One recommendation is to use a server – client configuration. We started with a peer-to-peer network in 1992 and it’s time to make the change in preparation for electronic medical records.

One OfficeMate recommended server is a Dell PowerEdge T310

• Budget around $3500 nicely equipped with redundant power supply, faster RAM and a Raid 5 array of 3 HDD’s spinning at a supersonic 15,000 RPM. I think one could cut $400 or so with base equipment.
• Expect a build and transit time of up to 45 days until delivery.

OfficeMate recommends having a good IT guy set up your network. This is good advice if you don’t wish to go much of the hassle.

Tip Only for the Tech Savvy

If you are very experienced with your gear and willing to learn and explore the changes you need to make to go from a peer-to-peer to a server based environment, Paul Thurrott’s Supersite for Windows has a Windows 7 tip of the week that may save you money.
If you are the guy that sets up and fixes your own computer network, You are an IT guy. Microsoft has a program to invite IT folks to explore and experiment with their Microsoft’s software. Microsoft Technet Plus subscription can save $$$ for IT guys. Read his post to learn more. There is a discount at the bottom of the post you can take advantage until June 30, 2010.

Ophthalmic Optics can have some complicated equations.  We we see patients, there are times when a contact lens for astigmatism does not perform the way we predict.  We perform a measurement of the blur called an over-refraction and mathematically combine the result with the prescription to predict the next lens power that would work.  Before this utility was developed, we would have to do the math by hand or set up lenses together and use a machine called a lensometer to predict the next lens.  X-Cyl does the math for us so a doctor can just enter the variables and click on the answer.  It became wildly popular because it was faster, more accurate and free.  We wrote the software as a fun project and to help other doctors.

We wrote another program called ImageRx.  This calculator helps doctors design lenses that are equal in magnification.  Some prescriptions can generate headaches, eyestrain and double vision if the powers before each eye vary by too much.  To minimize the difference, we can vary the design of the lens such as the power, the fitting distance, the thickness and the curvature and refractive index to achieve an equal magnification.  This involved even more difficult calculations than what X-Cyl solves.  Before ImageRx, most doctors would would rely on nomograms.  ImageRx streamlines the design process and ensures mathematical accuracy to allow the eye care professional to try differing variables to solve their design challenge.

Both software have been updated to run on 32 or 64 bit operating systems.  They have been tested to run on Windows XP, Windows Vista and Windows 7.  Both are free and can be downloaded from our practice website.

Click on the icon to download.

X-Cyl Toric Crossed Cylinder Calculator
(version 1.20)

Updated for 32 or 64 bit Windows use, New tooltips and a clear button for faster, easier use.

ImageRx Anisekonic Lens Design Calculator
(version 1.20)

Updated for 32 or 64 bit Windows use, Calculate both lenses together now for easier use.

The epithelium doesn’t attach to the cornea after an injury.  It is loose and easily torn off.  Normally the epithelium should attach back to the cornea.  When this part of the eye is injured as from a scratch, an abrasion or a foreign body, the epithelium should grow back, seal down to the cornea and heal in a quick manner.  The epithelium of the cornea is one of the quickest healing tissues of the body in fact.  The presumably healed epithelium may cover the injury site and even appear normal  even with a microscopic view.

This condition is considered a dystrophy which means the tissue doesn’t work the way it should.  In this case, it doesn’t heal properly.

This can be a very frustrating condition for patients to endure.  They will report a sensation that a foreign body must still be present even though it was completely removed earlier.  This feeling of pain can be quite intense.  Extreme sensitivity to bright light can occur also when this problem is at it’s worst.  The patient swears something is still there and will even doubt that the doctor got the foreign body out – suspecting that another must be present or that the doctor must have missed something.

What is happening is that the epithelium moves with each blink.  The blink moves the loose epithelium, healed but not attached over the cornea. The epithelium rubs against raw nerve endings giving the sensation of a persistent foreign body with each blink.  Doubt about the health care provider’s competency may enter the patient’s mind especially if previous foreign bodies never produced such a problem.  ”This used to always get better,” or “I’ve had these injuries before and they healed up quite quickly in the past,” are common statements made by some.

Patients with Recurrent Corneal Erosion may often seek several opinions for their condition if they feel their current doctor does not appear to be efficiently healing their problem.  They can move from doctor to doctor in frustration.

RCE can be difficult to treat because it recurs.  A patient may carefully follow the correct treatment and suddenly lose all their success upon awakening one morning in pain – the epithelium rubbed off because of dryness of the eye causing the upper lid to adhere to the epithelium, ripping it when the eyes are first opened upon awakening.  The can occur over weeks – even months.

We find that the treatment needs to be customized to each patient.  A strategy for one patient may not necessarily work for another.  The treatments we try include:

Artificial tears: Many times a day.  Usually more is needed than the patient can attend.  One drop even once an hour or more often may be necessary.

Nighttime Ointment:  A bland ophthalmic ointment such as Lacrilube or Refresh PM instilled into the eye helps to prevent nighttime drying – which may be the most common reason for recurrence.

Hypertonic saline solution such as Muro 128 5% by Bausch and Lomb is a salt water drop that is 5 times more salty than our natural tears.  The extra salt of these drops can draw fluid trapped between the epithelium and the cornea to help the epithelium adhere to the cornea.  This drop may be needed several times a day and can sting upon instilling.  An hypertonic ointment at night may also be prescribed.

Bandage contact lenses may help by fitting tight against the cornea preventing the epithelium from moving.  This can allow the epithelium to stay still long enough to adhere.  For some people, a bandage contact lens may not work or seem to worsen the condition.  Studies have demonstrated that snug to tight fittting lenses can work best.  However a dry eye condition itself can make a lens uncomfortable.

Patching of the eye can be used if a bandage contact lens does not work.  Patching for some people  however may feel worse in a way similar that the bandage contact lens didn’t work.

Debridement is a procedure that removes the loosened epithelium.  A very light scuffing of the cornea may roughen the surface enough to allow the epithelium to grow back attached to the eye.

Anterior stromal puncture accompanied with debridement places a grid of tiny anchor points for the epithelium to attach to the cornea as it grows back.

Ocular comfort drops is a recent development.  A formulation of dilute anesthetic was recently discussed at an ocular disease conference.  Only 10% the strength of normal anesthetic, it’s weak enough to prevent toxic effects but allow patient comfort until healed.  This requires careful follow up to prevent complications and can only be used for a very select few conditions.  We have had excellent results with this option.

Time is a critical component of any treatment of this condition.  Days may run into weeks which run into months.  Setbacks may occur frequently requiring we begin from the beginning all over again.  The good news is that most patients do get the upper hand in successfully managing this condition and achieving a complete healing – although it took longer than they wish.

If you suffer from this condition you have our sincere empathy and understanding.  Persistence on your part will pay off in overcoming this often painful and nagging healing problem.  We dedicate ourselves to staying with you during thick and thin in helping you achieve a normal life.

This type of strabismus is called a left intermittent hypertropia.  There is a deviation of the left eye upward.

Most images show Lincoln’s eyes pointing straight which suggest the problem was not constant.

The image above is probably amongst the most well known of Lincoln portraits and also one which shows the problem.  His left eye is deviating upward slightly revealing more of the white part of his eye (the sclera) than in his right eye which is looking into the camera.

Another image illustrates the problem – perhaps more so.

Most other portraits of Lincoln show a head tilt to the right which could be a compensation for the relative weakness of an extraocular muscle producing the deviation.

Finally, what if one applied colorizing technology to Lincoln’s portrait?  You may come up with this result.  Coloring of an image taken by Alexander Gardner on February 5, 1865 and colorized by James Nance for the Abraham Lincoln Art Gallery.

His head tilts to his right slightly.  What impact does this image bring to you by adding color?

Correction Options for Presbyopia
Eyeglasses have been the most popular and most efficient form of correction.  Contact lens options are also available to help compensate for the natural loss of focusing ability.  A careful evaluation of your vision needs is performed to see what type of challenges you have, what distances do you need to see clearly for, whether you work at a video display terminal for long periods of time and the general environmental conditions of your work such as  lighting and or even the humidity of the workplace.  Your hobbies and leisure activities may be evaluated as well.

Bifocal Contact Lenses
Have specialized optics to create a lens which has more than a single power.  The designs include simultaneous vision and alternating vision lenses.  Bifocal lenses are limited in the availability of parameters so not every patient may be a good candidate.

Simultaneous vision lenses provide a focus on the retina for objects at near and for objects at distance at the same time as illustrated below.  Contacts are available in soft and rigid gas permeable materials. Simultaneous vision lenses have areas of the lens with differing powers.  Designs have one power for near and a different power for distance.   This can occur in two distinct areas as shown on the left, alternating zones as in the center, or it may gradually change as shown on the right.

Simultaneous vision lenses have areas of the lens with differing powers. Designs have one power for near and a different power for distance. This can occur in two distinct areas as shown on the left, alternating zones as in the center, or it may gradually change as shown on the right.

Alternating vision lenses are more like traditional bifocals with the lower portion of the lens providing the near power.  Since we tend to look down as we view things at near, the contact lens must be able to move into proper position in order to work effectively.  Currently, lenses are available in rigid gas permeable materials only. When viewing objects in the distance, the line of sight passes through the top section of the contact.  When viewing near objects the line of sight passes through the bottom section of the lens.  Alternating vision lenses may not work well for people with loose eyelids or irregular corneas.

When viewing objects in the distance, the line of sight passes through the top section of the contact. When viewing near objects the line of sight passes through the bottom section of the lens. Alternating vision lenses may not work well for people with loose eyelids or irregular corneas.

Visual Phenomena Common to Presbyopic Correction with Contact Lenses…
You may notice an occasional fuzziness surrounding an otherwise clear object.  We call this effect ghosting or halos.  One of the most common side-effects is a perceived blur of a bright object such as a headlight against a dark background.  This glare at night can be eliminated by exchanging the near contact lens for a distance contact lens or through the use of special glasses designed to be worn for specific tasks such as driving.  Bifocal contact lenses may not be optimal for nighttime use and should be worn with caution while driving in the dark.  Monovision may require the use of a supplementary glasses for specific conditions.  Prolonged near activity (computers, needlepoint, form-work), night-time driving, or continued concentrated distance viewing (piloting, truck-driving) are examples.  Eyestrain or headaches which occur at near may indicate a need for a change in the power of the prescription or the need for special eyewear.  Call the doctor at our office to see if any fine-tuning to your specific needs is required.

Monovision

In monovision your doctor designs a contact lens prescription which allows one eye to remain clear for distance viewing while the other eye remains clear for near viewing.  This prescription is determined after a careful evaluation with you in which your visual needs are assessed for the best work, leisure and driving performance with the contact lenses.  Monovision allows the use of traditional contact lens designs. Monovision places your vision under new viewing conditions for combined near and distance viewing.  If you cover one eye you will notice that it will be more clear for the distance but not for near while the opposite will be true for your other eye.  With time, your brain should automatically select which eye is to be used.  This adaptation period lasts 2 to 3 weeks for most patients.  You should be especially careful in all your daily activities (i.e., driving, using curling irons, moving pots and pans on the stove) while you get used to your prescription. Monovision offers a compromise between the best vision possible with bifocal eyeglasses and the freedom from being dependent on some pair of reading prescription.  Some patients may require glasses to work over contacts for extended or critical near or distance tasks.

Modified Bifocal / Monovision
Is a fitting technique which utilizes both bifocal contacts and monovision.  Is a method which helps to fine tune a bifocal contact lens prescription to work better at distance or near.  The lens power is modified to enhance near or distance vision according to the needs of the patient. Sometimes only one bifocal on an eye with the other eye set for distance vision may be all the vision correction which is needed.

Contact Lens Tips
Wear your contacts when you go to see the doctor for progress checks.  It is important to see the lens after several hours of wear on the eye unless discomfort is severe. Because contact lenses are medical devices, yearly eye exams are required to check the health of the eye when wearing contact lenses.  New contact lenses can not be dispensed if you are past due for a check up.

• Comprehension reduces as reading continued: loses interest too quickly
• Mispronounces similar words as continues reading
• Blinks excessively at desk tasks and/or reading; not elsewhere
• Holds book too closely: face too close to desk surface
• Avoids all possible near-centered tasks
• Complains of discomfort in tasks that demand visual interpretation
• Closes or covers one eye when reading or doing desk work
• Makes errors in copying from chalkboard to paper on desk
• Makes errors in copying from reference book to notebook
• Squints to see chalkboard, or requests to move nearer
• Rubs eyes during or after short periods of visual activity
• Fatigues easily; blinks to make chalkboard clear up after desk task

Accommodative Insufficiency

Accommodative insufficiency occurs because of the eye can not maintain clear vision at near.

Ill-Sustained Accommodation

Ill-sustained accommodation is similar to accommodative insufficiency except print may initially appear clear and easy to read without effort.  With time, the task at near begins to require more effort to focus.  Blurred vision, eyestrain and headaches can occur with sustained effort.  A simple visual acuity test at near (as what is frequently done during a vision screening) will usually not detect this problem.

Normal Focusing

Our focusing system is usually quite fast at focusing.  Most people can focus at near in about 1/5 of a second as simulated above.

Accommodative Infacility

With accommodative infacility, there is a delay in the clearing of the print.  The simulation above shows how a student with this problem would be slowed.  Copying information from a chalkboard to your desk is a frequent activity in a classroom.  It takes the student longer to obtain and transfer the information.

For all of the above problems, lenses or vision therapy or a combination of both may be prescribed.  The success of treatment is quite high.  A few cases may require only short term use of lenses or vision therapy while others may have a need throughout their youth for this type of help.

Convergence Insufficiency can produce visual symptoms which also include blurred vision, double-vision, or jumbling and scrambled print as you try to read.

Causes

Convergence insufficiency occurs because of poor eye-teaming ability.  Initially when we view something up close the lines-of-sight from each eye should cross directly where we look at.  A tendency for the eyes to want to drift outward is present in individuals with this disorder.  In order to to keep the image clear and single, more effort is required in order to concentrate on the task.  This ever increasing effort is taxing and soon results in symptoms.  This disorder can run in some families.

Symptoms

Blurred vision at near, eyestrain while doing near work, headaches, sleepiness while reading, double-vision, frequent loss of place when reading,  inaccuracy while checking columns of figures or lists are common complaints.  Severe cases can result in an eye turn.

Diagnosis

A complete and thorough vision exam is required in order to detect this disorder.  During this exam tests must be performed at a near distance in order to measure the eyes tendency to drift and how much ability the eyes have to compensate for this effect.  If not performed this disorder can be missed by the doctor.

Treatment

1. Vision therapy is by and far the most successful treatment available for convergence insufficiency.  The goal of therapy is to build eye teaming ability to a level necessary to overcome the outward drift tendency.

2. Prism incorporated into an eyeglass prescription is a second option.  Success with this form of treatment is much limited than with vision therapy.  Very often adaptation to the new prescription occurs and the convergence insufficiency returns.

3. Alternatives include ocular muscle surgery however most experts do not support this mode of treatment today except in unusual cases.

Video on Convergence Insufficiency

This video reports on results from a study by the National Institutes of Health / National Eye Institute on the treatment of convergence insufficiency.

1. Check to see if the lens is inside-out or if it is correct.
2. Place the lens on the tip of the index finger of your right hand.
3. Pull up the upper eyelid with your left hand.
4. Pull the lower lid down using the middle finger of the right hand.
5. Look upwards, and place the lens on the white part of the eye.  Release the upper lid and blink.  The lens should center automatically.
6. Using the opposite hands place the other lens on the eye.

WEAR SCHEDULE
Your eyes require an adaptation period to adjust to contact lens wear.  Usually, the doctor will prescribe a wear schedule of 4 hours on the first day and increasing by 2 hours per day of wear (e.g. 4, 6, 8, etc. hrs).  Do not wear your lenses more than 12 hours until you have had your first progress exam.  At that time your doctor will let you know how long you should wear your lenses.  Be sure to wear your contact lenses to your progress exams unless you are having problems wearing them continuously.  Bring your glasses and contact lens case also.

REMOVAL OF LENS
Before removing your lenses, wash and rinse your hands  thoroughly.  Have your contact lens solutions and storage case opened and ready to receive the lens.

1. Look upwards and pull the lower lid down.
2. Using the right index finger, slide the lens onto the white part of the eye.
3. Press the lens gently between the thumb and index finger, and remove the lens from your eye.
4. Clean  and rinse the lens and place it in the storage case.

CLEAN
Daily cleaning of your lenses is necessary to remove tear residues, mucous films, lipid coatings and other foreign substances that accumulate on the lens surfaces.  Clean your lenses every evening after you have removed your lenses for the final time.

1. Wash your hands before handling.
2. Place the lens in the palm of your hand and place 1 drop of the prescribed daily cleaner or multipurpose solution on the lens and 1 drop on your hand by the lens.  Rub the lens with a small amount of pressure in a side-to-side and back-and-forth motion (do not go in a circular motion).  Clean each side for 25 seconds in this manner, invert the lens and repeat for the other side.  Instead of cleaning, disposable lens wearers should rub the lens with the multipurpose solution they are prescribed.

RINSE
After the cleaning process, place the lens in your free hand and rinse the soapy hand with tap water.

1. Place the lens in the palm of your hand and squirt the prescribed saline or multipurpose solution to the lens for several seconds.  Drain the excess solution and repeat 1 or 2 more times.

DISINFECTION
The disinfection cycle keeps your lenses free from harmful bacteria and other germs.  Disinfecting the lenses regularly reduces the possibility of contamination or eye infection.  This procedure is performed in addition to your daily cleaning procedure.

1. After cleaning and rinsing your lenses fill the storage well with the prescribed disinfecting or multipurpose solution to the fill line.  Place each lens in its appropriate well and close the cap.  Allow the lenses to sit overnight.  THE MINIMUM TIME FOR DISINFECTION IS SIX HOURS in most cases.
2. Rinse with the prescribed saline solution prior to lens insertion.  Discard the remaining solution from the container and wash the case so it is clean for the next use.

NOTE:
a)  AOSEPT systems utilize a catalytic disk to neutralize the disinfection solution.  These disks must be replaced each 3 months or 100 uses whichever comes first.

ENZYME
The enzyme procedure is designed to remove the protein buildup from your contact lenses which the daily cleaning solution does not remove.  Enzyme cleaning keeps your lenses cleaner, makes them more comfortable to wear and keeps the oxygen transmission at its highest level.  This procedure is performed in addition to your daily cleaning procedure.
Enzyme your lenses as recommended each week.  This is done just after daily cleaning and before you disinfect for the night.  Add one enzyme tablet to the contact lens solution in the appropriate container.  Allow to sit up to 2 hours and then use the daily cleaner again for maximum cleaning effect.

CARE TIPS

1. Use only the solutions that have been prescribed for you.  Other solutions may cause discomfort or damage your lenses.
2. Occasionally, contact lens wearers substitute sterile saline solution for the prescribed multipurpose solution thinking they are the same but cheaper.  Multipurpose solutions disinfect, clean and act as a rinsing-storage solution.  Sterile saline has no cleaning or disinfection properties.  This can result in eye infections and serious damage to the eye.  Always disinfect the lenses when stored overnight or longer.
3. Clean your lenses in the palm of your hand in the proper motion.  Lenses can tear if they are cleaned in a circular motion or between your fingers.
4. Keep your lenses wet at all times.  When you are not wearing your lenses, store them in your contact lens case with the prescribed saline solution.  Should the lens dry out on a countertop, do not touch it.  Wet the area with several drops of saline solution and wait 30 minutes before attempting to handle the lens.   Clean and inspect the lenses for damage before wearing.
5. Follow the wear schedule which was prescribed to you.  Do not sleep in your lenses unless your doctor approves the lenses for extended wear.  (If you should accidentally take a short nap wearing your lenses; remove, wet, and re-insert them as long as no discomfort is involved.)
6. If your lens becomes uncomfortable when it is inserted, remove the lens immediately.  Rinse the lens with saline solution and re-insert.  If the discomfort persists, remove the lens and call our office.
7. Inspect and clean your contact lens case often.
8. Blink often to keep your lenses wet.  Apply only prescribed wetting drops if dryness persists.  Never apply any medication to the eye with contact lenses in place unless approved by the doctor.
9. When in doubt about procedures, solutions or symptoms, do not hesitate to call our office!

Cataract Surgery is Done with Lasers
Never – almost. Yes, experimental research but nothing practical yet developed. Nearly 100% of cataract surgeries are still performed with traditional microsurgical techniques. Lasers can be used after cataract surgery to clear up cloudy membranes. This is where the confusion may often lie.

All Red Eyes are Infections
It has been our experience in our office that most red eyes are due to allergies or dry eye.We see more viral than bacterial etiological causes. This is why your eye doctor can’t just call in some antibiotic. Antibiotics fight bacteria and do not kill viri or decrease allergies.

Refractive Surgery Forever Removes the Need for Eyeglasses
People may assume no more visits are required to the eye doctor after refractive surgery. In fact people need MORE FREQUENT eye care after eye surgery. Refractive surgery today has a better than ever chance of eliminating your refractive error. One condition it can not cure however is Presbyopia. Presbyopia is the natural loss of focusing ability which first shows symptoms past the age of 40. Increasing working distance, eyestrain, blurred near vision are its symptoms. Presbyopia is not treatable except for corrective lenses.

Contact Lenses can be Welded to the Eye if you Weld with Them In
Nope. Contact lenses actually have been found to protect the eye from severe injury. Less trauma has been observed following foreign bodies and chemical splash/burns to the eye. A contact lens has been found to act as a protective shield for the cornea often taking the brunt of damage.

Stronger Glasses can Fix Every Vision Problem
“All I need is a pair of glasses that will work.” is a complaint often heard by eye doctors from patients seeking second opinions due to eye and vision conditions which have deteriorated their ability to see. Neurological problems can interfere with vision. Post-concussion syndrome frequently complicates vision problems. Cataracts interfere with a person’s ability to see. Retinal diseases like macular degeneration often cause a desire for a patient to ask the doctor for stronger glasses. Sometimes they are prescribed, but often special low vision magnifiers, electronic magnification aids and other special aids are needed.

Poor Night Vision is Infrequent
This is actually our most common complaint that we hear of. Small refractive errors is #1 cause. At night the pupil dilates which causes the eye to become more sensitive to changes in an eyewear prescription. Cataracts, macular degeneration, optic nerve disease and contact lens overwear can decrease night vision as well. Nicotine has been shown to decrease the ability to dark adapt. Dirty car windshields can create a phenonema known as the Mandelbaum effect. The focusing system draws inward creating an artificial form of near-sightedness. Night myopia is a similar phenonema which can occur as well despite perfectly clear windshields. Rainy weather decreases your ability to see to drive at night. Wet roads decrease the amount of light reflected back to you from your headlights and increase the amount of light from oncoming cars. Often no detectable problems are found. Aging is a frequent cause of night vision problems. The retina takes longer to recharge its photoreceptor chemicals as we mature. Retintitis Pigmentosa, a traditional cause of night blindness is another retinal disorder which has classically been associated with poor night vision is actually very uncommon.

Eyeballs are Removed During Surgery
Rarely, surgeons usually work around them. The muscles and the optic nerve are of a fixed length. Removing the eye risks avulsing (tearing) of the optic nerve.

“I’m Legally Blind Without my Glasses”
By it’s definition legal blindness is 20/200 in the better eye with correction (glasses or contact lenses) or less than a 20 degree visual field in the better eye. To say you are legally blind without glasses is not in keeping with the true definition.

These Lenses are Scratch-Proof
No lens yet developed is truly scratch-proof. There is always some material which can scratch a lens. A diamond can be scratched by another diamond. Lenses instead should be termed scratch-resistant. A plastic lens with a scratch-resistant lens is more durable than a lens without the coating. Glass to this date remains the most scratch-resistant material – more durable than plastic with a scratch-resistant coating.

1. Place the lens, concave side up, on the tip of the index finger of your right hand and place a drop of the prescribed conditioning solution on the lens.
2. Bend your head down so that your eyes will be looking down and your lens will be moving in an upward direction when being inserted.
3. Place the middle finger of your left hand on the upper eyelid by the eyelashes and pull the upper lid up.
4. Place the middle finger of your right hand by the lashes of the lower eyelid an pull the lower lid down.
5. Slowly bring the lens toward the cornea of your eye.  Look straight through the lens as it comes towards your eye.
6. Gently place the lens on your cornea, release your lower and then your upper eyelid, straighten your head and blink several times.
7. Repeat for the other eye.

WEAR SCHEDULE
Your eyes require an adaptation period to adjust to contact lens wear.  Usually, the doctor will prescribe a wearing schedule of 2 hours on the first day and increasing by 1 hour per day of wear (e.g. 2, 3, 4, etc. hrs).  Do not wear your lenses more than 12 hours until you have had your first progress exam.  At that time your doctor will let you know how long you should wear your lenses.  Be sure to wear your contact lenses to your progress exams unless you are having serious problems wearing them continuously.  Bring your glasses and contact lens case also.

REMOVAL OF LENS
Before removing your lenses, wash and rinse your hands  thoroughly.  Have your contact lens solutions and storage case opened and ready to receive the lens.  Removal is simpler if the lens is correctly centered on your cornea.  There are two effective ways to remove your lens.

Two Finger Method

1. Place a towel or your hand, palm up, under your eye to catch the lens.
2. Place the tip of the forefinger of one hand centered on the edge of your upper lid and the forefinger of the other hand centered on the edge of your lower lid.
3. Press the lid edge inward and then together.  The lens should be wedged out of your eye onto your hand or towel.
4. The lens may come out but remain on your eyelid or hand or be decentered into the white part of your eye.  If the latter occurs, recenter the lens onto your cornea before repeating the removal procedure.

Blink Method

1. Seat yourself at a table covered with a clean towel and lean over until you are looking down at the surface.
2. Place your index finger at the outer junction of your upper and lower lids, stretch the skin outward and slightly upward.  (Do not allow your upper lid to slide over the lens.)
3. Blink briskly.  The lens will be pinched by the pressure of your eyelids and the lens will pop out onto the clean surface of the towel, or you may catch the lens in the palm of your hand.

Clean  and rinse the lens and place it in the storage case.

CLEAN
Daily cleaning of your lenses is necessary to remove tear residues, mucous films, lipid coatings and other foreign substances that accumulate on the lens surfaces.  Clean your lenses every evening after you have removed your lenses for the final time.

1. Wash your hands before handling.
2. Put the lens in the palm of your hand and place 1 drop of the prescribed daily cleaner on the lens and 1 drop on your hand by the lens.  Rub the lens with a small amount of pressure in a side-to-side and back-and-forth motion (do not go in a circular motion).  Clean each side for 20 seconds in this manner. A cotton-tipped applicator often helps to clean the concave surface.
3. Place the lens in the palm of your hand and thoroughly rinse the lens with fresh tap water.

DISINFECTION / STORAGE
The disinfection cycle keeps your lenses free from harmful bacteria and other germs.  Disinfecting the lenses regularly reduces the possibility of contamination or eye infection.  This procedure is performed in addition to your daily cleaning procedure.

1. After cleaning and rinsing your lenses fill the storage well with a fresh supply of the prescribed disinfecting/conditioning solution.  Place each lens in its appropriate well and close the cap.  Allow the lenses to sit overnight.  THE MINIMUM TIME FOR DISINFECTION IS FOUR HOURS for most solutions.
2. If desired, reapply fresh conditioning solution prior to lens insertion.  Discard the remaining solution from the container and wash and air dry the case so it is clean for the next use.

ENZYME

The enzyme procedure is designed to remove the protein buildup from your contact lenses which the daily cleaning solution does not remove.  Enzyme cleaning keeps your lenses cleaner, makes them more comfortable to wear and keeps the oxygen transmission at its highest level.  This procedure is performed in addition to your daily cleaning procedure and will  be needed only if your doctor mentions it.

Enzyme your lenses  once or more each week.  This is done just after daily cleaning and before you disinfect for the night.  Add one enzyme tablet to the contact lens solution in the appropriate container.  Allow to sit for 2 hours or more for maximum effect.  Daily clean them again, rinse and disinfect for the next days use.

RECENTERING A LENS

In rare instances, or due to improper performance of insertion or removal techniques, your lenses may decenter onto the white part of the eye.  Because of the anatomy of the eye, the lens cannot go “behind” the eye.

1. Locate the lens by using a mirror and pulling the lids away with your fingers to identify its position.  Combine large head and eye movements to locate difficult to find lenses.  Your fingers may also be useful in feeling for the lens.
2. When located, massage the lens gently back towards the cornea, looking in the direction of the lens  until it slips back into position.  If the first method doesn’t work, try pulling the lids apart and rolling the eyes in a circular motion to recenter the lens.

CARE TIPS

1. Use only the solutions that have been prescribed for you.  Other solutions may cause discomfort or damage to your lenses.
2. Clean your lenses in the palm of your hand in the proper motion.
3. Keep your lenses wet at all times.  When you are not wearing your lenses, store them in your contact lens case with the prescribed soaking/conditioning solution.
4. Follow the wear schedule which was prescribed to you.  Do not sleep in your lenses unless your doctor approves the lenses for extended wear.  (If you should accidentally take a short nap wearing your lenses; remove, wet, and re-insert them as long as no discomfort is involved.)
5. If your lens becomes uncomfortable when it is inserted, remove the lens immediately.  Rinse the lens with wetting solution and re-insert.  If the discomfort persists, remove the lens and call our office.
6. Clean your contact lens case often.  Scrub your case weekly using your daily cleaner and a clean toothbrush.  Rinse the case well with hot tap water and allow it to air dry before further use.
7. Blink often to keep your lenses wet.  Apply only prescribed wetting drops if dryness persists.  Never apply any medication to the eye with contact lenses in place unless your doctor says it would be safe.  The drugs can ruin the lenses and irritate your eye.
8. When in doubt about procedures, solutions or symptoms, do not hesitate to call our office!  Our courteous staff will always be willing to help you