, the therapy needs to be personalized and innovative to produce the desired results.
However, VT has shown dubious results in adult people eager to gain control over their progressive myopia or focusing inability brought on by aging.
12. Why are contact lens wearers warned to keep contacts in their eyes while sleeping? What damage could occur?
Dr. Brelvi: Sleeping in contacts is never a great idea as the stagnation of your tear flow under the cornea leads to hypoxic conditions, further compromising its structural integrity. Also, by keeping the contact lenses in overnight gives the bacteria lingering within the tear film and eyes more opportunities and time to "burrow" into the cornea and promote infections.
13. I currently wear glasses but not as often as I should. I was thinking of switching to contacts. Are contact lenses better than glasses and what risks factor should I be concerned about?
Dr. Brelvi: The new generation of so-called "silicone hydrogels" are not only extremely permeable to oxygen but also exceptionally comfortable to wear. Infusion of silicone into their matrix makes them resistant to dehydration. Consequently, you don’t feel them in the eye even after a full day of wear.
Wearing contact lenses can give you a more natural correction of your refractive error with minimal peripheral distortions. This can lead to a sort of "stabilization" of your Rx over time, especially in younger myopic (near-sighted) children.
14. How safe are the implantable contact lenses? Are they encouraged for patients with astigmatism?
Dr. Brelvi: Implantable contact lenses come in numerous flavors and you can get plenty of info on the web by using any search engine.
Dr. Brelvi: Implantable contact lenses come in numerous flavors and you can get plenty of info by using any search engine. Various reports of complications especially those leading to glaucoma or a sharp increase in IOP (internal ocular pressure) have been cited in medical literature.
Implantable contact lenses in the form of triangular wedges or even circular rings are used not only in patients with astigmatism but also in "correcting" myopia and hyperopia (far-sightedness).
15. I am 24 years old and have been wearing contacts since the 4th grade and I’ve always worn the soft lenses. For the last few years I have been wearing the ‘old technology’ soft contact lenses, and I am really in love with their comfort factor. Several eye doctors have informed me that they are not the best for my eyes since they don't allow oxygen into my eye. But the ‘new technology’ lenses do. I have tried several other contact lenses that are more "oxygen-friendly," but to no avail. My eyes cannot stand them! I can feel the contact lens in there!
What do you recommend? And if I am "stuck" wearing the ‘old technology’ soft lenses, is that really bad? I am very tempted to just keep wearing soft lenses as my eyes really "like" them. Should I be worried?
Dr. Brelvi: Hey. You are 24 years old and, in my opinion, a pretty sophisticated contact lens wearer. The fact that you have been wearing contacts since 4th grade indicates that your Rx is on the "high" side.
But, despite that fact, as long as your corneas do not display overt signs of lens-induced stress like vascular encroachment or circum-limbal injection (red, tired looking eyes) then by all means continue with your current lens wear regimen.
The new silicone hydrogels do have higher dK values (oxygen permeability) than the "older" lenses that you have clearly gotten used. Consider that they acquire "mucin balls" that coat their surfaces with a "sandpapery" layer, which then begins to abrade your cornea and lead to further corneal stress. They also tend to feel a bit "stiffer" to your eye initially because of their lower water and higher silicone content.
They can acquire "mucin balls" that coat their surfaces with a "sandpapery" layer, which then begins to abrade your cornea and lead to further corneal stress. They also tend to feel a bit "stiffer" to your eye initially because of their lower water and higher silicone content.Question 15 continuted: Also, I never sleep in contacts. I wear a pair a month. I wear contacts the entire day, constantly, especially while I am studying while in medical school, with glasses for nighttime use only.
Dr. Brelvi: I agree. Sleeping in contacts is never a great idea as the stagnation of your tear flow under the cornea leads to hypoxic conditions, further compromising its structural integrity.
16. My 11 year old daughter wants to get contacts, but I’m worried that she may be too young. What is the best age to introduce contacts to children?
Dr. Brelvi: In my practice, which is predominantly contact lenses, I have fitted children as young as five years of age. However, traditionally I consider ten years of age as a good starting point, especially in girls. Boys, on the other hand are a bit immature at this age to handle contact lenses so I wait until they are twelve or even thirteen.
Lisa Turner, Online Editor: Thank you Dr. Brelvi for your expertise and insight.
Dr. Brelvi: Hope you found most of my answers enlightening and informative.
Thanks again for giving me the opportunity to field such interesting questions.
Good Night.
Warm regards, Dr. Brelvi
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