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Dry Eye Syndrome

Dry Eye Syndrome is a multifactorial disease with a vast amount of symptoms. It is one of the most common diseases diagnosed during an eye exam by an eye care provider, with varying level of degrees, with a plethora of treatment options. 
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Pink Eye

What is “Pink Eye?”
Pink eye is a general term for when the eyes are red or “pink.” The cause of this appearance is often from something causing swelling and redness that leads to irritation of one of the front surfaces of the eyes. Pink eye is also known as conjunctivitis (inflammation of the conjunctiva). The conjuntiva is a thin clear tissue that covers the white part of the eye. When a patient has pink eye clear tissue becomes red from the blood vessels engorging and leaking out blood.
Pink Eye causes many symptoms that can vary widely with how much they affect a person. Pink Eye can cause irritation, pain, light sensitivity, discharge, itchiness, burning, and it can cause blurred and fluctuating vision.

What causes Pink Eye?
There are many causes of Pink Eye. The type that most people refer to as Pink Eye is when it is from a viral infection. Viral Pink Eye is one of the most common causes, and it is very contagious. Viral Pink Eye can be transferred by direct contact with the discharge from the eye, but certain types of viral particles can survive up to weeks on a surface. Viral Pink Eye is most often spread in populated areas like malls, schools, and recreation centers; but it can also sprout from an upper respiratory infection.

There are many other causes of Pink Eye and some of which include allergies, bacterial infections, contamination, sensitivities to medications, and contact lenses. Sometimes, conditions such as Dry Eye Syndrome or Blepharitis can mimic the symptoms of Pink Eye.

What is the Treatment of Pink Eye?
The most important part in the management of Pink Eye is determining what is causing the condition. Diagnosis of the type of Pink Eye is done by eye care providers under a slit-lamp microscopic examination. Depending on the culprit, treatment can include over-the-counter drops, prescription drops, prescription ointments, prescription oral medications, but many times it may have to run its course like a cold.
If you or a friend or family member is having symptoms of Pink Eye it is important to have an eye exam right away. This is to determine the cause and to start the correct course of treatment to help resolve it, as well as to help limit the spread of the infection.
Whenever one has a red eye, he or she should be evaluated by an eye care provider like an optometrist. "Pink Eye" has many causes, and only viewing under a slit-lamp microscope and a careful examination can reveal the underlying cause to incorporate the right treatment. 


“Is my ‘Stigmatism’ getting worse?”
This is one of Dr. Komornik’s most common questions he gets on a day-to-day basis. This is because Astigmatism is one of the most famous eye-related words. If one was to ask a person to name three blinding eye conditions, most would probably say glaucoma, cataracts, and astigmatism.

Astigmatism, although the name is menacing, is a very benign condition with a plethora of treatment options. However, it has caught popularity mostly because it is difficult to say and sounds like a bad eye disease (even though it is not).

Dr. Komornik has a theory that previous eye doctors would use it as a way out for patients with many questions. They may have used it for why a patients vision was still not good with their new glasses, why their vision may feel off, or why their eyes feel tired.  It was a great go-to answer because it sounds like a bad eye disease and patients went with it.
So what is Astigmatism really? Astigmatism is a type of refractive error (which means the light doesn’t focus where it needs to in the back of the eye and requires glasses or another form of correction). Astigmatism is similar to nearsightedness (Myopia: when one can see better up close than far away) and farsightedness (Hyperopia: when one can see better away better than up close).

The cause of these refractive errors just deal with the shape, curvature, and length of the eyes. When an eye has a steep curve or is too long, a patient is nearsighted. When an eye has a flat curve or is too short, a patient is farsighted. When the front curvature of the eye is not a perfect circle (like a basketball), but rather the up and down meridian is steeper or flatter than the side-to-side meridian (like a football), a patient has Astigmatism.

Due to these different focusing powers across different areas of the eye, the light is focused to two different planes in the back of the eye on the retina. Without glasses or contacts to counteract the Astigmatism, the result is blurred vision, double vision, a shadow image, and or eye strain if a patient overstrains to try to make the vision clear. So, without correction Astigmatism is an ocular ailment that can be frustrating for patients because it can cause many symptoms.
However, Astigmatism can be easily fixed with glasses! Glasses can be made such that the curvature of the lens counteracts the curvatures of the eye so that the light goes in straight and focuses on one spot in the back of the eye to obtain clear, single, and sharp vision. In higher degrees of Astigmatism, a patient’s glasses may cause distorted vision or other problems; especially when the patient looks at an angle out of the glasses like way off to the side.

Contact lenses can also be used for many patients with Astigmatism by utilizing the same principle. Although, contact lens prescriptions are not as adjustable as glasses, so often a prescription that is “close” to the correct powers will be utilized. The trade-off is the vision may not be as sharp as compared to glasses, but the patient will be free of having a frame on his or her face and will not get any distortions from the lenses.

People with astigmatism need glasses or contact lenses that counteract the astigmatism. For example in glasses, in addition to fixing any nearsightedness or farsightedness, they will have less power in the same meridian the eye has more power: to neutralize it.

So although Astigmatism has a lot of hype from the media and from its history, it is a very manageable condition. It does lead to some difficulties in its correction. These difficulties include the following:
  • contact lenses that correct Astigmatism often have to be a larger diameter so may not be as comfortable as spherical contact lenses
  • Contact lenses for Astigmatism do not come in as wide of parameters as do glasses, so the vision may not be as perfectly sharp
  • If the amplitude of Astigmatism is high, looking out of the side of eyeglass lenses may result in distorted vision or eye strain
  • Patients that need help with vision far away and up close do not have as many options for multifocal contact lenses that also correct Astigmatism
  • High degrees of Astigmatism may not be able to obtain the perfect eyeglass or contact lens prescription, and even being a small degree off on the axis or power can cause some shadowing of the vision or slight blurred vision
  • Extremely high degrees of Astigmatism can be an early sign of a corneal disease like Keratoconus.
  • High amounts of Astigmatism may make a patient a poor candidate for LASIK or Orthokeratology
Dr. James Komornik and staff at Sea Eye Care have various instruments which can measure the front curvature of the eye, produce elevation maps of the front surface of the eye, and perform digital refractions to determine if a patient has Astigmatism, and the degree of the condition. Dr. Komornik will go over the different treatment options, and together the best modality will be implemented to help patients see clearly.

Diabetic Eye Care

What is Diabetes and how can it affect the eyes?
Diabetes is when a person’s body does not use sugar (glucose) in the correct or efficient ways. Insulin allows the body to utilize sugar for energy. In patients with Diabetes, the insulin the body makes may not work properly, or the body may not produced enough of it.

If Diabetes is not managed properly, it can result in a lower utilization of sugar in the body, and rather the sugar stays in the blood. When the sugar stays in the blood, tissue in the body does not receive its energy source. This can result in damage to the tissue from having too little sugar, but also the blood vessels can be damaged from having too much sugar.
Diabetes results in damage to small blood vessels, typically. These tiny blood vessels can only be seen in one place in the body: the back of the eyes. Eye care professionals can directly visualize these small blood vessels and determine the status of the blood sugar affecting the retinal (back of the eye where the light receptors are housed) blood vessels. Because of this, eye doctors play an important role in helping Primary Care Doctors and Endocrinologists with the management of their patients diabetes, since eye doctors can visualize the direct impacts of the blood sugar.

The standard of care for patients with Diabetes is to have an annual dilated eye exams, and often times the exam maybe required on stricter intervals. Primary Care Doctors and Endocrinologists utilize many different avenues of information to determine if the treatment level is adequate in patients with Diabetes. They utilize fasting blood sugar readings, a measurement of the average blood sugar over a three month period (HbA1C testing), organ functioning, and many other means to ensure blood sugar in patients with Diabetes is under control. The report from an eye exam is another piece to the puzzle that those doctors utilize in patients’ care.

How will Diabetes show up in the eyes?
Diabetes can damage the eyes in many ways. Sometimes, patients will not eve have the diagnosis of Diabetes, yet eye doctors will see signs of the condition. This is just one of many reasons to have regular eye exams. The main way Diabetes can manifest during an eye exam is by causing leaky blood vessels in the back of the eye. The back of the eye is where the retina is which includes the light receptors that help us see. Small portions of blood vessels can start to leak from damage to the blood vessel wall from the blood sugar. Little areas of leaking blood vessels may not cause vision problems, but larger areas can result in swelling in the retina that can cause blurred or distorted vision.

Outside of bleeding/leaking spots, Diabetes can impact the eyes in many other ways. Some of these include premature onset of cataracts, worsening of already present cataracts, reduced oxygen flow to the retina and or optic nerve, retinal detachments, dry eye syndrome, and glaucoma.
Dr. James Komornik at Sea Eye Care performs thorouh dilated eye exams, retinal photography (high resolution pictures of the retina in the back of the eye), and optical coherence tomography (a layer-by-layer scan of the retina). These tests are the standard of care for patients with Diabetes and will show the earliest onset of signs of high blood sugar damaging the eye. When early signs are caught they can be communicated with Primary Care Doctors and Endocrinologists such that changes in treatment may be implemented per the doctors expertise. Dr. James Komornik makes it a promise to any patient or doctor that the results of the testing will be sent out the same day of the diabetic eye exam so the co-managing doctors are always up-to-date.
Note the blood components (white and red) that have leaked out of the blood vessels. This is a common finding in patients with diabetes. This is an important finding for eye care providers to communicate with primary care doctors and endocrinologists for them to factor in on treatment decision making. Diabetes can also affect the eye in worse ways, that needs to be ruled out at least annually by an eye doctor. 

Digital Eye Fatigue

Eye doctors have started noticing a new group of symptoms associated with the use of phones, tablets, computers, and other digital devices. This new condition is now known as Digital Eye Fatigue (DEF), Digital Eye Strain (DES), or Computer Vision Syndrome (CVS). The American Optometric Academy describes DEF as "the complex of eye and vision problems related to near work which are experienced during or related to computer use."

The symptoms of DEF include irritated eyes, dry eyes, the eyes feeling tired, eye strain, burning eyes, light sensitivity, fluctuating vision, and trouble adjusting from viewing near to far distances (to name a few).

DEF is something eye doctors see on a daily basis due to the more regular use of digital devices. A study showed 90% of workers who use computers for more than 3 hours in a day experienced Digital Eye Fatigue.

The other factor in Digital Eye Fatigue outside of computers and laptops, is the use of smartphones. Cellphone use has increased dramatically as more functions have been added to their capabilities so that cellphones are truly portable computers. Now almost everyone has a smartphone.

Screen time on digital devices has increased dramatically since people use both computers and smartphones on a regular basis. Studies show that smartphone users check their phones on average 150 times per day!
Although the backlight of these devices includes all different colors (wavelengths), with most devices the main wavelength utilized for the backlights on digital devices is of the blue wavelength spectrum. Blue wavelengths of light are more susceptible to scattering. This is why the sky is blue, because of something called Rayleigh’s Phenomenon in which the blue wavelengths hit light particles in the atmosphere and scatter so that they become more apparent. When light scatters in the eye it can lead to eye fatigue and glare because it disrupts the normal visual processing functions.
The symptoms of Digital Eye Fatigue can be broken down into two main categories: Binocular Vision Fatigue and Dry Eye Syndrome.

Binocular Vision Fatigue relates to the tiring and wearing out of the muscles that keep our eyes aligned and properly focused to see clear, single images. The symptoms include tired eyes, eye strain, difficulty changing the distance of focus, double vision, heavy-feeling eyes, and blurry vision. There are eye disorders that can cause similar symptoms to DEF including strabismus (eye turns), convergence insufficiency (limited ability to turn the eyes inwards), accommodative insufficiency (reduced ability to focus the eyes), oculomotor dysfunction (trouble with eye movements), and many others. However, DEF can cause these symptoms even in a patient that has no history of these disorders and their eyes are aligned, focus properly, and make normal eye movements. Patients can even have up-to-date glasses and perform perfectly when we test their Binocular Vision system, but due to the high stress of computer work the visual system can become fatigued. Eye doctors have to first rule out other eye problems before we can attribute these symptoms to Digital Eye Fatigue.

DEF causes Binocular Vision symptoms due to overworking the eye muscles that focus the eyes, locking the muscles that turn the eyes inwards for near viewing too long, and because of the high visual demand of computer work looking at small letters and subtle changes in contrast. Even small changes in glasses prescriptions (refractive error) that normally would not cause symptoms can be exacerbated at these times.

Symptoms of dry eyes, irritated eyes, red eyes, watering eyes, itching and burning eyes, and even contact lens discomfort can be associated with DEF as well. This stems from the fact that we don't blink as much when doing near work. When a person blinks, the eyelids spread new layers of tears across the eyes. Studies show patients should blink 20-22 times a minute, but when doing near computer work we blink only 5-7 times per minute. With reduces blinking comes less tears placed on the eyes. Without a fresh coat of tears at regular intervals, the eyes can dry out and cause symptoms.
Do your eyes feel dry or tired when looking at a computer or other digital device too long? Come have a Digital Eye Fatigue evaluation at Sea Eye Care. During the exam we will check your eye muscle function, evaluate your focusing system, check your glasses prescription, and look for evidence of Dry Eye Syndrome. After the information gathered during the evaluation, we can determine a proper treatment based on the findings. Treatment of DEF can include ergonomic recommendations for monitor placement and backlight settings, glasses made for you to wear solely at the computer, a change in lens material and or  anti-reflective coating, tint recommendations like amber or blue-blocking designs, intervals to take breaks and rest the eyes, eye exercises, and different levels of dry eye therapy based on what we see.


What is Glaucoma?
Glaucoma is an eye condition that most people have heard the name of, but few know what it is. Glaucoma is when pressure inside of the eye damages the optic nerve. The optic nerve is like a cable that connects the eye to the brain, so that we can interpret what information goes in to the eyes. Dr. Komornik often relates it to a cable that connects the TV to an outlet. If there was pressure or some force pushing on that cable: it could damage it. The same thing happens to the cable in the eye.

When there is damage to the optic nerve it disrupts the communication between the eye and the brain. So even though the light receptors and the brain still work fine; the communication between them does not.

The tricky thing with glaucoma is that it does not cause any symptoms in the early to moderate stages. Our eyes and visual pathway were made in a genius way in that they have many lines of extra communication for back-up. So even if there has been a good amount of damage to the optic nerve, the vision may not be affected. There is often no pain, irritation, burning, itching, blurred vision, redness, or any other symptoms in early to moderate stages of glaucoma.
Early glaucoma’s damage to the optic nerve results in death and subsequent thinning out of the tissue. This thinning out can be seen by an eye doctor looking at the optic nerve with a dilated eye exam, or by a scan of the back of the eye that measures the thickness of the nerve (called optical coherence tomography). Often, when someone is told they are a glaucoma suspect it is because his or her nerve looks thin.
Eventually, in later stages of glaucoma, the side/peripheral visual field can be affected. Even in these stages often patients will not have symptoms. This is because the brain is extremely smart. Despite possible chunks of side vision being absent for a person, the brain will smooth over the image so they will not notice it. Again, glaucoma is often an asymptomatic condition.

By the time glaucoma causes symptoms that a patient can acknowledge, it is often very late in the disease process and difficult to control. Glaucoma will cause larger areas of the side vision to become reduced so that the brain cannot smooth over the image over any longer. Eventually, glaucoma can affect the central vision as well and potentially be a blinding condition if not caught early and managed appropriately.

At Sea Eye Care, Dr. James Komornik and staff have all of the equipment and technology necessary to not only catch glaucoma at the early stages, but also to manage and follow it appropriately over a lifetime to prevent it from causing significant vision loss. Dr. Komornik always says that glaucoma has a “train down the hill effect.” This means that if caught early it is at the top of the hill and has not picked up much speed and is easier to manage, but when it is at the bottom of the hill it is going very fast and is more difficult to treat. Because of this, it is recommended that everyone have an eye exam every one to two years even if they have no symptoms, do not wear glasses, and overall have no problems with their eyes. This is for ruling out asymptomatic conditions like glaucoma. Come to our office located in Norfolk near Virginia Beach and the Chesapeake Bay Bridge Tunnel for a comprehensive exam today to rule out the need for a glaucoma work-up.
Pictured is a normal, healthy optic nerve. Note the light orange area with the white center. This is the optic nerve. The light orange is the nerve tissue, and the white area is empty space- a hole. The orange tissue makes up the majority of the nerve which means the tissue is thick and healthy. 
This photograph shows an unhealthy optic nerve that is affected by glaucoma. Note how the light orange, nerve tissue is very thin and the hole in the middle is larger. This shows pressure in the eye has damaged that tissue to cause it to thin out, as more thinning occurs- more vision is lost.   


About Floaters
    "Floaters” are a very common symptom patients have. Floaters are something a person perceives in their vision that looks like a grey, black, or clear spot, shadow, string, or cobweb-like appearance. There are a few different types of floaters.

    The main cause of floaters are from a gradual breakdown of the jelly (vitreous) that fills the eye. When this jelly breaks down it forms water pockets. If a water pocket goes in front of the central vision a person will notice the shadow it casts on the back of the eye where the light receptors are located. This shadow is the floater.

    Since the floater is inside of the eye, when a person notices it and tries to look towards it, the floater will move with the eye and thus it moves away, so it is very difficult to directly view floaters.

    These types of floaters are often very annoying for patients because they can obscure vision and make it seem like something is there (like a gnat flying around), but from a health standpoint they are not a problem.

    The second type of floaters that is also a normal change that comes with having birthdays is due to the vitreous jelly in the eye pulling off and detaching from the retina. This is normal and it happens to everyone eventually. Essentially, as the first type of floaters form (from the water pockets), the jelly itself starts to shrink in size. As it shrinks, it begins to pull off of the back of the eye (the retina). Eventually, where it was most strongly adhered will also pull off of the back of the eye. This tissue is more dense and is thicker than other former areas of adhesion. Thus, when that area pulls off it forms what many patients describe as a "new" or "different" floater. It is often darker in appearance and can be larger than the first type. This type of floater, again, is also normal, but it can lead to problems with the retina. As the jelly continues to pull off the other areas of the retina, sometimes, it can pull a piece of the retina with it or cause traction on the retina. These changes can result in retinal holes, detachments, tears, and fluid in the retina. Typically, when someone has this type of floater they will be brought back in six weeks for a re-evaluation, because that is typically how long it takes for the rest of the jelly to pull off the back of the eye and is when patients are at the highest risk for a retinal problem. 

Other causes of floaters may not be as safe as the aforementioned. The bad types of floaters can come from problems with the retina (where the light receptors are in the back of the eye). These problems can include holes, tears, detachments, inflammation, or even tumors in the back of the eye. This is why it is important to have an eye exam right away if a person has floaters for the first time or new floaters that weren’t there before. Patients with these problems often have other symptoms that coincide with floaters like flashes of light, streaks of light, a curtain of darkness or blurriness coming across their vision, or a loss of vision.

Treatment for Floaters
    The “normal” causes of floaters (where it is from the jelly forming water pockets) do not require treatment. This is because they are benign in nature and the fix for them is a very invasive surgical procedure that is prone to complications. Although floaters can be very annoying at first, over time the brain learns to ignore them. Most people will still notice them in bright settings or looking at white backgrounds, because this allows the shadow casted to be more prominent. Floaters may also settle to the bottom of the jelly over time where they will not impact the line of sight or resolve on their own.

    The bad conditions that result in the symptoms of floaters’ often have various treatment options. However, the treatment depends on what the underlying cause is, and many times the management does not have an ideal prognosis. 

The most important part of the management of floaters is determining the cause of them. A thorough, dilated eye exam from an eye doctor like Dr. James Komornik is necessary to determine reason behind the floaters. Most instances do not require a surgical fix, but it is of the utmost importance to catch those cases early. Dr. Komornik can determine the correct treatment approach for your floaters. 
Pictured is how floaters can be viewed by eye care providers. 
This is a picture of a thin area of the back of the eye (lattice degeneration) that many people have with no symptoms. This thin area puts a patient at risk for a retinal detachment. If one was to look closely: note there are already retinal holes forming on the lattice degeneration. 
Imaged is a retinal tear and retinal detachment. These are other, more pathologic, causes of "floaters." These possible complications are why it is extremely important to communicate new floaters with an eye care provider so that a thorough examination can be set up to rule out these finings.


About Blepharitis
    Blepharitis is the most common eye condition in the world. It is inflammation along the eyelid margin, eyelid glands, and eyelashes. Blepharitis can occur in people of all ages, and it can have varying degrees of symptoms.

    There are many causes of this inflammation. It is important to know that there are bacteria all over our body (in our skin, in our gut, and you guessed it- in and along our eyes). These bacteria are what are known as the normal flora, and they are “normal” to be in these places and are not an infection. Often blepharitis is from a person’s immune system overreacting to the normal flora around the eyelids. Other times, the normal flora overpopulate around the eyes to result in blepharitis.

    The body reacts to infection by sending inflammation. In blepharitis, the body sends this inflammation because of the normal flora and it results in redness along the eyelid margin, clogging of the oil tear glands around the eye, flaky material accumulation along the eyelashes, redness and irritation of the eyes, and tearing of the eyes. Crust along the eyelashes in the morning is very characteristic of blepharitis.

    Symptoms of blepharitis include eye irritation, burning, dryness, dull pain, soreness, tired eyes, and light sensitivity. Blepharitis often will have “flare-ups” of excessive irritation from time to time. During a flare-up, it can cause a form of pink eye, it can cause excessive dry eye, or it can result in a stye (hordeolum).
    There are many forms of treatment for blepharitis. The treatment depends on the examination findings as well as the patient’s symptoms. Some patients have no symptoms at all, while others are miserable because of the blepharitis. The baseline treatment includes eyelid hygiene. Eyelid hygiene includes removing the flaky material and the bacteria from the eyelids and eyelashes with scrubs, shampoos, and or foams. Baby shampoo has been used in the past as it is safe to use around the eyes and can work well, but often over the counter scrubs and foams are a preferred treatment.

    At Sea Eye Care we recommend Oasis products as they have a proven track-record for helping patients with Blepharitis. Warm compresses are also utilized as it heats up the oil glands that get clogged in Blepharitis, to help secrete the tear film better.

    When baseline treatment of eyelid hygiene does not work, often times the next lines in treatment are required. Prescription eye ointments, eyelid scrubs, oral medications, or in-office procedures like Lidpro are utilized to help limit signs and improve symptoms.

    Many times these next measures are needed during a flare-up of blepharitis. As a baseline, or if baseline treatment is not working, give Sea Eye Care’s Norfok/Virginia Beach office a call to get scheduled for an evaluation today.