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Post-LASIK Refraction and Pregnancy – Much Ado About Nothing?

Written by
Dr. David Evans
Last modified on August 23, 2018

During pregnancy, women experience a drastic shift in their hormonal balance that has a ripple effect throughout the body. The spike in hormones like progesterone, estrogen, prolactin, oxytocin and relaxin are all important for a healthy pregnancy, but these increased levels can also impact gastrointestinal processes, blood pressure, skin pigmentation and, you guessed it, ocular health.

Due to refractive changes that often occur during pregnancy, most refractive surgeons advise against LASIK during pregnancy, instead suggesting women wait several months after giving birth before considering treatment. Women who have already undergone LASIK may then wonder if the changes in ocular health that can occur during and after pregnancy impact post-LASIK refraction. New research presented by John Kanellopoulos, MD, New York University Medical School, NY, and seems to throw cold water on any such concern.

pregnancy-410x263.jpgThe Eyes and Pregnancy

A number of studies have previously evaluated the correlation between pregnancy and ocular changes. Dry eye syndrome, decreased sensitivity of the cornea, increased corneal thickness and decreased intraocular pressure are a few of the side effects previously linked with pregnancy. These combination of changes can affect refractive error during pregnancy. But the question of refractive changes for post-LASIK patients is something of an open question.

The current study involved 61 female patients from a single practice who had undergone LASIK prior to pregnancy to correct myopia and/or astigmatism, and had since giving birth. The average patient age was 28, and the average period of time that passed between LASIK surgery and pregnancy was 55 months. The study also weighed the various epithelial profiles of all patients using optical coherence tomography in order to obtain a more precise measure of spherical refraction.

Although refractive error changes have previously been attributed in part to the hormonal shifts during pregnancy, the study found no such correlation with long term changes.  Dr. Kanellopoulos noted that “pregnancy does not appear to affect long-term post-LASIK refractive stability.” However he noted that there are few studies evaluating this aspect of pregnancy and ocular health, and suggested that further study could help confirm his findings.

What This Means for You

If you are considering LASIK but also planning on having children, and are concerned about how the latter may interfere with the former, then this study is good news. It suggests that women need not put off LASIK until after pregnancy and sacrifice their quality of vision in the short term out of a concern that a future pregnancy could impact the long-term quality of vision achieved with LASIK.  It is still a good idea not to have LASIK during pregnancy, but based on this study, treatment before pregnancy does not appear to pose any post-pregnancy problems. However, as Dr. Kanellopoulos clearly states, this is but one, relatively small-scale study, and further evaluation is needed to corroborate the findings.

If you’re interested in LASIK and unsure whether or not the timing is right, or whether you are a good candidate for LASIK, I urge you to sit down with a qualified ophthalmologist to discuss your options in detail.

If you’re looking for a LASIK surgeon, I’ve written previously about the best method for choosing the right surgeon for your needs.

To learn more specifics related to the study, view the complete Ophthalmology Times article here.

Refraction remains stable post-LASIK in female patients after pregnancy – Ophthalmology Times June 2018


Can a Cup of Coffee Help to Protect Your Eyes?

Written by
Dr. David Evans
Last modified on October 4, 2018

I’m not much of a coffee drinker, but based on recent figures from the National Coffee Association (NCA), it appears I’m part of a growing minority. According to the latest data from the NCA, 64 percent of Americans over the age of 18 said they had at least one cup of coffee the previous day (up from 62 percent in 2017). There’s no arguing the fact that coffee is the fuel that many people need to jumpstart their day. But, did you know that in addition to helping you wake up, that morning Cup of Joe could be protecting your long-term eye health?


A study from Cornell University found that a daily cup of coffee can potentially protect against the retina damaging effects of glaucoma, age-related vision loss and diabetic retinopathy. Published in the Journal of Agricultural and Food Chemistry, the research tested a particularly strong antioxidant (chlorogenic acid or CLA) on mice and monitoring retinal health. Those pretreated with CLA developed no retinal damage during testing.

It has yet to be determined whether the CLA in coffee is capable of crossing the blood-retinal barrier in order to be beneficial. But given the relatively high amount of CLA found in raw coffee (roughly 7 to 9 percent per ScienceDaily), it’s plausible that by regularly drinking coffee, you could help to support retinal health. However, even if additional study finds that the CLA is not capable of crossing the blood-retinal barrier and that drinking coffee has only minimal benefit in aiding retinal health, the CLA study remains valuable. Research results could lead to synthetic CLA compounds could be developed and administered via medicated eye drops.

Eye Health and Caffeine

In addition to the studies focused on the benefits of CLA on retinal health, there is a broader connection between eye health and coffee: caffeine. A number of studies have evaluated the effects that caffeine plays on eye health, including aiding common issues like dry eye. Some research suggests that caffeine helps to stimulate tear production, the lack of which is a leading cause of dry eye.

But as with most things, moderation is key. Too much caffeine has been linked with a number of negative health issues including migraines, insomnia, irritability, muscle tremors and irregular heartbeat. Excess caffeine has also been linked with an increased risk of glaucoma. A study published in Investigative Ophthalmology & Visual Science suggested that consuming more than three cups of coffee a day increased risk for pseudoexfoliation glaucoma.

The Good, the Bad and the Bottom Line

The Cornell study is promising in terms of coffee serving as a protector against retinal damage, but there are clearly some red flags associated with excessive coffee consumption. The bottom line is that if you’re not a coffee drinker, don’t feel the need to start force-feeding yourself a daily cup in order to protect your vision. And if you are a coffee drinker, don’t drink cup after cup thinking it’s a magic health elixir and that more is better, because drinking too much caffeine can be problematic.

Better Vision Guide will continue to track the progress of CLA studies and the potential eye health benefits of coffee, but for now, I’m sticking with my current routine until I read something more conclusive; an occasional cappuccino after meals.

The Relationship between Caffeine and Coffee Consumption and Exfoliation Glaucoma or Glaucoma Suspect: A Prospective Study in Two Cohorts – IOVS – Sep. 2012
Could your morning coffee be goof for your eyes? – American Optometric Association – May 2014
A cup of coffee a day may keep retinal damage away, study shows – ScienceDaily – May 2014
Caffeine: How much is too much? – Mayo Clinic – Mar. 2017

The Rise of Eye Allergies

Written by
Dr. David Evans
Last modified on August 6, 2018

Once up on a time, allergies were a seasonal issue. The start of spring would bring with it some nasal congestion, respiratory stress and itchy, red eyes. The increased pollen count associated with spring and the source of the allergic reaction typically lasts through summer. After which you could rest easy until the start of the next season. But if you’re an allergy sufferer like me, you might be feeling like the last couple of allergy “seasons” have stretched a little longer than usual. Turns out this is more than a feeling.

This issue was recently addressed at the 2018 American Academy of Allergy, Asthma and Immunology (AAAAI) annual meeting. Experts weighed in noting a growing prevalence of asthma and allergy health problems outside the typical seasonal schedule.


The rise in allergy prevalence can be explained in part by some of the aberrant weather cycles and their associated effects. Increased storms and associated flooding, rampant wildfires (something we’re particularly susceptible to here in Southern California) and warmer temperatures are a perfect recipe for allergies. The recent volcanic eruptions in Hawaii and Venezuela, and the toxic smoke and debris they are delivering into the atmosphere, is merely the latest example.

It’s worth noting that these studies tend to focus more on respiratory and nasal symptoms. However, experts agree that it’s safe to assume ocular effects as well. Even more so given this assumption is backed up by ophthalmologists seeing a surge in the number of patients seeking treatment for conditions like allergic conjunctivitis (pink eye).

Allergy season is getting longer and far more intense in certain regions around the world. As a result, approximately 65 percent of AAAAI members surveyed expect to see allergy-related care increase sharply over the next 10 to 20 years. And those studying the potential impact of changes in climate and weather — like Dr. Leonard Bielory, professor of medicine, pediatrics, and ophthalmology at Rutgers University Center for Environmental Prediction ­— warn that “there are incredible changes coming downstream.

Protect Yourself

In order to help counter this growing allergy trend, ophthalmologists are encouraged to be even more proactive in educating patients about how best to protect their eyes against allergy-related issues. But there are steps that patients can take as well to help protect themselves from the nuisance of allergies.

We put together a great slideshow last year featuring 5 tips for tackling eye allergies, but there are some additional measures you can take, including:

Identify Your Triggers: Different people have different allergy triggers. I’m particularly sensitive to freshly cut grass, which means that I let our landscaper take care of mowing the lawn during the summer to avoid or minimize my allergic response. You can work with your eye doctor to get a sense of your triggers, which can better help manage your allergy cycle and avoid stressors. For example, there are apps that track pollen levels at specific times of day. If you typically ride your bike in the morning, but there’s a high pollen count at that time of day, perhaps you’d be better suited for that ride later in the day.

Be Aware of the Season: Allergy sufferers often schedule appointments before the start of allergy season. But as I’ve mentioned above, the season is shifting, meaning that perhaps your schedule should as well.

Tracking the season and identifying your triggers will make it considerably easier for you to protect against allergy attacks.

Consult an Allergist: Ophthalmologist are well-quipped to manage the ocular symptoms of allergies, but what about respiratory and/or nasal symptoms? If you are particularly sensitive to allergens, you may consider meeting with a specialist in the diagnosis and treatment of allergies.

For more information, check out 5 tips for tackling eye allergies.

You can also check the pollen count in your location courtesy of this clever tool from AAAAI.

The Benefits of Benfotiamine

Vitamins are becoming a very popular way to fulfill nutritional needs. It’s becoming especially popular for those who may be deficient in one or more necessary nutrients. Sometimes, these supplements are derivatives of the actual vitamin or mineral, but because they are absorbed better by the body, they’re used to manage deficiencies. One example of this kind of supplement is benfotiamine.

What Is Benfotiamine?the-benefits-of-benfotiamine.jpg

Benfotiamine is a derivative of thiamine or Vitamin B1. Foods like legumes, seeds, nuts, and fortified wheat products, including bread, rice, and cereal, contain thiamine. Used as an antioxidant and anti-inflammatory, benfotiamine is fat-soluble and chemically manipulated by enzymes in the intestines then broken down by red blood cells or the liver into thiamine. It seems to be more bioavailable and easier to absorb than thiamine alone as it increases blood levels of Vitamin B1 fivefold, making it a prime candidate for inclusion in a multitude of nutritional aids.

What Can Benfotiamine Help With?

As mentioned, benfotiamine can help increase thiamine levels in the blood, but it can also help manage and maintain certain health issues. There are several areas of health that benfotiamine may have a positive impact on, including heart, kidney, nerve, and brain health. It may also protect the body against the negative effects of advanced glycation end products (AGEs), which can cause inflammation and the progression of some age-related health concerns.

Benfotiamine & Poor Blood Glucose Control


Benfotiamine helps reduce free radical damage and protects the body from the dangerous side effects of too much sugar. In fact, it has been proven to be beneficial for patients with blood glucose control issues. Benfotiamine has been shown to have positive effects on issues caused by poor blood glucose control. It helps reduce harmful glucose metabolites and the intracellular formation of certain proteins involved in microvascular damage. It also improves vibratory sensation, nerve conduction, and pain sores caused by nerve damage.

Benfotiamine benefits circulation and blood vessel health and even helps muscles heal after suffering poor circulation. In the eyes, benfotiamine protects retinal cells from high blood glucose levels, stabilizes cells structure, and reduces cell death. With all these benefits, perhaps the best effect benfotiamine has with patients is its little to no effect on blood glucose levels.

Are There Side Effects of Supplementing with Benfotiamine?

It’s rare to have any negative reactions to benfotiamine supplementation. However, there are a few documented side effects related to benfotiamine. Those with a sulfur sensitivity should avoid benfotiamine as it’s been known to contain this chemical. Other recorded side effects include:

  • Upset stomach
  • Nausea
  • Dizziness
  • Hair loss
  • Weight gain
  • Body odor
  • Decreased blood pressure

Benfotiamine can be a very beneficial nutrient to include in a daily nutritional supplement, especially if that supplement is aimed at helping patients with poor blood glucose control. Though there are benefits, it is best to be cautiously optimistic if patients begin to supplement this B-vitamin derivative. More research needs to be done to confirm its overall health benefits.


  1. Cohen, Joe. “10 Surprising Health Benefits of Benfotiamine + Mechanisms.” Selfhacked, Selfhacked, 5 Oct. 2018,
  2. “Benfotiamine,”, published on 11 July 2013, last updated on 14 June 2018,
  3. Fraser DA, Diep LM, Hovden IA, Nilsen KB, Sveen KA, Seljeflot I, Hanssen KF: The effects of long-term oral benfotiamine supplementation on peripheral nerve function and inflammatory markers in patients with type 1 diabetes: a 24-month, double-blind, randomized, placebo-controlled trial. Diabetes Care 35:1095–1097, 2012
  4. Haupt E., Ledermann H., Köpcke W. (2005). Benfotiamine in the treatment of diabetic polyneuropathy—a three-week randomized, controlled pilot study (BEDIP study). Int. J. Clin. Pharmacol. Ther. 43, 71–77. 10.5414/CPP43071
  5. Wong, Cathy. “The Benefits of Benfotiamine.” Edited by Richard N. Fogoros, Verywell Health, About, Inc., 17 Sept. 2018,

Photo credit: USDAgov on / CC BY

I Spy a Stye in Your Eye

Written by
Dr. David Evans
Last modified on August 6, 2018

What’s that small, red, pimple-like bump on your eyelid that’s causing so much discomfort? It’s probably a stye (sometimes referred to as a sty or hordeolum). Besides being difficult to say 5 times quickly, an eye stye is a type of localized infection that can occur along the base of your eyelashes or underneath your eyelid.

Styes that form along the base of the eyelashes are called external styes. They typically occur as a result of an infected eyelash hair follicle and look like the type of pimple that occurs when your pores are clogged with dirt and oil.


Styes that form inside the eyelid are called internal styes. Similar to external styes, they are caused by an infection of an oil-producing gland behind the eyelid rather than an eyelash hair follicle. Internal styes result in generalized swelling of the eyelid rather than forming a pimple-like bump.

Stye Symptoms

As a stye develops, you might begin to experience pain and tenderness around the affected area. This can be accompanied by redness and swelling (which may be localized or affect the entire eyelid). Eyelid swelling can cause additional issues, including itchiness, light sensitivity, eye discharge and eyelid dryness.

Styes are contagious, so it’s important that you avoid sharing towels, washcloths, pillows, sheets or blankets with anyone during an active infection. This is similar to the management of another eye infection commonly referred to as pink eye. (Check out our 5 tips on stopping the spread of pink eye.)

Although many people “pop” pimples on their skin to get rid of them, you should absolutely not do anything of the sort with a stye. Avoid contact altogether and let it heal naturally. Or, contact your eye doctor for treatment. If you do come into contact with a stye, wash your hands immediately.

What Causes Styes?

The bacteria most commonly causing the infection is staphylococcal (staph), which is typically found in the nose and can be transferred when you rub it, then rub your eyes. Although staph is the most common bacteria associated with styes, it is not the only one.

Should You Be Concerned?

Styes are relatively common and not necessarily a cause for concern. They typically heal on their own over the course of a few days (similar to pimples). That said, you should consult with an eye doctor if your stye is causing significant pain or discomfort, if you experience any changes to vision, or if it doesn’t go away within a week or two.

Help the Heal

Styes typically go away on their own, but there are a number of things you can do to facilitate the healing process.

One of the most important ways to help is by keeping your eyes clean. Rinse your eyelids with warm water and dab them dry using a soft washcloth or disposable makeup remover. (If you use a washcloth, remember to disinfect it.)

Don’t wear makeup and avoid soaps and shampoos that can further irritate your eyes or cause you to rub them. Once a stye develops, you are encouraged to treat it with a warm compress several times a day for a period of 10-to-15 minutes. This warm compress can help alleviate the itching and generalized discomfort, in addition to helping speed up the healing process.


Dr. Brian Brazzo

If your stye doesn’t go away, you may need an eye doctor to drain it, or treat it with antibiotic cream or a steroid injection. Dr. Brian Brazzo is a board-certified ophthalmologist and fellowship-trained plastic surgeon specializing in ophthalmic plastic, reconstructive and cosmetic surgery who practices in New York City with Pamel Vision and Laser Group.

When it comes to treating Styes, Dr. Brazzo notes “my first choice of treatment for nearly all stye cases I see is an injection of steroid medication.” Dr. Brazzo has not done a formal study on the effectiveness of steroids as a stye treatment, but after treating thousands of lesions, he estimates “that approximately 70 – 80% improved significantly within three-to-four days following injection.”

It’s a Bump, but it’s Not a Stye

An important caveat to note is that not all bumps that form on the eyelid are styes. Chalazia is often mistaken for a stye because it causes a bump on the eyelid resulting from blocked oil glands. Although it initially shares some of the same symptoms as a stye, it can develop into a small, painless, hard lump (chalazion) and linger for weeks or months.

If you have a lump on your eye or any other type of irritation or swelling that you are concerned about, schedule an appointment with an eye doctor for a thorough exam.

Cataract Surgery Leads to Longer Life in Women

Written by
Dr. David Evans
Last modified on September 6, 2018

An article I wrote back in April described a National Bureau of Economic Research study that concluded cataract surgery patients have a life expectancy 1.8 years longer than people with cataracts who do not undergo surgery. Much of that piece focused on the finding that people, who have vision diminished by cataracts, are less likely to be active, and more likely to suffer accidental falls and related injuries. As a follow-on, a new study published in JAMA Ophthalmology suggests an even stronger link between cataract surgery and mortality risk.


About the Study

The genesis of this study was something completely different than evaluating effects of cataract vision loss. Its original purpose was to evaluate the effects of hormone therapy and dietary changes in postmenopausal women. That study was cut short once it was determined that hormone therapy increased the risk of vascular events. Although the hormone therapy aspect of the study was cancelled, investigators continued to collect health-related data on participants through 2015, giving them 20 years of valuable information.

Armed with this long-term information, researchers were able to evaluate almost 73,000 women from the hormone therapy study, aged 65 and older, who had a cataract diagnosis. From this group, the women who died over the course of the 20 year span of data collection were further divided into a study group, focusing on “cause mortality” and “cause-specific mortality.” (Cause mortality refers to all deaths, regardless of cause, whereas cause-specific refers to deaths that occur as a result of a specific disease/illness.) The categories of cause-specific mortality included neurological, cardiovascular, cancer-related, infectious, pulmonary and accidental causes.

Researchers found that the women who underwent cataract surgery had a decreased risk of mortality across the board, to the tune of a 60 percent lower risk of death, compared with women with cataracts who did not have surgery.

What this Means

Although researchers were admittedly a bit surprised by the consistency of the results, regardless of what kind of mortality was considered, the results make perfect sense. “As an ophthalmologist, I was not surprised because I think that people take their vision for granted, and vision helps with functioning in life,” noted Anne Coleman, MD, PhD, a professor of epidemiology at the Fielding School of Public Health, UCLA.

I echo Dr. Coleman’s sentiment, not only because I’ve written previously about the benefits of cataract surgery, but also because of the basic logic at play.

A cataract is a vision impediment that causes contrast loss which cannot be corrected with glasses or contacts. The inability to see levels of contrast impedes a person’s functioning in everyday lighting environments. If you can’t see clearly under most contrast conditions, you are going to be less active and perform less exercise, which can speed up the aging process and create more exposure to disease. Cataracts can also inhibit driving, which limits social interaction, leading to isolation, depression and less mental activity. Vision impairment can also have more direct consequences, such as causing a mix up with pills or other medications, or — as mentioned in my previous article — not seeing obstacles clearly in certain situations, like in a dimly lit closet or while stepping over a curb at dusk.

Dr. Coleman sums things up quite succinctly when she says, “as a clinician, I think it’s one of the best surgeries you can do.”

For more information, check out our slideshow covering 8 cataract truths.

I also invite you to schedule a consultation with a local cataract surgeon to learn more about how cataract surgery can benefit you or a loved one.

New Beneft of Cataract Surgery – EyeWorld June 2018
Understanding the Improvement in Disability-Free Life Expectancy in the U.S. Elderly Population – the National Bureau of Economic Research March 2017

Balance Goggles – A New Approach to Glaucoma Treatment

Written by
Dr. David Evans
Last modified on September 13, 2018

Glaucoma is a leading cause of irreversible vision loss for people over the age of 60. Typically viewed as an age-related vision problem, glaucoma is associated with abnormal pressure levels inside the eye (intraocular – IOP) resulting from a buildup of fluid. (Although in Asian countries, many glaucoma patients do not have high IOP.) There is no curative treatment available for glaucoma, however there are a number of options available to help slow its progression and limit additional vision loss. These treatment methods have typically included the use of medicated eye drops, drugs and eye surgery aimed at reducing IOP.

Given the serious impact of glaucoma and its relative common nature, there is ongoing research aimed at developing new and innovative treatments (I’ve previously written about exfoliation glaucoma research). One such new and innovative treatment that recently caught my attention is Balance Goggles.

glaucoma-410x234.jpgWhat are Balance Goggles?

The Balance Goggles are a first-of-their-kind device aimed at regulating the pressure within the eye. Developed by a South Dakota-based company called Equinox through a research grant from the National Space Biomedical Research Institute Industry Forum, Balance Goggles are engineered to offer a nonsurgical, nonpharmacological treatment for glaucoma.

The goggles themselves are similar in appearance to regular swim goggles. For patients, rather than helping to protect the eyes and help you see underwater, Balance Goggles create a vacuum over the eye that works to lower IOP. An attached tube connects the goggles with a vacuum pump which controls the pressure inside the goggles within 1 mm Hg. The goal is to balance IOP with another type of pressure that has gained a bit more attention in recent years: cerebrospinal fluid pressure (CSFp), the pressure inside the head pushing against the back of the eye.

Cerebrospinal Fluid and Glaucoma

Dr. John Berdahl — Founder and CEO of Equinox — is a specialist in advanced cataract surgery, corneal surgery and glaucoma surgery at Vance Thompson Vision. He is a leading advocate behind the idea that glaucoma could actually be a “two-pressure disease,” those pressures being IOP and CSFp.

The idea of the Balance Google came about in two ways that merged through research. When scuba diving with his wife, Dr. Berdahl wondered why scuba divers don’t get glaucoma as a result of spending so much time in increased pressure. His theory was that the same pressure is being applied all over the body, and that perhaps there was an imbalance at play with regard to glaucoma. This imbalance was confirmed through research by Dr. Berdahl and his team. It was found to cause “cupping” of the optic disc, which could lead to eventual optic nerve damage.

Another idea for the Balance Goggles came about through the NASA program, in which scientists were looking for a non-invasive way to help astronauts struggling with vision loss as a result of long-term space travel. (Believe it or not it’s related.) The issue for astronauts is essentially the opposite of that faced by glaucoma patients. Their CSFp is higher than IOP, again creating a vision-damaging imbalance. Dr. Berdahl thought about how to increase eye pressure to restore balance, and the idea of wearing pressurized goggles was born. And if you can pressurize a pair of goggles to help astronauts, why couldn’t you depressurize them with a vacuum to help glaucoma patients?

What This Means for the Treatment of Glaucoma

The Balance Goggles are certainly a new and innovative approach to glaucoma and its treatment. Although proof-of-concept and in-human trials have been conducted, the device has yet to see clinical trial testing; though it is expected to begin sometime in 2019. Dr. Berdahl certainly has my attention and Better Vision Guide will be following the Balance Goggles as they see more testing and yield additional treatment data.

Noninvasive, Nonpharmacologic, Nonsurgical Glaucoma Therapy – EyeWorld  – Sep 2018
Glaucoma Faces Pressure – American Academy of Ophthalmology – Feb 2016