What is Dry Eye Disease?
Dry Eye Disease or Meibomian Gland Dysfunction is much more commonly seen than in previous decades.  Those that have it know its symptoms well: dryness, watery eyes, itchiness, stinging, burning, grittiness, redness, blurry vision and a foreign body sensation in the eye.  The symptoms just don’t seem to go away and are very annoying.  More than annoying, dry eyes can also produce chronic eye inflammation, corneal abrasions and corneal ulcers. Patients sometimes come in complaining that they have blurry vision and think they need new glasses when in fact, they have Dry Eye Disease that is disrupting their vision.

Is it a simple problem to fix?
Yes and No.  Firstly, it requires an eye doctor to take a careful history, medical review of existing diseases and an eye examination. Correct Diagnosis of the cause is very important as it will dictate what treatments will work and what will not. If a patient has contact lenses that are not fit well, it may be a simple fix to change the contact lens prescription.

How is Dry Eye Disease treated?
Early treatment is the key to preventing irreversible damage to the glands of the eyes. The doctors of Morris Eye Group have a three- prong treatment plan with the goal to not just treat the symptoms but to treat the underlying cause.  This necessitates a proper diagnosis of the underlying problem.

Our doctors analyze the patient’s tear film quantity and quality.  Are the eye glands producing proper lubrication to the eye or is the lubrication lacking enough essential oils to do the job?   If the dry eye is a side-effect of a prescribed medication our doctors work with a patient’s primary care doctor or specialist to find an alternate medication to those that produce dry eyes.  If a patient’s Meibomian glands are blocked the doctors prescribe a treatment to unblock them.  There is also a home regimen to keep the glands open and a new Omega7 nutritional supplement that promotes the production of the oils that bathe the eye.   We always recommend adding UV protection in prescribed eye wear.

What causes Dry Eye Disease?
 The causes of Dry Eye Disease are varied and many.  Here are the main causes:
Aging, contact lens wear, autoimmune diseases such as Lupus, Sjorgen Syndrome and Thyroid Disease. Many prescribed drugs produce dry eye side-effects.  We also know that computer, tablet and smart phone use have added to eye strain from their screen- emitted blue light.  
It is more common in females and in those that participate in outdoor sports such as golf, surfing and tennis.  Dry Eye may also be due to an occupational exposure to known eye irritants.   In some instances, over -the -counter eye drops to clear up red eyes actually make Dry Eye Disease worse.  ​

What is a cataract?
Inside our eyes, we have a natural lens. This lens bends (refracts) light rays that come into the eye to help us see. The lens should be clear; however, if you have a cataract the lens has become cloudy. It is like looking through a foggy or dusty car windshield. Things look blurry, hazy, or less colorful with a cataract.

In a healthy human eye, light rays travel into the eye through the pupil, they pass through the clear lens and focus onto the retina.

In an eye with a cataract, the light rays scatter throughout the eye instead of focusing precisely on the retina, causing distorted vision.

What are the symptoms of a cataract?
Cataracts are the most common reason people start to lose vision. Most age-related cataracts develop gradually. As a result, some patients do not notice changes in their vision right away. However, over time most patients will begin to notice some, or all, of these symptoms:

• Blurry or hazy vision
• Seeing double or ghost images- when you see two images instead of one
• Being extra sensitive to bright light, especially when outdoors
• Having trouble seeing well at night, or needing more light when you read
• Colors aren’t as bright- may appear dull, faded, or yellow instead

What causes a cataract?
Though there are other risk factors for cataracts, aging is the most common cause. This is due to normal eye changes that begin around age 40, when proteins in the lens start to break down causing the lens itself to discolor. Not until around age 60 will people usually start to notice some increasing symptoms of their cataract. Most age-related cataracts develop gradually. However, other types of cataracts can develop more quickly, such as those in younger people or those in people with diabetes. Doctors unfortunately cannot always predict how quickly a person’s cataract will develop. Besides age, other cataract risk factors include:​

• having parents, brothers, sisters, or other family members who have cataracts
• having certain medical problems such as diabetes, high blood pressure, or obesity
• taking certain medications such as steroids
• having had an eye injury, eye surgery, or radiation treatments on your upper body
• having spent a lot of time in the sun, especially without sunglasses that protect your eyes from damaging ultraviolet (UV) rays

Who needs cataract surgery?
If your cataract symptoms are not very bothersome, you do not have to have surgery right away. A new eyeglass prescription may help you see better for now. However, as your cataract matures even a new prescription will not help. You should consider cataract surgery when your cataracts are making it difficult for you to do things you want or need to do (like reading, watching TV, driving, golfing, etc.). Your doctor will help you decide when the right time is for your cataract surgery.
If you are not ready for cataract surgery, this is what we recommend in the meantime:

• Have an eye exam every year if you're older than 65, or every two years if younger.
• Get the right eyeglasses or contact lenses to help correct your vision as much as possible
• Protect your eyes from UV light with sunglasses and a hat when outdoors.
• If you smoke, quit. Smoking is a key risk factor for cataracts.
• Use brighter lights for reading and other activities. A magnifying glass may be useful, too.
• Limit driving at night once night vision, halos, or glare become bothersome.
• Take care of any other health problems, especially diabetes.
• Do not use eye drops or other treatments that claim to dissolve or remove cataracts. There is no proven way to resolve cataracts with eye drops. Surgery is the only way to remove cataracts.

What to expect with cataract surgery?
When your vision is making it difficult to complete your regular activities, schedule a cataract consultation with one of our surgeons. At this appointment our staff will go over all your surgical options and help you make an informed decision about cataract surgery, including: preparation for and recovery after surgery, benefits and possible risks of cataract surgery, surgical techniques and options, cataract surgery costs, insurance coverage, scheduling, and any other questions you may have.

Cataract surgery is a quick outpatient procedure (about 20-30 minutes) done in an outpatient surgery center or hospital under twilight anesthesia. During cataract surgery, your surgeon will remove your eye’s cloudy cataract lens and replace it with a clear artificial lens. This new artificial lens is called an intraocular lens (or “IOL”). When you decide to have cataract surgery, your doctor will talk with you about different surgical techniques, IOLs and how they work.

Recovery after cataract surgery is generally very easy. Most patients can expect to have about 1-3 days of downtime following their procedure. You will be using eyedrops for a few weeks to help protect against any inflammation or infection. Your surgeon will talk with you about how active you can be following your surgery. Often patients need to refrain from exercise, heavy lifting, underwater activities (pool, ocean, sauna, etc.), and dusty dirty environments for a few weeks. Driving can typically be resumed in a day or two after surgery.

Does insurance cover cataract surgery? 
Cataract surgery is generally covered by Medicare and most private medical insurances when your vision tests at a certain decreased level of acuity or clarity. However, even if surgery is covered by insurance you may still have some additional costs. Special types of IOLs and refractive correction (for patients who want to be less dependent on eyeglasses after surgery) are typically not covered and may cost you more.
Also, choosing to have cataract surgery before your vision has deteriorated enough may not be covered. In certain cases, it might be possible to get coverage before you meet the age or vision requirements. Talk with your surgeon if you are considering having early cataract surgery.
What do you do if you don't have Medicare or insurance coverage? You may still be able to reduce and manage the cost of cataract surgery. See if your employer offers flexible spending or health saves programs or sign up for outside financing such as CareCredit. We are here help if you have any questions!​

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What is Blue Light?
Blue light is a color in the visible light spectrum.

​Without getting into complicated physics, there is an inverse relationship between the wavelength of light rays and the amount of energy they contain. Light rays that have relatively long wavelengths contain less energy, and those with short wavelengths have more energy. Blue light is a short wavelength, which means it produces higher amounts of energy. 

Light wavelengths are measured in nanometers (nm). Blue light resides in the range from 400-500nm. 

How are people exposed to Blue Light?
Blue light is everywhere in our world. It used to be that the only source of blue light was from the sun. Now we have brought blue light inside by the way of digital screens (found on TV's, smartphones, computers, laptops, tablets and gaming systems), electronic devices, LED and fluorescent lighting. Blue light is beaming at us from all directions!
 
Are there any benefits to Blue Light exposure?
Without even thinking about it, your body uses blue light to regulate your biological clock, or sleep/wake cycle. Blue light also plays a role in basic functions of the human brain such as alertness, memory, emotion, and cognitive performance. In certain conditions, light therapy using the correct wavelengths of blue light is known as an effective treatment helping people of all ages.

What are the negative effects of Blue Light exposure ?
​​As one of the shortest, yet highest energy wavelengths in the light spectrum, the blue light flickers easier and longer than other types of weaker wavelengths. This flickering casts a glare that reduces your visual contrast, affecting clarity and sharpness. Scientific research has linked blue light to the onset of digital eye strain in as little as two hours of exposure. Blue light can help elevate your mood and boost awareness, but chronic exposure to blue light at night can lower the production of melatonin, the hormone that regulates sleep, and disrupt your circadian rhythm.  Harvard researchers have linked working the night shift and exposure to blue light at night to several types of cancer (breast, prostate) diabetes, heart disease, obesity and an increased risk for depression.  And according to The Vision Council, more than half of all Americans experience symptoms of; 
                - Dry Eyes             - Blurred Vision
                - Tired Eyes           - Sore Eyes
                - Headaches          - Watery Eyes
Our eyes have not evolved to provide filters against this type of artificial light. Prolonged exposure to blue light may lead to macular cellular damage, which may lead to loss of vision.
The medical profession is concerned about the exposure level of blue light for adults and children. Here are some interesting statistics:

•  43% of adults have a job the requires prolonged use of a tablet or computer
• 74% of teens between the ages of 12 to 17 use electronic devices at least occasionally
• 70% of adults that regularly use electronic devices report symptoms of digital eye strain
• 93% of teens have access to or have a computer

How does Blue Light exposure effect sleep?
Blue light exposure turns off the production of melatonin in the brain.

Tips, tricks and things you can do to protect yourself and your kids from too much Blue Light exposure.
You can minimize the amount of blue light that enters your eyes by wearing glasses that filter some of these harmful rays. Morris Eye Group offers a high quality blue light lens that eliminates a portion of the short wavelength blue light.
Children’s eyes are particularly vulnerable to the effects of blue light as virtually all of the blue light they are exposed to passes through their cornea and lens, and reaches the retina. Coupled with a high amount of screen time, this puts them at risk for over-exposure to blue light that may prove to have long-term consequences. Recommended below are some safe technology habits for you and the entire family:

• Say goodnight to technology two hours before bedtime.
• Limit children’s screen time to one to two hours per day for children over two years of age and restricting it completely for children under two years old.
• Turn down the brightness on your devices.
• Change digital device background colors from bright white to warmer colors to reduce eye strain.
• When staring at a digital screen, blink more often
• Take frequent breaks from staring at electronic devices
• Clean your screen, as a smudge-free, dust-free screen helps reduce glare

Our bodies do not make lutein and zeaxanthin, so it is important to obtain these pigments through diet or supplements for eye protection. These supplements are plant nutrients that absorb in the retina of the eye. This is helpful as creates a yellow film that covers the macula to helps filter out blue light.  Not surprising, kale and spinach are the top food choices for blue light protection, as these Eye foods are some of the best food sources of lutein. Watercress, pea shoots, and Chinese broccoli are other often overlooked, good leafy greens choices. Consuming orange peppers — both raw and cooked — and eggs four times per week will also help to increase the concentration of lutein and zeaxanthin in the body and macula.

Why does Morris Eye Group ask for my Medical insurance?
Morris Eye Group is a medical practice specializing in ophthalmology that diagnoses and treats medical conditions associated with the eye. Medical insurance generally covers eye care in relation to a medical condition. For example, if you need an eye exam because of cataracts, dry eyes, complications from diabetes, or in relation to diagnosed high blood pressure, then your medical insurance will provide coverage with ophthalmologist/optometrist. Medicare and other Medical Insurance Plans do cover the portion of the eye examination devoted to the determination of eye disease and the treatment of that disease.  Medical plans also cover diagnostic testing to aid the doctor in diagnosing eye disease and monitoring its progress.  If you have diagnostic testing performed, charges for these services will be billed to your medical insurance carrier.  You will be responsible for any copays, coinsurance and medical deductibles associated with your specific insurance plans. Vision insurance covers the vision screening, a refraction which is the test performed to obtain a glasses prescription, including dilation, and benefits towards glasses/ contact lenses. Vision Insurance rarely covers diagnostic testing to diagnose eye disease or monitor its progress.  If you need those services, their charges will be applied to your medical insurance plan, and any deductibles of coinsurance requirements of your medical insurance plan will apply.  Vision Insurance typically covers an eye exam once every 12-24 months, depending on the plan. Medical Insurance can be used as frequently as the doctor deems necessary for monitoring any ocular Medical diagnosis.

Why doesn’t my health insurance cover my eye glass prescription?
Although eye refractions are an integral part of a comprehensive eye examination, they are specifically excluded from coverage by Medicare and most Medical Insurance Plans (HMO’s and PPO’s).  Refractions are considered routine eye examinations for prescriptions for eyeglasses or contact lenses. Please see the CMS Publication “Your Medicare Benefits”.
https://www.medicare.gov/coverage/eye-exams-routine
 
Why are diagnostic pictures of my eyes not covered under my vision insurance?
Vision insurance covers a once a year eye exam which includes; vision screening, a refraction which is the test performed to obtain a glasses prescription, dilation, and benefits towards glasses/ contact lenses. Photos are a diagnostic tool to assist the doctor in the treatment of eye conditions.  If a patient has a medical condition and we take a photo, it is billed to their medical insurance. 
 
Why are some medical plans considered out-of-network?
Since the Affordable Care Act (ACA) has been rolled out there are some insurance companies that have plans through Covered California and the Exchange Marketplace. Although we contract with many insurance companies including Blue Cross and Blue Shield, we are not a contracting provider for the Blue Cross and Blue Shield Covered California and Exchange plans.
 
I have Medicare; why don’t they cover me 100% for my exam?
Medicare has an annual deductible that must be met.  Once that deductible is met, Medicare will cover the patient at 80% leaving a 20% responsibility for the patient.  There are supplemental plans to Medicare that one can purchase to cover the portion that Medicare doesn’t cover.
 
What’s the difference between Morris Eye Group and a Big Box Eye Care Center?
Big box eye care centers only provide vision exams.  Morris Eye Group is a full-service medical practice that provides medical diagnosis, treatment and surgical services including; cataract surgery, LASIK, glaucoma management and treatment, and corneal treatments.  In addition to medical services, we have the largest optical dispensary in North County San Diego providing our patients with quality glasses and contact lenses. When a patient chose to get full eye care with us, from start to finish, we have the ability to titrate any issues that arise after glasses have been dispensed because we monitor and control the process. If a patient elects to purchase eyewear elsewhere we have don’t have control on; materials/brand used, coding used, or how qualified the optician taking measurements. At Morris Eye Group, we use quality brands for our lenses and have access to choices for higher prescriptions, prism, and other brands should what we selected not work for the patient. Most of our opticians are licensed and certified and have a combined experience in optics of over 50 years.

Why do I need to come back for a Contact Lens Check after being given trial lenses?
We want to verify if the lens is fitting properly on the eye and fine tune the prescription if needed.

My eyes are very dry, is there contact lenses brand that can help with dryness?
Daily disposable lenses. In cases of extreme dryness, we might suggest a scleral lens.
 
I have been wearing contact lenses for years, why do I need to have an evaluation done every year for contact lenses?
California law requires optometrist to evaluate a patient’s cornea every year when prescribing contact lenses because contact lenses are defined by law as a medical device. In addition, your optometrist needs to see the contact lens on your eye to make sure that the lens is fitting properly and that you are seeing well out of the lens, before they can sign off on the prescription. Contact lens technology is constantly advancing and with that, while the contacts the year before might have worked well for you there is a chance there will be something better we want to make you aware of.

I wear my contact lenses all day every day. Why do I still need a pair of glasses?
A contact lens wearing patient needs a pair of glasses to give your eyes a break. It’s always good to have a fall back in case of emergency, maybe you run out of lenses or get an eye infection. If people have a pair of glasses to fall back on they are less likely to over-wear their contact lenses.

I got my trial contact lenses and I don't see well out of them, why do I need to wear them (when I know they don't work) to my appointment for my contact lens check?
Seeing the lenses on the eye is helpful to determine why they aren’t working. Examples: checking the rotation for astigmatism.

How long does it take to get used to wearing contact lenses?
It is normal to feel slight irritation or a foreign body sensation at first, but after a few days that sensation should subside. Some patients don't have any discomfort, especially if the contact lenses are daily disposables.

Can a contact get lost in my eye?
The most common misconception for new contact lens wearers is the fear that they will get a contact lens stuck in or behind their eye. While this cannot happen, the lens may go under your eyelid which would initially make it difficult to see, but not impossible to remove. If you are struggling putting in or removing your contacts, we offer contact lens education at our practice, call for an appointment.

What are the benefits of wearing daily disposable contact lenses?
Even though the lenses themselves may be more expensive in some cases, (since you are replacing the lenses daily) you actually save by not having to purchase contact lens solution! Many manufacturers now use special breathable material for their lenses which allow more oxygen to pass through. Most of the complaints from my contact lens patients are from those who wear biweekly or monthly contact lenses and are actually having a reaction to the disinfecting solution, not the contacts themselves. Thus, just by switching to a daily disposable lens, they immediately have less irritation and dryness. You open a sterile package with sterile solution and a sterile contact lens everyday- this leads to less problems with wear and irritation.

Are there contacts that correct for both distance and reading?
If patients need help with both their distance and reading, I might recommend trying multi-focal contact lenses as they can be adjusted for computer use as well. 

What age is recommended for first time contact lens wearers?
I do not determine eligibility solely based off a patient's age. Instead I assess their motivation and maturity. Wearing contacts comes with a responsibility to use them correctly. If a young patient is not motivated on their own to do the work and learn how to insert and remove their own lenses, then the patient will not succeed with contact lenses. He has had patients as young as 10 or 11 years old who succeeded with contact lenses. This is greatly in part to the use of daily disposable lenses which have greatly reduced the risk and maintenance required for use of contact lenses.