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As an eye doctor, diagnosing a red eye can be challenging. Are we dealing with an infection, allergy, inflammation or dryness?

One of the most common questions I get is, “Doc, my eyes are red, burning, itchy, and tearing. Is this dry eye or from allergies?” The short answer is it could be one, both or neither. I’ll outline various ways these conditions present clinically and the treatments for them.

The hallmark symptom of allergy – meaning if you have this symptom you almost definitely have the condition – is itching. Red, watery, ITCHY eyes are almost invariably due to an allergen, whether environmental or medicinal. It is one of the most common ocular conditions we, as eye doctors, treat - especially when plants are filling the air with pollen as they bloom in the spring and then die off in the fall.

The itching occurs because an immune cell called a Mast cell releases histamine, causing the itching sensation. It can be quite unbearable for the sufferer, causing them to rub their eyes constantly, which unbeknownst to them, actually increases the amount of histamine in the eye, leading to worsening of the symptoms.

Treatments may include:

  • Over-the-counter or prescription allergy drops (mostly anti-histamines or mast cell stabilizers).
  • Topical steroids (to get the inflammation under control).
  • Cool compresses applied to the eye.

Patients sometimes need to take drops every day to keep their symptoms under control.

Dry eye can have many of the same symptoms as allergic eye disease, with the eye being red and possibly watery (‘My eyes are tearing how could it be dry eyes?’). The main exceptions are that people with dry eyes tend to complain more of burning and a foreign body sensation - like there is sand or gravel in the eye - rather than itchiness.

Dry eye is a multi-faceted disease with many different causes and treatments. Treatment ranges from simple re-wetting eye drops to long-term medications (both topical and oral), as well as non-medicinal treatments such as eyelid heating treatment.

So how do we determine the difference? The first question I ask patients who complain of red, watery, uncomfortable eyes is, “What is your MAIN symptom? Itching or burning?” The answer will likely direct which course of treatment we take, and as those treatments sometimes overlap, you may have a component of both dry eye and allergy.

That is important to distinguish because many of the treatments we use for allergies - like antihistamine eye drops - can sometimes make the dryness worse. Though neither of these conditions is 100% curable (except maybe for allergy, where if you remove the allergen, you obviously won’t get symptoms!). We have many tools in our treatment arsenal to keep the symptoms at bay.

Unfortunately, dry eye and allergy aren’t the only two things that can cause your eye to have the multiple symptoms of red, watery, itchy, burning eyes. There are other problems, such as Blepharitis, that can produce a similar appearance, as well as bacterial and viral infections.

So before embarking on a particular therapy, it is wise to have a good exam to help you get on the right track of improving your symptoms.

Article contributed by Dr. Jonathan Gerard

It’s imperative to understand the importance of sunglasses when the weather turns cold.

Polarized sunglasses are usually associated with summer, but in some ways it is even more important to wear protective glasses during the winter.

It’s the time of year when the sun sits at a much different angle, and its rays impact our eyes and skin at a lower position. This translates to an increase in the exposure of harmful UV rays, especially if we are not wearing the proper sunglasses as protection.

Polarized sunglasses, which are much different than the older dye-tinted lenses, are both anti-reflective and UV resistant. A good-quality polarized sunglass lens will protect you from the entire UV spectrum. This not only preserves your vision, but it also protects the skin around the eyes, which is said to have a much higher rate of susceptibility to skin cancer.

The accumulation of snow poses another issue that can be countered by polarized sunglasses.

Snow on the ground tends to act as a mirror because of its white reflective surface and this reflection can become a hindrance while driving. The anti-reflective surface of polarized sunglasses will help reduce the glare and give drivers a better view.

Polarized sunglasses come in many different options based on a patient’s needs. Whether it’s single-vision distance lenses, bifocals, or progressive lenses, there is a polarized lens for every patient.

Winter is a great time of year to ask your optical department about purchasing polarized sunglasses.

 

Article contributed by Richard Striffolino Jr.

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ

Have you ever wondered what happens to the visual system as we age? What does the term "second sight" mean? What is presbyopia? What are the eyes more susceptible to as the aging process occurs? What can be done to prevent certain aging factors of the eye? The answer lies in a theory known as apoptosis (no that's not the name of the latest pop artist).

Apoptosis is the pre-programmed life of every cell in our body. Most studies show that it's a function of our programmed DNA. It's the ability for cells to survive and thrive in the anatomical environment. The body's ability to withstand and thrive during the aging process depends on proper nutrition, good mental health, exercise, and adequate oxygen supply. That's why studies have shown smoking can shorten your life by a decade or more.

In regards to aging and the eye, there is a phenomina during the 6th to 7th decade of life called "second sight". This is simply progressive nearsightedness in older adults secondary to cataracts. Close to 50% of the population over 60 years old has cataracts. Cataracts are a clouding of the natural lens of the eye that can impair vision causing glare and loss of detail. When patients experience second  sight, it is sometimes quite convenient for them: they see up close without their reading glasses they have been depended on since their 40s.

Another aspect of the aging process is loosing your reading vision you had all your life. This is called Presbyopia. Presbyopia is a Latin term which means "old eyes."

What happens in Presbyopia?

Before our mid-forties, the natural lens of the eye is very pliable and can easily focus on items up close. But in our mid forties, the lens tends to lose it's elasticity. While experiencing presbyopia, you generally hold reading material farther away to see it more clearly. Presbyopia can be managed through Bifocal or multifocal  glasses or contact lenses, and some surgeries.

As aging occurs, the eyes are more susceptible to cataracts, glaucoma, macular degeneration and vascular disorders of the eye as well as dry eye syndrome.

To help prevent and manage these conditions, there are a variety of options.

  1. Maintaining yearly dilated eye exams for preventative care.
  2. Protect your eyes against the sun with UV sunglasses.
  3. Take antioxidant vitamins to help bolster the protection of the macula of the retina.
  4. Use artificial tears to hydrate the eye and keep your body hydrated by drinking plenty of water.
  5. Keep emotional, physical, and mental stress to a minimum.

Being Educated on how we age is the first advancement of good ocular health and diminishing the chances of early apoptosis.

 

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

There are several different variations of Glaucoma, but in this article we will mainly focus on Primary Open Angle Glaucoma. This means that there is no specific underlying cause for the Glaucoma like inflammation, trauma or a severe cataract. It also means that the drainage angle where fluid is drained from the inside of the eye into the bloodstream is not narrow or closed.

Closed or Narrow Angle Glaucoma, which will be discussed in another article, is treated differently from Open Angle Glaucoma

In the U.S., Primary Open Angle Glaucoma (POAG) is by far the most common type of Glaucoma we treat.

Glaucoma is a disease where the Optic Nerve in the back of the eye deteriorates over time, and that deterioration has a relationship to the Intraocular Pressure (IOP).  Most - but not all - people diagnosed with Glaucoma have an elevated IOP.  Some people have fairly normal IOP’s but show the characteristic deterioration in the Optic Nerve. Regardless of whether or not the pressure was high initially, our primary treatment is to lower the IOP. We usually are looking to try to get the IOP down by about 25% from the pre-treatment levels.

The two mainstays of initial treatment for POAG in the U.S. are medications or laser treatments. There are other places in the world where Glaucoma is initially treated with surgery. However, while surgery can often lower the pressure to a greater degree than either medications or laser treatments, it comes with a higher rate of complications. Most U.S. eye doctors elect to go with the more conservative approach and utilize either medications - most often in the form of eye drops - or a laser treatment.

Drops

There are several different classes of medications used to treat Glaucoma.

The most common class used are the Prostaglandin Analogues or PGA’s.  The PGA’s available in the U.S. are Xalatan (latanaprost), Travatan (travapost), Lumigan (bimatoprost) and Zioptan (tafluprost).

PGA’s are most doctors’ first line of treatment because they generally lower the IOP better than the other classes; they are reasonably well tolerated by most people; and they are dosed just once a day, while most of the other drugs available have to be used multiple times a day.

The other classes of drugs include beta-blockers that are used once or twice a day; carbonic anhydrase inhibitors (CAI’s ), which come in either a drop or pill form and are used either twice or three times a day; alpha agonists that are used either twice or three times a day; and miotics, which are used three or four times a day. All of these other medications are typically used as either second-line or adjunctive treatment when the PGA’s are not successful in keeping the pressure down as single agents.

There are also several combination drops available in the U.S. that combine two of the second-line agents (Cosopt, Combigan, and Symbrinza).

Laser

The second option as initial treatment is a laser procedure.

The two most common laser treatments for Open Angle Glaucoma are Argon Laser Trabeculoplasty (ALT) or Selective Laser Trabeculoplasty (SLT).  These treatments try and get an area inside the eye called the Trabecular Meshwork - where fluid is drained from the inside of the eye into the venous system - to drain more efficiently.

These treatments tend to lower the pressure to about the same degree as the PGA’s do with over 80% of patients achieving a significant decrease in their eye pressure that lasts at least a year.  Both laser treatments can be repeated if the pressure begins to rise again in the future but the SLT works slightly better as a repeat procedure compared to the ALT.

Article contributed by Dr. Brian Wnorowski, M.D.

And old Creek Indian proverb states, "We warm our hands by the fires we did not build, we drink the water from the wells we did not dig, we eat the fruit of the trees we did not plant, and we stand on the shoulders of giants who have gone before us."

In 1961, the Eye Bank Association of America (EBAA) was formed. This association stewards over 80 eye banks in the US with over 60,000 recipients each year of corneal tissue that restores sight to blind people. Over one million men, women, and children have had vision restored and pain relieved from eye injury or disease. The Eye Bank Association of America is truly a giant whom shoulders that we stand upon today. Their service and foresight into helping patients with blindness is remarkable.

It is important to give back the gift of sight. You may be asking, “how does this affect me?” On the back of your drivers license form there is a box that can be checked for being an organ donor. Many people forego this option because they are not educated on the benefits of it. There are many eye diseases that rob people of sight because of an opacity, pain, or disease process of the cornea. Keratoconus, a disease that causes malformation of the curvature of the cornea, can be treated by a corneal transplant. Chemical burns that cause scarring on the cornea leave people blinded or partially blind. This is another condition that requires a corneal transplant. 

When it comes to corneal tissue, virtually everyone is a universal donor, because the cornea is not dependent on blood type. Corneal transplant surgery has a 95% success rate. According to a recent study by EBAA, eye disorders are the 5th costliest to the US economy behind heart disease, cancer, emotional disorders, and pulmonary disease. The cost is incurred when the person, for example, is a working age adult and can no longer hold a job because of vision issues. The gift of a corneal transplant can be one way to restore not only their vision, but their way of life, and their contribution to society.

By becoming a donor, or educating others to consider being an organ donor, you can give the gift of sight to someone on a waiting list. When you educate others to give the precious gift of sight, you become a giant whose shoulders others can stand on. Become a donor today.

For more information go to www.restoresight.org or contact your local drivers license office.

 

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Christmas is one of the most joyful times of the year... thoughts of cookies, decorations, family gatherings, and toys abound. Birthday parties for kids add to the list of wonderful memories as well. But there are a few toys that may not make memories so fun because of their potential for ocular harm. The American Optometric Association lists dangerous toys each year to warn buyers of the potential harm to children’s eyes that could occur because of the particular design of that toy.

Here is a sample of that toy list:

  • Laser toys and laser pointers, or laser sights on toy guns pose serious threat to the retina, which may result in thermal burns or holes in the retina that can leave permanent injury or blindness. The FDA’s Center for Devices and Radiological Health issues warnings on these devices at Christmas peak buying times.
  • Any type of toy or teenage gun that shoots a projectile object. Even if the ammo is soft pellets, or soft tipped it can still pose a threat. Even soft tipped darts are included in this harmful toy list. A direct hit to the eye can be debilitating.
  • Any toy that shoots a stream of water at high velocity can cause damage to the front and or back of the eye. The pressure itself, even though its just water, can damage small cells on the front and back of the eye.
  • Any toy that shoots string out of an aerosol can can cause a chemical abrasion to the front of the eye, just as bad as getting a chemical sprayed into the eye.
  • Toy fishing poles or toys with pointed edges or ends like swords, sabers or toy wands. Most injuries occur in children under 5 without adult supervision and horseplay can end up in a devastating eye injury from puncture.

The point is, that there are so many great toys to buy for children that can sidestep potential visual harm, that it behooves one to be aware of pitfalls of certain dangerous toy designs.

A great resource of information comes from World Against Toys Causing Harm.

For more information and for lists updated yearly see the W.A.T.C.H. website: www.toysafety.org

 

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Your Eyes Are A Gift, Protect Them During The Holidays

“I want an official Red Ryder, carbine action, two-hundred shot range model air rifle!”

“No, you'll shoot your eye out.”

This line from “A Christmas Story” is one of the most memorable Christmas movie quotes ever. Funny in the movie, but the holiday season does present a real eye injury threat.

For those of who celebrate Christmas that risk begins before the actual day.

Some of the most frequent holiday-related eye injuries come from the Christmas tree itself.

Holiday eye safety begins with the acquisition of the tree. If you are cutting down your own tree please wear eye protection when doing the cutting, especially if you are going to be using a mechanical saw such as a chain saw or sawzall. You need to also be careful of your eyes when loading a tree on top of the car. It is easy to get poked in the eye when heaving the tree up over your head.

Once back at home take care to make sure no one else is standing close to the tree if you had it wrapped and now need to cut the netting off. The tree branches often spring out suddenly once the netting is released.

Other injuries occur in the mounting and decorating phase. Sharp needles, pointy lights and glass ornaments all pose significant eye injury risk. If you are spraying anything like artificial tree snow on the branches be sure to keep those chemicals out of your eyes.

Having now successfully trimmed the tree without injury, let’s move our holiday eye safety to the toys.

We want to spend the holiday happily exchanging gifts in front of a warm fire, drinking some eggnog, and snacking on cinnamon buns and not going to the emergency room with an injury.

The Consumer Product Safety Commission reported there were 254,200 toy-related emergency room visits in 2015, with 45% of those being injuries to the head and face - including the eyes.

In general, here are the recommendations from the American Academy of Ophthalmology in choosing eye-safe toys for gifts:

  • “Avoid purchasing toys with sharp, protruding or projectile parts.
  • “Make sure children have appropriate supervision when playing with potentially hazardous toys or games that could cause an eye injury.
  • “Ensure that laser product labels include a statement that the device complies with 21 CFR (the Code of Federal Regulations) Subchapter J.
  • “Along with sports equipment, give children the appropriate protective eyewear with polycarbonate lenses. Check with your eye doctor to learn about protective gear recommended for your child's sport.
  • “Check labels for age recommendations and be sure to select gifts that are appropriate for a child's age and maturity.
  • “Keep toys that are made for older children away from younger children.
  • “If your child experiences an eye injury from a toy, seek immediate medical attention from an ophthalmologist – an eye medical doctor.”

More specifically there is a yearly list of the most dangerous toys of the season put out by the people at W.A.T.C.H. (world against toys causing harm).

Here are their 10 worst toy nominees for 2016, with three on the list that are specifically there for potential eye injury risk.

Here are other toys to avoid:

  • Guns that shoot ANY type of projectile. This includes toy guns that shoot lightweight, cushy darts.
  • Water balloon launchers and water guns. Water balloons fired from a launcher can easily hit the eye with enough force to cause a serious eye injury. Water guns that generate a forceful stream of water can also cause significant injury, especially when shot from close range.
  • Aerosol string. If it hits the eye it can cause a painful irritation of the eye called chemical conjunctivitis.
  • Toy fishing poles. It is easy to poke the eye of nearby children.
  • Laser pointers and bright flashlights. The laser or other bright lights, if shined in the eyes for a long enough time, can cause permanent retinal damage.

There are plenty of great toys and games out there that pose much lower risk of injury so choose wisely, practice good Christmas eye safety and have a great holiday season.

 

Article contributed by Dr. Brian Wnorowski, M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Itching, burning, watering, red, irritated tired eyes... what is a person to do? The symptoms aforementioned are classic sign of Dry Eye Syndrome, affecting millions of adults and children. With increased screen time in all age groups, the symptoms are rising.

What causes this? One reason is that when we stare at a computer screen or phone too long, our blink reflex slows way down. A normal eye blinks 17,000 times per day. When our eye functions normally, the body produces enough tears to be symptom free, however, if you live in a geographical area that is dry, or has a high allergy rate, your symptoms could be worse.

Dry eye syndrome can be brought on by many factors: aging, geographical location, lid hygiene, contact lens wear, medications and dehydration. The lacrimal gland in the eye that produces tears, in a person over forty years old, starts slowly losing function. Females with hormonal changes have a higher incidence of DES (dry eye syndrome). Dry, arid climates or areas of extreme allergies lend to higher incidences of DES as well.

A condition of the eyelids, called blepharitis, can cause a dandruff like situation for the eye exacerbating a dry eye condition. Contact lenses can add to DES, so make sure you are in high oxygen contact lens material of you suffer from DES. Certain medications such as antihistamines, cholesterol and blood pressure meds, hormonal and birth control medication, and others may cause symptoms of a dry eye. Check with your pharmacist if you are not sure.

And finally, overall dehydration can cause DES. Some studies show we need 1/2 our body weight in ounces of water per day. For example, if you weigh 150 lbs, you need approximately 75 ounces of water per day to be fully hydrated. If you are not at that level, it could affect your eyes.

Treatment for DES is varied, but the main treatment is a tear supplement to replace the evaporated tears. These come in the form of topical ophthalmic artificial tears. Oral agents that can help are Omega 3 supplements such as fish oil or flax seed oil pills. They supplement the function of meibomian glands located at the lid margin. Ophthalmic gels used at night, as well as humidifiers, can add to moisturizing your eyes. Simply blinking hard more often can cause the lacrimal gland to produce more tears automatically.

For stubborn dry eyes, a method of retaining tears on the eye is called punctum plugs. They act like a stopper for a sink, they are painless and can be inserted by your eye care practitioner medically in the office. Moisture chamber goggles are used in severe dry eye patients to hydrate the eyes with their body’s own natural humidity. This may sound far out but it gets the job done.

Being aware of the symptoms and treatments for dry eye syndrome can prevent frustration, and allow your eyes to work more smoothly and efficiently in your daily routine. If your eyes feel dry as the Sahara, or the eyes water too much: know that help is on the way through proven techniques and products. You do not need to suffer needlessly in the case of Dry Eye Syndrome anymore. 

 

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Who can forget the news of the capturing of Osama Bin Laden by our US Special forces? An interesting fact was that the Navy Seal unit that made the capture attributes much of their military success to NVGs (night vision goggles). The capture of Bin Laden, along with numerous captures of Al-Qaeda members in Desert Storm, came from night vision capabilities that were provided by this ocular technology.

The top of the line NVG has a sophisticated four tube version of an earlier model, and costs upwards of $60,000 to $65,000 per pair. They have superb capabilities to see into enemy lines for our military.

So what exactly are NVGs and what is the technology behind them? What other visual expectations do our military troops use to give us the edge in a battle?

Expertly made night vision goggles can spot a target close to 200 years away. NVG use infrared and thermal detection technology to capture the image in the darkest of circumstances. The electronic information that comes from the NVG has no color. but in order for our eyes to see it, a green picture is emitted from the screen.

What exactly do you have to be able to see to enter the military as a pilot of a plane or helicopter? To understand this, it helps to understand the difference between corrected and uncorrected vision. 20/20 vision is the ability to achieve "Normal" vision.

In other words, the patient sees the same line of letters at 20 feet that a normal person sees at 20 feet. A patient with 20/15 vision can see objects at 20 feet that a person with 20/20 vision can only see at 15 feet. Corrected vision means you can achieve 20/20 vision with glasses or contacts. Uncorrected vision is your vision without glasses or contacts.

Here are the military requirements listed by branches of the military:

Army: 20/50 uncorrected (correctable to 20/20)

Air Force: 20/70 uncorrected (correctable to 20/20)

Navy and Marine Corps: 20/40 uncorrected (correctable to 20/20)

Pilots must pass a color vision test and have normal depth perception or 3-D vision.In regards to Laser Vision Correction (LASIK), since 2007 it has no longer become a deterrent to entering the military as a pilot, as the restriction has been lifted for potential pilots.

With the knowledge of ophthalmic technology, and the requirements to achieve optical clarity for the military, its no wonder they have the cutting edge in most wars and battles. So whether you use NVG for hunting, military use, or just recreational activity, its helpful to know and understand the “why” behind the know how, and be able to appreciate the capabilities of night vision goggles.

Exciting headline news comes understanding the technology behind the capture of Bin Laden! 

 

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

“Space....the final frontier“ as Captain James T. Kirk from StarTrek quoted was all the buzz in the late 60s and 70s as NASA took our space program literally to the moon and back. Then came more orbiting satellites, piping fresh new information to our science hungry minds. Then, in 1980, the advent of the Hubble telescope changed everything. The telescope sent pictures of space with vivid vibrant colors, breathtaking pictures that eager science buffs could only dream of.

What does the science of space have to do with my eyesight you might ask. Well, the answer lies in the aerospace engineering that scientists at NASA used to help the space shuttle and rockets re-enter the earth's atmosphere. This same technology is used in laser vision correction for the eye. The angle of the laser beam and the amount of energy needed for a desired effect were both derived from the same science that NASA uses for space flight. Because the cornea of the eye is dome shaped, just like a planet, harmonious technology could be used to advance excimer laser refractive treatment of the eye. This laser technology is used to allow patients to have little or no dependency on glasses or contact lenses.

Refractive laser eye surgery has been popular since the 1980s and is used to correct patients who are nearsighted, farsighted, and have astigmatism. In most cases, patients can go without full glasses or contact lenses after their procedure. Additionally, this type of laser surgery can removes scars of the cornea and restore measures of vision.

Another fun fact is that the anatomy of the eye was used to restore function to the Hubble telescope. The Newsweek story goes like this: NASA in 1990 had just received news that their $1.5 billion scope was severely nearsighted, not able to focus on the objects at hand. Therefore a team of engineers, opticians, and optometrists were recruited to produce a “telescope contact lens” to go over the original flawed lens of the Hubble. NASA’s name and future funding were at risk. The $23 million contact lens worked, restoring space vision to the Hubble at last.

So next time you have experience with a contact lens on the eye to correct myopia (Nearsightedness) or see breathtaking pictures of our milky way from Hubble, thank the eye care profession for technology to peer into space...the final frontier!

 

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Is it safe to use ‘Redness Relief’ eye drops regularly?

The short answer is NO.

Here’s the slightly longer answer.

There are several eye “Redness Relief” products on the over-the-counter market, such as those made by Visine, Clear Eyes, and Bausch & Lomb - as well as generic versions sold by pharmacy chains.

Most commonly, the active ingredient in redness relief drops is either Tetrahydrozoline or Naphazoline. Both of these drugs are in a category called sympathomimetics.

Sympathomimetics, the active ingredient in redness relief drops, work by a process called vasoconstriction, or artificially clamping down the superficial blood vessels on the eye surface. These blood vessels often dilate in response to the irritation. This increase in blood flow is trying to help repair whatever irritation is affecting the surface of the eye. Clamping down on those vessels by using a vasoconstrictor counteracts the body’s efforts to repair the problem.

The other downside to repetitively using redness relief drops is that after the vasoconstrictor wears off the vessels often dilate to an even larger degree than when the process started. This stimulates you to use the drops again.

All of these drops carry these same two warnings on their labels:

Do not overuse as it may produce increased redness of the eye.

Stop using and ask a doctor if you experience eye pain, changes in vision, continued redness or irritation of the eye condition worsens or persists for more than 72 hours.

Does anyone read those warnings?  Almost never.

These drops are meant to be used for a VERY short duration - one or two days. That’s it!

They are not meant to be used indefinitely and they are certainly not meant to be used daily.

Take a good look at that first warning: MAY PRODUCE INCREASED REDNESS OF THE EYE.

If you are using redness relief drops repetitively you are likely making your eye redness WORSE, not better.

If you have been using redness relief drops daily you need to stop and replace them with an artificial tear or lubricating drop - something that DOES NOT say “gets the red out.”

After you make that switch your eyes are initially going to be red as your blood vessels take time to regain their normal vascular tone without the vasoconstrictor clamping down on them. The lubricating drop will actually help the repair the damage done by exposure to adverse conditions. This will decrease the inflammatory signals that make the vessels dilate. You will actually be doing something helpful to the surface of your eyes instead of just masking everything by artificially clamping down on your vessels and decreasing the flow of oxygen and nutrients to the front surface of your eye.

Using redness relief drops if you wear contacts is an even worse idea. If you put the drop in with your contact in, the contact will hold onto the drug and keep it on your eye surface longer, thus likely increasing the vasoconstriction. 

Your cornea has no blood vessels in it and it depends on the blood vessels in the conjunctiva over the whites of the eye to bring in nutrients and oxygen. The other source of oxygen for the cornea is what it gets from diffusion from the atmosphere and that is also cut down by the presence of the contact lens.

The redness relief drop combined with the contact lens are now BOTH reducing the levels of oxygen getting to the cornea. Decreased oxygen to the cornea is one of the biggest risks for contact lens-related infections, including corneal ulcers.

Don’t get me wrong, I’m not condemning redness relief drops if used appropriately for a very short time to soothe the eyes if they have been temporarily exposed to elements that made them irritated. For a day or two redness relief drops are fine. But for long-term use or for use while wearing your contacts they are much more likely to cause problems than to provide any benefits.

 

Article contributed by Dr. Brian Wnorowski, M.D

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Remember back to the last time you experienced the birth of a baby.....What are one of the first questions people ask? It’s “ WHAT COLOR ARE THEIR EYES?

What makes the color of our eyes appear as they do? What role do genetics play? What if you don’t like your eye color..... can you change it? Are there any medications that can change the eye color? Get ready to explore the science behind eye color by starting at the beginning.......

Baby’s eye color can change. A baby can start out with blue eyes, for example, and change to brown as they age. It’s all dependent on a brown pigment called melanin which develops as a child ages. The more melanin present, the darker the eye color. Brown eyes have the most pigment saturation, green/hazel eyes have less melanin, and blue eyes have the least pigment. The color of eyes are dependent upon genetics. Genetics are complicated, but generally speaking brown trumps blue in the probabilities if there is a brown eyed parent. This is because darker pigment is the dominant trait in genetics. This isn’t to say that two brown eyed parents could not have a blue eyed child......its just very rare.

So what if you don’t like your eye color? Can you change it? Yes you can. The most common way is through cosmetically colored contact lenses. It’s possible to change almost any eye color, even changing brown to blue. A special colored dye is injected into the contact lens material creating magnificent colors. There have been surgical remedies to changing iris color but the risks far outweigh the benefits, so it is not recommended. Furthermore, contact lenses are medical devices that alter cellular tissue, so only get contacts by obtaining a prescription from an eye care practitioner.

Some medications can change eye color. A class of medication called prostaglandins, used to treat glaucoma, has a side effect of darkening the iris color. This same class, in a weaker strength, is used to lengthen eyelashes. Studies have shown that in a certain percentage of patients, lighter colored blue and green eyes, have turned brown.

So maybe Crystal Gayle was looking into a crystal ball when she sang, “Don’t It Make My Brown Eyes Blue “, predicting eye color changing medications to come.

Only science in the future holds the key to permanent eye color change. But in the meantime, genetics, medication, and cosmetic colored contact lenses can enhance and change the color of your eyes. 

 

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Erectile Dysfunction (ED) drugs like Viagra, Cialis and Levitra have been implicated as possibly causing an increased incidence in a serious eye disease called Anterior Ischemic Optic Neuropathy (AION).

In 2005 the FDA received 43 post-marketing reports of sudden vision loss attributed to AION in patients taking ED medications. There was also a report in the Journal of Neuro-Ophthalmology that identified seven patients who had AION within 36 hours of their last use of an ED drug. These reports caused the FDA to issue the following drug safety alert to physicians:

Physicians should:

  • Advise patients to stop use of all PDE-5 inhibitors and seek medical attention in the event of a sudden loss of vision in one or both eyes. Such an event may be a sign of non-arteritic anterior ischemic optic neuropathy (NAION), a cause of decreased vision, which can result in permanent loss of vision.
  • Discuss with patients the increased risk of NAION in individuals who have already experienced NAION in one eye, including whether such individuals could be adversely affected by use of vasodilators such as PDE-5 inhibitors.

But does the subsequent research support the link between ED drugs and AION?

A 2006 article in the British Journal of Ophthalmology reported that men who took an ED drug and had a history of hypertension or a myocardial infarction (heart attack) had in increased rate of suffering vision loss from AION. That article, however, had to later be retracted because of irregularities in the data and inappropriate statistical methods.

Another study presented at the 2006 meeting of the American Urological Association reported data on 13,400 men who had used an ED drug and demonstrated that the incidence of AION was 2.8 cases per 100,000 patient-years. Previous epidemiologic studies have identified the annual incidence of AION in the general population to be 2.5-11.8 cases per 100,000 men over the age of 50 years. Therefore, the rate of AION in the population was not statistically different then the age group as a whole. In full disclosure, this study was run and funded by Pfizer, the maker of Viagra.

A study published in JAMA Ophthalmology investigating a group of men treated daily for six months with either an ED drug or placebo showed no significant differences were found between treatment/placebo groups for any of the visual functions tested by the study. The medications were well tolerated. Again, in full disclosure, this study was funded by Eli Lilly, the maker of Cialis.

There are some visual changes that are causally related to these drugs. Many men report a transient blue or blue-green tinge to their vision and some light sensitivity after taking these drugs. These changes only last a short while and have not been shown to correlate with any lasting impairment.

So in the end, do they or don’t they? Most of the evidence points to them not causing AION at any rate above what is expected in the population of the men who use the drug. ED itself is correlated with other vascular conditions such as cardiac disease, hypertension and diabetes. These conditions also have an increased risk for AION.

I think even though there is not a definite cause and effect relationship it is probably reasonable to follow the warning that the FDA posted.

If you experience an episode of sudden vision loss, then you should discontinue the use of ED drugs and see your doctor. Likewise, you should stop if you’ve already had an episode of AION in one eye.

 

Article contributed by Dr. Brian Wnorowski, M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Fall brings a lot of fun, with Halloween bringing loads of it.

But did you know that some Halloween practices could harm your vision? Take Halloween contacts for instance. They are wildly fun with everything to monster eyes, goblin eyes, cat eyes, sci-fi or a glamour look. If properly fit by an eye care professional, they can be just the added touch you need for that perfect costume. However, some people do not realize that the FDA classifies contact lenses as a medical device that can alter cells of the eye and that damage can occur if they are not fit properly.

Infection, redness, corneal ulcers, hypoxia (lack of oxygen to the eye) and permanent blindness can occur if the proper fit is not ensured. Another concern that ICE, FTC, and FDA have are the illegal black market contacts that come into the country unchecked. Proper safety regulations are strictly adhered to by conventional contact lens companies to insure that the contact lenses are sterile and packaged properly and accurately.

Health concerns arise whenever black market, unregulated contacts come into the US market and are sold at flea markets, thrift shops, beauty shops, malls, convenient stores and the likes. These are sold without a prescribers prescription, and are illegal in the US. Buyer beware because these are the contacts that cause concern, after all, you don’t want to bargain shop on parachutes OR your eyes! There have also been reports of damage to eyes because Halloween Spook houses ask employees to share between shifts the same pair of Halloween contact lenses as they dress up for their costume.

So the take home message is, have a great time at Halloween, and enjoy the flare that decorative contacts can bring to your costume, but get them from a reputable venue and be fit by a eye care professional with a proper legal prescription. 

 

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ

The changing of the seasons and the holidays bring fun times and activities into our lives, but also mark the beginning of a health concern: Flu season.

Flu season starts in the late Fall and runs through early Spring in some cases, so you want to be armed against this epidemic by doing several things to ensure your health stays at its optimal level. HAND WASHING is a primary deterrent against the flu. Taking vitamin supplements and getting extra rest during the holiday season also helps. Preventative maintenance also includes a preventative flu shot. Many employers and health care clinics offer them at no or little charge. For children especially, they even have a flu mist, so that the needle can be avoided.

Some simple things you can do in your house to prevent flu from spreading is use a bleach water mixture and spray countertops, doorknob handles, light switches, phones, and steering wheels of your car.

Influenza A is the most typical culprit in our fight to stay healthy, so when the outbreak in your area occurs, be ready. If you are in a career that requires close contact with people, a mask and sometimes rubber gloves can help protect you. If you, yourself, are feeling “under the weather” with fever, lethargy, chills, sore throat, or the like be sure and STAY HOME. You should get plenty of rest and stay home from work or school to insure you don’t pass the bug onto others.

There is a type of flu that affects the eyes called adenovirus. It can give you symptoms such as redness, watery, irritated eyes and blurred vision. Be sure and keep your immune system up with plenty of fluids, rest, vitamins, and exercise as well as eating healthy foods during the winter months to avoid, the flu, “achoo“, so you can take care of YOU!

 

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

One of the hardest questions eye care professionals deal with every day is when to tell people who are having difficulty with their vision to stop driving.

Giving up your driving privilege is one of the most difficult realities to come to terms with if you have a problem that leads to permanent visual decline.

The legal requirements vary from state to state. For example, in New Jersey the legal requirement to drive, based on vision, is 20/50 vision or better with best correction in one eye for a “pleasure” driving license. For a commercial driving license, the requirement is 20/40 vision or better in both eyes.

In some states there is also a requirement for a certain degree of visual field (the ability to see off to the sides).

According to the Insurance Institute for Highway Safety, the highest rate of motor vehicle deaths per mile driven is in the age group of 75 and older (yes, even higher than teenagers). Much of this increased rate could be attributable to declining vision. There are also other contributing factors such as slower reaction times and increased fragility but the fact remains that the rate is higher, so when vision problems begin to occur with aging it is extremely important to do what is necessary to try to keep your vision as good as possible.

That means regular eye exams, keeping your glasses prescription up to date, dealing with cataracts when appropriate and staying on top of other vision-threatening conditions such as macular degeneration, glaucoma and diabetes.

It is our responsibility to inform you when you are no longer passing the legal requirement to drive. Although there is no mandatory reporting law in all states, it is recorded in your medical record that you were informed that your vision did not pass the state requirements to maintain your privilege. And, yes, it is a privilege - not a right - to drive.

If you have a significant visual problem and your vision is beginning to decline, you need to have a frank discussion with your eye doctor about your driving capability. If you are beginning to get close to failing the requirement you need to start preparing with family and love ones about how you are going to deal with not being able to drive, preferably before it becomes absolutely necessary.

We have had the very unfortunate occurrence of having instructed a patient that he should stop driving because his vision no longer met the requirements only to have him ignore that advice and get in an accident. Don’t be that guy. Be prepared, have a plan.

 

Article contributed by Dr. Brian Wnorowski, M.D.

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ. This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician.

The spots, strings, or cobwebs that drift in and out of your vision are called “floaters,” and they are more prominent if you’re looking against a white background.

These floaters are tiny clumps of material floating inside the vitreous (jelly-like substance) that fills the inside of your eye. Floaters cast a shadow on the retina, which is the inner lining of the back of the eye that relays images to the brain.

As you get older, the vitreous gel pulls away from the retina and the traction on the retina causes flashing lights. These flashes can then occur for months. Once the vitreous gel completely separates from the back wall of the eye, you then have a posterior vitreous detachment (PVD), which is a common cause of new onset of floaters.

This condition is more common in people who:

  • Are nearsighted.
  • Are aphakic (absence of the lens of the eye).
  • Have past trauma to the eye.
  • Have had inflammation in the eye.

When a posterior vitreous detachment occurs, there is a concern that it can cause a retinal tear.

Symptoms of a retinal tear include:

  • Sudden increase in number of floaters that are persistent and don't resolve.
  • Increase in flashes.
  • A shadow covering your side vision, or a decrease in vision.

In general, posterior vitreous detachment is unlikely to progress to a retinal detachment. Only about 15 percent of people with PVD develop a retinal tear.

If left untreated, approximately 40 percent of people with a symptomatic retinal tear will progress into a retinal detachment – and a retinal detachment needs prompt treatment to prevent vision loss.

Generally, most people become accustomed to the floaters in their eyes.

Surgery can be performed to remove the vitreous gel but there is no guarantee that all the floaters will be removed. And for most people, the risk of surgery is greater than the nuisance that the floaters present.

Similarly, there is a laser procedure that breaks the floaters up into smaller pieces in hopes of making them less noticeable. However, this is not a recognized standard treatment and it is not widely practiced.

In general, the usual recommendation for floaters and PVD is observation by an eye care specialist.

 

Article contributed by Jane Pan M.D.

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ. This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician.

The Background

Over the last several years, research has indicated a strong correlation between the presence of Obstructive Sleep Apnea (OSA) and glaucoma. Information from some of these pivotal studies is presented below.

Did you know

  • Glaucoma affects over 60 million people worldwide and almost 3 million people in the U.S.
  • There are many people who have glaucoma but have not yet had it diagnosed.
  • Glaucoma is the second-leading cause of blindness in the U.S. behind macular degeneration.
  • If glaucoma is not detected and goes untreated, it will result in peripheral vision loss and eventual, irreversible blindness.

 

  • Sleep apnea is a condition that obstructs breathing during sleep.
  • It affects 100 million people around the globe and around 25 million people in the U.S.
  • A blocked airway can cause loud snoring, gasping or choking because breathing stops for up to two minutes.
  • Poor sleep due to sleep apnea results in morning headaches and chronic daytime sleepiness.

The Studies

In January 2016, a meta-analysis by Liu et. al., reviewed studies that collectively encompassed 2,288,701 individuals over six studies. Review of the data showed that if an individual has OSA there is an increased risk of glaucoma that ranged anywhere from 21% to 450% depending on the study.

Later in 2016, a study by Shinmei et al. measured the intraocular pressure in subjects with OSA while they slept and had episodes of apnea. Somewhat surprisingly they found that when the subjects were demonstrating apnea during sleep, their eye pressures were actually lower during those events than when the events were not happening.

This does not mean there is no correlation between sleep apnea and glaucoma - it just means that an increase in intraocular pressure is not the causal reason for this link. It is much more likely that the correlation is caused by a decrease in the oxygenation level (which happens when you stop breathing) in and around the optic nerve.

In September of 2016, Chaitanya et al. produced an exhaustive review of all the studies done to date regarding a connection between obstructive sleep apnea and glaucoma and came to a similar conclusion. The risk for glaucoma in someone with sleep apnea could be as high as 10 times normal. They also concluded that the mechanism of that increased risk is most likely hypoxia – or oxygen deficiency - to the optic nerve.

The Conclusion

There seems to be a definite correlation of having obstructive sleep apnea and a significantly increased risk of getting glaucoma. That risk could be as high as 10 times the normal rate.

In the end, it would extremely wise if you have been diagnosed with obstructive sleep apnea to have a comprehensive eye exam in order to detect your potential risk for glaucoma.

 

Article contributed by Dr. Brian Wnorowski, M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided on this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

In trying to answer the question of how blue light affects eye health we need to explore several topics.

Sunlight Exposure and Damage to the Eye

There have been multiple studies over the years that have shown excessive exposure to sunlight might cause damage to the eyes and the eyelids.

There is a very strong association with exposure to ultraviolet light and the incidence of skin cancer on the eyelids.

Research has demonstrated that exposure to sunlight also increases the risk of cataracts.

These studies include:

  • Chesapeake Watermen Study (Taylor et al. New Engl J Med. 1988; 391:1429-33.)
  • Beaver Dam Eye Study (Cruickshanks et al. Am J Public Health 1992; 82:1658-62)
  • Salisbury Eye Evaluation (West et al. J Am Med Assoc. 1998; 280:714-8)
  • Blue Mountains Eye Study (Mitchell et al. Ophthalmology 1997; 104:581-8).

The majority of this research implicates the UV portion of sunlight as the source of the damage, not blue light.

So where does the blue light problem come in?

Blue Light and Its Potential Effect on the Retina

Most of the evidence pointing to the potential detrimental effects of blue light has been inferred from an accumulation of several experimental studies, rather than any studies of direct correlation

A study by Han et al. (Nature 1976; 260:153-5) demonstrated that the retina of a rhesus monkey was most sensitive to shorter wavelengths of visible light with a maximum sensitivity at 441 nm, which is in the violet/blue spectrum.

Some of the studies mentioned previously that demonstrated a connection between sunlight exposure and cataracts also showed some increase in the amount of macular degeneration seen later in life in these same patients. Since UV light is almost completely absorbed by our own natural lens, the portion of sunlight that reaches the retina is the visible portion of light. Experimental evidence has shown that it is the blue/violet end of the visual spectrum that is the mostly likely cause of retinal damage.

The Beaver Dam eye study mentioned above showed that people who reported more than five hours of summer sun exposure in their early years had a higher rate of early macular degeneration. And since it appears that the blue/violet end of the visible spectrum causes the most retinal damage, it infers that blue light may be the major culprit.

Blue Light and Sleep

Blue light suppresses melatonin receptors. Suppressing these receptors helps improve “wakefulness,” so exposure to blue light during daylight hours helps keep us awake and attentive.

This same exposure to blue light in the evening may inhibit your ability to get to sleep by suppressing those same receptors.

Therefore, it might be wise to limit your exposure to screens on cell phones, tablets and E-readers in the hour or two before bedtime if you are having trouble falling asleep.

Another alternative is to wear blue-light-blocking lenses when using those devices in the evening. Wearing those same glasses in the daytime might actually decrease your attentiveness.

So What Should You Do?

Remember, the strongest evidence that light causes health problems is still the damage that can be done from the UV spectrum in sunlight. Cataracts and eyelid skin cancer are both strongly correlated with sunlight exposure. A good pair of sunglasses during daylight hours is the most important health benefit you can give yourself when it comes to protecting yourself from light damage.

As far as blue light is concerned, it might make sense to consider blue-light-filtering lenses if you are staring at light-emitting screens all day, particularly in the evening hours when exposure to blue light might throw off your sleeping patterns. The evidence that blue light exposure is a definitive risk factor for macular degeneration, especially at the levels given off by screens as opposed to sunlight, is much less clear.

So the answer is, there some evidence that there are some real possible health risks with exposure to blue light. But the degree of hype the subject is getting - especially by some specialty eyeglass makers - might be out of proportion to the degree of evidence that these effects are truly harmful at the levels to which we are currently being exposed.

 

Article contributed by Dr. Brian Wnorowski, M.D.

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ

Here are 11 bad things that can happen if you don’t wear and care for your contact lenses properly.

1) Sleeping in your contacts. This is the No. 1 risk factor for corneal ulcers, which can lead to severe vision loss and the need for a corneal transplant. Your cornea needs oxygen from the atmosphere because it has no blood vessels. The cornea is already somewhat deprived of oxygen when you have your eyes closed all night, and adding a contact on top of that stresses the cornea out from lack of oxygen. You don’t need to see when you are sleeping. Take your contacts out!!!! I promise your dreams will still look the same.

2) Swimming in your contacts. Salt, fresh or pool water all have their individual issues with either bacteria or chemicals that can leach into your contacts. If you absolutely need to wear them to be safe in the water, then take them out as soon as you are done and clean and disinfect them.

3) Using tap water to clean contacts. Tap water is not sterile. See No. 2.

4) Using your contacts past their replacement schedule. The three main schedules now are daily, two weeks and monthly. Dailies are just that – use them one time then throw them away; they are not designed to be removed and re-used. Two-week contacts are designed to be thrown away after two weeks because they get protein buildup on them that doesn’t come off with regular cleaning. Monthly replacement contacts need to have both daily cleaning and weekly enzymatic cleaning to take the protein buildup off. Using your lenses outside of these schedules and maintenance increases the risk of infection and irritation.

5) Getting contacts from an unlicensed source. Costume shops and novelty stores sometimes illegally sell lenses. If you didn’t get the fit of the lenses checked by an eye doctor, they could cause serious damage if they don’t fit correctly.

6) Wearing contacts past their expiration date. You can’t be sure of the sterility of the contact past its expiration date. As cheap as contacts are now, don’t take the risk with an expired one.

7) Topping off your contact lens case solution instead of changing it. This is a really bad idea. Old disinfecting solution no longer kills the bacteria and can lead to resistant bacteria growing in your case and on your lenses that even fresh disinfecting solution may not kill. Throw out the solution in the case EVERY DAY!

8) Not properly washing your hands before inserting or removing contacts. It should be self-evident why this is a problem.

9) Not rubbing your contact lens when cleaning even with a “no rub” solution. Rubbing the lens helps get the bacteria off. Is the three seconds it takes to rub the lens really that hard? “No rub” should never have made it to market.

10) Sticking your contacts in your mouth to wet them. Yes people actually do this. Do you know the number of bacteria that reside in the human mouth? Don’t do it.

11) Not having a backup pair of glasses. This is one of my biggest pet peeves with contact lens wearers. In my 25 years of being an eye doctor, the people who consistently get in the biggest trouble with their contacts are the ones who sleep in them and don’t have a backup pair of glasses. So when an eye is red and irritated they keep sticking that contact lens in because it is the only way they can see. BAD IDEA. If your eye is red and irritated don’t stick the contact back in; it’s worst thing you can do!

 

Article contributed by Dr. Brian Wnorowski, M.D.

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ

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Dr. Michelle Presson

Dr. Michelle Presson

Dr. Michelle received her undergraduate degree from the University of South Florida in Tampa and her Doctor of Optometry from the Southern College of Optometry in Memphis in June of 1996.

Dr. Shane Presson

Dr. Shane Presson

Dr. Shane received his undergraduate degree from the University of Tennessee at Knoxville and his Doctor of Optometry from the Southern College of Optometry in Memphis in June of 1995.

Rachel Powell

Rachel Powell

Rachel is our General Office Manager. Rachel attended Grace Christian Academy through high school and received her Associates in Marketing at Pellissippi State in 2012. She graduated from King University with her Bachelor’s in Business Management in May 2014.

Michelle Beavers

Michelle Beavers

Michelle is one of our front office managers. Michelle has been with Karns Vision Center since the doors were opened in 2008. She is instrumental in all aspects of our office and patient care.

Kirsten Hibbert

Kirsten Hibbert

Kirsten is one of our front office managers. She went to Karns High School and graduated from Maryville College in 2010 with her Bachelor’s Degree in Business Management.

Kaitlyn

Kaitlyn

Kaitlyn is one of our optometric technicians who assists our doctors with our patients. She is invaluable to our office in the optical as well. Kaitlyn graduated from Karns High School in 2011.

Kelsey

Kelsey

Kelsey is one of our optometric technicians. She helps our patients learn the basics of contact lens insertion and removal and assists in our optical department. Kelsey graduated from Karns High School in 2012 and is currently attending Johnson University to receive her Religious Studies and Bible Bachelor's Degree.

Zoë

Zoë

Zoe is one of our optometric technicians who helps in every department of our office. She graduated from Halls High School in 2012 and graduated in 2016 from Tusculum College with her Bachlor's Degree of Arts in Psychology.

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