by Empish J. Thomas
Editor's note: As we end Women's Eye Health and Safety Month, Empish Thomas talks about the cosmetic reasons for her choice to wear ocular lenses and the vital importance of properly caring for them.
Decision to Wear Ocular Lenses
In 2012, I made a radical decision, to stop wearing dark sunglasses and start wearing ocular lenses. It was a huge step for me because I had been wearing sunglasses for such a long time. But I felt it was the right decision. I wanted to do it because of cosmetic reasons. I wanted my face to have a more natural look and I wanted to feel better about my appearance. My decision had nothing really to do with any medical problems I was having with my eyes. I openly shared about this transition in a blog post for VisionAware called “They Look So Real!”
Tips on Care and Maintenance
Well, in these passing years I have had no regrets about my decision and have grown to really love my ocular lenses because they really do look so real. But with that being said there is work to be done when wearing ocular lenses or what some people commonly call prosthetic or fake eyes. In the next few paragraphs I want to share some common tips on care and maintenance of ocular lenses. These tips are good to follow to keep your lenses in good shape and keep your eyes safe. If you are wearing ocular lenses or considering doing so, I hope these tips will be helpful.
- One of the first things I did when I started wearing my ocular lenses was to get clear instructions from the ocularist. He gave me both verbal and written instructions on how to properly clean, wear and maintain my lenses. These instructions were important to follow not only so that my lenses could last but to keep my natural eyes safe and free from damage or complications.
- Since my ocular lenses were designed to fit my eyes only, I wear them day and night so I don’t have to remove them very often. Initially I removed them more often while going through the adjustment process. Since my natural eyes had shrunk and my eyelids had closed for some time it took a while for my eyes to get use to a foreign object inserted over top of my eyeball. I would wear them during the day and then remove at night. Today I wear them day and night; only removing them for proper cleaning. I was advised the less handling of the prosthesis the better.
- When it comes to cleaning, I clean my ocular lenses once a week. But it can vary with each person depending on the amounts of tear, mucus and protein deposits and debris. Taking care and cleaning your lenses will not only keep them looking natural but increase their longevity. First wash your hands thoroughly. Next, remove the lenses either with your fingers or with a suction cup. Softly wash lenses with warm water and mild soap like baby shampoo. Do not clean the lenses with any solvents, hand sanitizer or alcohol because these chemicals may damage the lenses and your eyes and eye socket. Gently rub the lenses thoroughly then rinse clean. Next, dry with soft towel. Before inserting lenses back into your eye sockets it is a good idea to clean them too. You can take a washcloth and gently lift the eye lid and clean the area including the eyelashes. Then insert lenses into eye socket. To avoid dry eyes, my ocularist recommended using some mineral water. So I squeeze a few drops over each lens before inserting.
- Even with proper cleaning, over time heavy surface deposits formed by tears, protein and mucus, can present a dull film. This dull film can cause irritation and can also be a sign that it is time to get your lenses polished. It is advised to get ocular lenses polished at least once a year; or sometimes every six months depending on the buildup. During this appointment the ocularist will polish the lenses, check them for any needed adjustments and answer any questions you might have about care and maintenance.
- Although you can properly clean, maintain and polish ocular lenses, they do not last forever. Depending on your ocularist, lenses will have to be replaced every 3-7 years. This might be due to the fact that your natural eyeball has shrunk more causing the lens to no longer fit snuggly. Or the tissue in the eye socket can change causing the lenses to become scratched or damaged. Another cause is the natural deterioration of the lenses’ plastic and pigmentation. Other factors can be your age, overall health and lifestyle.
- While writing this post I scheduled my next appointment to see my ocularist. I have noticed that my right lens keeps moving around and I have to keep adjusting it. This might be due to more shrinkage and time for a new fitting. But only through a conversation will I know for sure. It is so important when wearing ocular lenses that when you notice changes that you talk with your ocularist so that they can check and make any adjustments. This will insure proper fitting, longevity and overall enjoyment of your lenses.
Let's Discuss Maintenance Tips
Wearing ocular lenses has been an enjoyable experience for me. The cleaning, care and maintenance can sometimes be a bit of an inconvenience but I would not go back to dark sunglasses for anything.
So, do you wear ocular lenses? If so, did you find my tips helpful?
Are there other tips or suggestions you use to keep your lenses clean and well-maintained? Share your comments with us.
More Information About Prosthetic Eyes
by Steph McCoy
The Magic of Eye Makeup
Oh, the wonders of makeup. It's one of those things that from the time we are young girls we cannot wait to get glammed up with cosmetics. The use of lipstick, blush, mascara, and eye shadow is not only transformative; it's almost magical. But did you know there are dangers lurking in your cosmetics arsenal, especially when it comes to your eyes?
The Past and Present of Eye Makeup
"Eyes are captivatingly beautiful. Not because of the color but because of the words they hold within them." This quote from an unknown author speaks to the powerful mystique of the eyes. From as far back as ancient Egypt women and men enhanced their eyes with makeup for cosmetic, medicinal and religious purposes.
Today, we've come a long way from just using colors and liners to beautify our eyes. We have choices like mascara, eyeliners, false eyelashes and eyelash extensions. We also use eyelash enhancer serums, eyelash dye, permanent eye makeup and colored contacts. All of these intensifying enhancements of our eyes can have a dramatic effect on our overall appearance.
Cosmetic Secrets You Need to Know
Damaging our eyes through the use of cosmetics is not something we typically associate with makeup but harmful bacteria, ill-advised application techniques, some types of cosmetics, and certain procedures can have harmful and lasting effects on our vision. Below we'll look at four cosmetics/procedures, associated risks, and what can be done to remain safe.
1. Eyelash extensions are individually glued to each natural eyelash to increase volume and length to lashes.
- Formaldehyde is one of the ingredients used in many of the glues for false eyelashes and extensions. Allergic reactions, swelling, inflammation, infections and even the loss of natural lashes are some of the issues that can arise from the use of extensions and false eyelashes.
- Careful consideration and research should be done prior to using false eyelashes or eyelash extensions. Reviewing the list of ingredients in the adhesive for potential red flags could help avoid eye injury. Going to a reputable establishment is highly recommended.
2. Eyelash enhancer serums help promote natural lashes to become longer and lusher.
- The side effects to some of these serums are itching, redness of the eye and darkening of the eyelids and iris.
- Consultation with your doctor prior to using any eyelash enhancer serum is recommended, especially if you are currently on a treatment plan for glaucoma or any other eye condition.
3. Permanent eyeliner is a tattoo application that replaces the need for liquid, pencil or gel eyeliner. It can be done on the upper/lower or both lids.
- Irritation or infection can result from the use of pigment applied to the delicate skin around the eye.
- This procedure is relatively safe if done by a reputable salon. I checked with my ophthalmologist who said that there is no danger of sight loss from the use of permanent eyeliner. However if you are considering this for yourself I recommend following up with your doctor.
4. Colored contacts for cosmetic use are packaged under different names (decorative, Halloween, doll-eyed, theatrical, etc.) but they all change the appearance of the iris. To learn more about colored contacts read Maureen Duffy's post titled "Halloween,Lady Gaga, and Cosmetic Contact Lenses."
- In the U.S., all contacts (corrective or non-corrective) are considered medical devices and require a prescription. The risks on the use of these contacts are the same as with prescription contact lenses. Some of these risks include: corneal scratches, conjunctivitis, infection, decreased vision and blindness.
- Always get a prescription for cosmetic contacts. Wash your hands before handling lenses, never share contacts with another person, only use contact lens solution for cleaning and storing lenses, follow the doctor's instructions.
Cosmetic Eye Safety Tips
In addition to all of the above, being aware of harmful ingredients in cosmetics is a key step in preventing allergic reactions or infections in the eyes. Dangerous ingredients such as parabens, petrolatum, formaldehyde, fragrance, phthalates and many others can be found in mascaras, eyeliners, and glues. I have heard it said that if you can't pronounce the name of the ingredient it probably isn't safe for use in or on the body. In addition, contrary to what many believe, the FDA does not approve any tints or dyes for eyelashes and eyebrows. Though the FDA takes a strong stance on the use of color additives, they do not regulate the ingredients in cosmetics. In view of this the burden is on us, the consumer, to become personal product safety advocates. We have to do the necessary legwork to ensure that the cosmetics we are using, especially those that we use on our eyes, are safe. So, I have listed some resources from the FDA below for further information.
Follow Good Eye Safety Tips
Even though you've done your homework, and learned how to properly apply makeup as a visually impaired person choose eye makeup deemed safe, avoid specialized procedures like eyelash extensions or permanent liner. Unfortunately, These steps still don't make you immune to allergies or infections, so follow these steps to minimize these situations:
- Always wash your hands before applying your eye makeup
- When applying eyeliner do so at the lash line and not inside the eye
- Throw away mascara at 3 months (perfect breeding ground for bacteria is the dark, moist container)
- Throw away dried out mascara do not add liquid to it to extend its life
- Throw away liquid eyeliner at 3 months
- Throw away eyeliner pencils at 2 years and frequently sharpen them
- Do not store makeup in the bathroom (heat and humidity contribute to the growth of bacteria)
- If you notice eye irritation from the use of any eye makeup throw it away
- If your eyes are irritated or you have an eye infection do not put on eye makeup until it clears
- Never share or borrow makeup
- Always remove makeup before going to bed
Educate Yourself and Be Safe
Undoubtedly a person's eyes are the focal point and as history has shown us women have and will continue to use products to enhance their eyes. Even so just ask anyone who has lost their vision to inappropriate use of cosmetics or through a cosmetic procedure gone awry and they will tell you that no amount of beautification is worth the loss of eyesight. The final message is to educate yourself on the products you are using, ensure that you are using the correct tools and techniques in makeup application and protect the health of your eyes by following safe practices in storing and discarding cosmetics.
FDA and CDC Resources on Eye Makeup and Decorative Contact Lens Safety:
by Priscilla Rogers
New Date for Celebration of Vision Rehabilitation Therapists Awareness Week
This year marks a change of date for Vision Rehabilitation Therapist (VRT) Awareness Week. In the past, the week of Helen Keller’s birthday, June 27th was the highlight of this commemoration. For 2015 VRT Awareness Week will take place, April 12-18, the week of Anne Sullivan’s birthday, which was April 14.
Commemorating Anne Sullivan
Commemorating Anne Sullivan, Helen Keller’s teacher, as part of VRT Awareness, is a natural fit for the profession. Ironically, it’s been my observation that most individuals outside our profession have no idea what a Vision Rehab Therapist does, yet most people, of all ages, know that Anne Sullivan was a great teacher for her pupil, Helen Keller who became deaf-blind following a serious illness when she was 19 months old.
In 1887, Anne Sullivan was a recent graduate from the Perkins Institute for the Blind (now called Perkins School for the Blind or Perkins International) in Watertown, Massachusetts when she traveled to the Keller home in Tuscumbia, Alabama. At that time, she may have been considered a "Home Teacher" for her new student, 7 year-old Helen. “Home Teacher” was one of the earliest occupational titles for vision rehabilitation professionals, and were individuals who traveled to consumer’s homes to teach skills related to vision loss, such as Braille, reading embossed books, crafts, and other activities we might call Adapted Daily Living skills today.
Often, home teachers were blind or visually impaired themselves, as was the case with Anne Sullivan. Sullivan herself lost much of her vision in early childhood from an eye disease called Trachoma. As an adolescent, she regained enough vision from a surgical procedure to read print again, but would remain visually impaired the rest of her life.
Professional preparation for VRTs is much different today, than in Sullivan’s time, often including a Master’s Degree and national certification through the Academy for Certification of Vision Rehabilitation and Education Professionals (ACVREP). Sullivan’s preparation for teaching included her 6 years of schooling at Perkins, and studying the successful work Dr. Howe (former director of Perkins) undertook with another Perkins student, Laura Bridgman, who was also deaf-blind. Bridgman was a resident at Perkins during the time Sullivan was a student so she was experienced communicating with her. Perhaps even more important experiences for teacher training, however, were the life lessons Sullivan learned growing up in profound poverty. The eldest child of Irish immigrants who fled the potato famine, she found herself at 10 years old caring for her younger brother Jimmie after her mother died and father abandoned the family. Nearly blind, and with no formal education, she and Jimmie were taken to the Tewksbury Almshouse (Massachusetts), where her brother died shortly after their arrival. It was surely these lessons that helped Sullivan develop her persistence, creativity, and efficacy as a teacher.
Setting the Precedent for Vision Rehabilitation Professionals
Over the years, there has been considerable debate about some of the facts surrounding Helen’s acquisition of skills and the details of Sullivan’s teaching methods. Much of this has to do with abridged letters in Keller’s autobiography from Sullivan to her former teacher and mentor Mrs. Sophia Hopkins, and Perkins Director Michael Anagnos. Regardless of the specifics it is evident that Sullivan’s efforts as a teacher were creative and focused on the goals of the student.
In the following quote from the Perkins History Museum page on Anne Sullivan, it is clear that Sullivan set a precedent for the vision rehabilitation professionals who followed, that recognized the importance of meeting the student wherever they are and focusing on their goals: "It was not long before Sullivan realized that the rigid routine did not suit her exuberant and spontaneous young pupil. Never one to be limited by rules, Sullivan abandoned the prescribed schedule and shifted the focus of her teaching. Sullivan decided to enter Helen's world, follow her interests and add language and vocabulary to those activities"
No doubt, the specifics of this debate will have some historical merit, but will not influence our recognition of Anne Sullivan's great teaching ability and lifelong dedication to her student, Helen Keller. It is for this reason that the VRT Recruitment and Retention Committee has selected the week of Sullivan's birthday to further recognize one of the pioneer teachers in vision rehabilitation therapy!
- Personal Reflections
Preparing for the 2015 White House Conference on Aging: Highlights of the Phoenix Conversation on Aging and Vision LossPosted on 4/16/2015 at 7:40 AM
by Priscilla Rogers
On April 8, 2015, a large group of older individuals with vision loss, family members, service providers, eye care specialists, policy makers, and researchers gathered in the same room in Phoenix, Arizona, during the American Foundation for the Blind Leadership Conference. The purpose of the gathering was to hold a “conversation about aging and visual impairment” to discuss issues to be raised at the upcoming White House Conference on Aging (WHCOA) to be held in July, 2015.
White House Conference to Be Held July, 2015
How fitting that the conference will be held in July, the month that symbolizes independence in this country. How sad that what the conversation in Phoenix highlighted was the lack of independence that older persons with visual impairment experience on a daily basis and in a variety of ways. Even sadder is the fact that these same concerns were voiced at a similar meeting one decade ago.
Highlights of the Phoenix "Conversation on Aging and Vision Loss"
At the Phoenix meeting, a representative of the Department of Health and Human Services, Melissa Stafford Jones, was on hand to speak about the White House Conference and its purpose. She stayed to hear some of the comments brought up from the presenters and the audience.
Rebecca Sheffield, policy researcher from AFB, led the meeting and reviewed the overall themes, garnered from an online survey that AFB structured to gather input on the issues that the WHCOA will be addressing.
Cross-cutting Themes from Survey Input
Quality of Life
Older Americans want to be sure that policies and programs are designed to prioritize not just the years in one’s life, but also the life in one’s years.
Supports to Age-in-Place
Most older Americans prefer to live in their homes and their home communities to the greatest extent possible.
Transportation and Pedestrian Access
Vision and health issues for aging Americans often mean that they need new options for transportation. Public transportation and walkable communities are important for ensuring that older Americans maintain the freedom to travel when and where they want.
General Accessibility of Commonly Used Items
Consumer electronics are increasingly relying on touch-screen and flat-screen displays. Manufacturers and designers should consider the needs of older Americans, including older people with vision loss, and should design products with accessible features and options.
The general public needs to be better informed about vision loss, the rights of people with visual impairments, and the possibilities and preferences of older Americans with vision loss.
More Trained Professionals
As the population of older Americans with vision loss is growing, there is a pressing need for professionals, including orientation and mobility specialists, vision rehabilitation therapists and teachers, gerontology specialists, etc.
Supports in Rural Areas
All of the above-listed issues are even more difficult for people in rural areas. Access to programs and services, especially transportation, is a major limiting factor in many rural areas of the United States.
Themes Voiced at the Phoenix Meeting
The audience also heard from Dr. John Crews, Health Scientist at the Centers for Disease Control, who laid out a bleak picture about the numbers of people who will be experiencing eye conditions such as macular degeneration as well as the additional types of health issues they will be having. Dr. Vladimir Yevseyenkov, a low vision optometrist and associate professor at Midwestern University, presented his concerns about the lack of coordinated service delivery between eye care professionals and the rehabilitation field and how that affects his patients in robbing them of low vision devices that can help them carry out everyday tasks such as reading. Deborah MacIlroy, Assistant Program Manager, Arizona Rehabilitation Services Administration, discussed the issues and concerns that older clients of her agency experience related to all aspects of independence from managing medications, to transportation to economic security.
Consumers with vision loss brought up personal concerns related to both independence and interdependence. Themes were similar to those raised by online survey respondents reported above. To summarize: A major area of concern was obtaining reliable assistance with managing financial and other concerns, managing medications, obtaining transportation for social, shopping, and medical needs. Financial considerations raised included having to retire early due to vision problems and having enough money to make ends meet. Participants also expressed concerns about obtaining low vision and equipment that make living with vision loss more manageable, waiting lists for services and lack of trained personnel, lack of funding for services, lack of coordination between the medical community and rehabilitation services, lack of understanding on the part of the eye medical community including doctors who discount patient concerns because they do not understand the impact of vision loss, and the need for public education and education of service providers such as assistive living staff and other aging service providers.
Dr. Crews summed up the frustrations of the participants observing, "Support systems value everyday things." The feedback at the conference and through the survey brought home the fact that we are sadly lacking in “valuing everyday things” when it comes to our nation’s older population with vision loss.
Tell Us What You Think
What do you think? Do any of these concerns resonate? Please take time to complete AFB’s online survey. AFB will be compiling all of the survey data and results in the meeting in Phoenix to send to the White House Conference on Aging for their consideration. We need your voice and your advocacy.
by Audrey Demmitt
Editor's note: This post is the second in a series that Audrey Demmitt, R.N., is writing on diabetes. Her first addressed the importance of diabetes education in lowering your A1C and the risk of diabetic retinopathy.
How Diabetes Is Diagnosed
When teaching people with diabetes, I encourage them to 'know their numbers' and use them to better manage their diabetes. Let's take a look at the A1C and why it is an important number. Diabetes is a complex condition to diagnose and manage. In the early stages there are no symptoms and in the long term, there can be devastating effects on every system in the body. Prevention, early detection, and vigilant management are key factors in reducing diabetes complications such as blindness and blood vessel disease. The A1C blood test, also known as glycated hemoglobin, hemoglobin A1C and HbA1c, is the primary tool used to diagnose diabetes and pre-diabetes and to monitor blood glucose control in people with type 1 and type 2 diabetes. This test enables health care providers to diagnose diabetes and treat it before complications occur and to diagnose pre-diabetes so as to prevent or delay the development of type 2 diabetes. Below are the established A1C levels used to diagnose diabetes and pre-diabetes:
|Normal||below 5.7 percent|
|Pre-diabetes||5.7 to 6.4 percent|
|Diabetes||6.5 percent or above|
What Does the A1C Measure?
The A1C test reflects a person’s average blood glucose, or sugar in the blood for the past three months. When glucose enters the bloodstream, it attaches itself to hemoglobin, a protein in red blood cells. The A1C test measures what percentage of your hemoglobin is coated with sugar or "glycated." A normal A1C is below 5.7 percent. This number represents an average of all the ups and downs in blood glucose levels as if recorded on a video camera over the past many weeks. The higher the A1C, the higher the blood glucose levels have been over time and the higher your risk is for diabetes complications.
How Does the A1C Compare to Other Blood Glucose Tests?
There are several other traditional blood glucose tests which are used to diagnose and manage diabetes: the fasting and random blood glucose tests, the glucose tolerance test, and the self-monitoring home glucose test. These can be thought of as snapshots, measuring the blood sugar level in a moment of time or day to day. Normal blood glucose levels range from 80-100mg/dL (milligrams per deciliter), fluctuating throughout the day in response to food, activity, medication, illness and stress. Daily readings are interpreted in the short term to monitor blood sugar changes. It is helpful to do daily testing and record the values to reveal patterns and responses so that corrective actions can be taken and adjustments can be made to the daily care plan.
In contrast, A1C is a long term average of blood glucose levels and gives a "big picture" perspective on how well you are doing in controlling daily blood sugars. It can be useful in evaluating the overall success of the treatment plan, your daily efforts and the efficacy of medications.
How Does the A1C Relate to My Daily Blood Sugars?
Your A1C can be converted to a number that is expressed in the same terms as your daily blood glucose readings. This is called "estimated average glucose" or eAG. For example, an A1C of 7 percent is equivalent to an estimated average glucose (eAG) of 154 mg/dL, reflecting blood sugars that may have ranged between 180 and 140 mg/dL over the past three months. The A1C/eAG is not the same as the average blood glucose you may see on your meter since it is an average of all the blood sugar levels - not just the ones you may have recorded on your meter. The average blood glucose reported on your meter is likely to be lower than your actual A1C/eAG. Maintaining blood sugars as close to normal range as possible is the goal to reduce risks and complications of diabetes. When daily blood sugars are kept in optimal range, the corresponding A1C will also be optimal. Below is a table with conversions of A1C levels to eAG.
|A1C in percent||eAG in mg/dL|
(Source: Adapted from American Diabetes Association. Standards of medical care in diabetes—2014. Diabetes Care. 2014;37(Supp 1):S14–S80, table 8.)
How Often Should my A1C be Tested?
The American Diabetes Association (ADA) recommends you have the A1C test twice a year if your blood sugars are stable and you are meeting your treatment goals. Health care providers may repeat the A1C test as often as four times a year if there are changes in treatments or you are not meeting your A1C target. The A1C is like a report card on how well you are managing your diabetes.
What Should My Target A1C Be?
People will not have the same A1C target. It will depend on your individual diabetes history and general health. You and your doctor need to discuss this and set goals that are appropriate for your situation. The ADA suggests a target A1C below 7%. Research shows that keeping A1C levels below 7 percent can reduce complications of diabetes. But an A1C of 7 percent or below may not be safe or realistic for everyone. Less strict control may be suitable for the elderly, those who experience severe hypoglycemic (low blood sugar) episodes or those who already have advanced diabetes complications, for instance. People who are younger and have had diabetes for a shorter time may have a target A1C of 6.5% or below, according to the ADA recommendations. The key is to make sustained daily efforts to achieve the target that is best for you.
How Can I Meet My A1C Target?
Managing diabetes requires a lifestyle of healthy self-care practices. The keys to bringing down A1C levels are the same as for bringing down blood sugar levels. The essentials are:
- Taking the right medications at the right times and in the proper doses. Work with your doctor to evaluate your medications periodically so they can be adjusted when needed. Since diabetes is a progressive disease, it is likely that you will need to increase and/or add to your glucose-lowering medications over time.
- Eating the right portions of fruits, vegetables, whole grains, low-fat dairy and healthy fats. A diet rich in fiber has been linked to lower blood sugar levels. You may want to learn more about counting carbohydrates and portion control. Eat about the same amount of carbs at each meal and at the same times each day. Ask a dietician to help you create a meal plan that will help control your weight and A1C.
- Increasing daily physical activity. Engage in at least 30 minutes of moderate exercise like brisk walking 5 days a week and strength training 2 days a week. Find ways to move more and incorporate activities you enjoy into your day.
- Managing stress and depression. Negative emotions, depression and diabetes burnout can make following your treatment plan difficult. If you are finding it hard to cope with diabetes, let your doctor know and enlist the support of a loved one. There are many resources to help you.
By making daily efforts to stick to your treatment plan and making healthy lifestyle changes, you can achieve your A1C goal, avoid long term complications, and live well with diabetes. Here are some additional resources:
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