expert type icon EXPERT

Dr. Peter J. Polack, M.D.

Ophthalmologist

Peter J. Polack M.D., F.A.C.S., is a board-certified ophthalmologist specializing in laser vision correction including LASIK and PRK, laser cataract surgery, the latest techniques in corneal transplants such as DMEK and DSAEK, and external diseases of the eye including dry eye. After attending the University of South Florida College of Medicine, he was awarded the Dyson Foundation Research Fellowship at the Cornell University Medical College. He then completed a residency in ophthalmology at the New York Eye & Ear Infirmary where he was a chief resident, followed by a fellowship in cornea, refractive surgery and external diseases at the University of South Florida. Dr. Polack has published numerous abstracts and has co-authored textbooks on ophthalmology, and has taught other doctors corneal transplantation surgery. He is a technology columnist for Ophthalmology Management magazine and is a top contributor on Quora.com with over a quarter of a million views. He also hosts an iTunes podcast and blog, Medical Practice Trends, for fellow physicians.
31 years Experience
Dr. Peter J. Polack, M.D.
  • Ocala, FL
  • University of Central Florida College of Medicine
  • Accepting new patients

Should my child get colored contacts?

You don't say how old your daughter is, but I am guessing not very. Nevertheless, colored contact lenses are not a good idea. Simply using regular prescription contact lenses, READ MORE
You don't say how old your daughter is, but I am guessing not very. Nevertheless, colored contact lenses are not a good idea.

Simply using regular prescription contact lenses, particularly if they are soft contacts which is what most people wear, increases your risk of serious infections such as corneal ulcers. If they are worn overnight, the risk goes up even higher. Extended wear contacts? The risk goes up even more.

But patients who need to see are willing to accept some of these risks so that they can function.

Someone who just wants their eye color to be different is taking a significant chance of harm to their eyes for a cosmetic reason. This risk can be much higher for people who get these colored contacts from novelty stores or places that don't take the time to ensure a proper fit.

Bottom line: colored contact lenses are not advisable, especially for younger people. If an adult still insists on getting these, they should at least see an eye doctor such as an optometrist to ensure that they are getting a health product and that it is properly fitted and maintained and subject to proper followup exams.

Can sunglasses spoil kids eyesight?

As long as his vision is normal this should not be a problem. In fact, this may even be a good habit to have growing up. I grew up the child of an eye doctor and started wearing READ MORE
As long as his vision is normal this should not be a problem. In fact, this may even be a good habit to have growing up. I grew up the child of an eye doctor and started wearing sunglasses at a young age, too - not 5, but a bit older.

Sun exposure to the eye is associated with macular degeneration - in people who have a hereditary tendency - cataracts, growths on the eye (pterygium and pingueculum) as well as cancers of the superficial layers of the eye and the eyelids.

The only thing I would have checked is that he does not do that because his eyes are sensitive to light, because that can indicate a possible problem.

So, as long as everything - including his vision - checks out as normal and he is just doing it to be fashionable and he is not using them inappropriately (in the classroom for instance) but mostly when outside, then this should not affect the eyes negatively.

Periodic checkups will insure that this is the case. There are studies that suggest that exposure to blue wavelengths of light during childhood - such as what is in natural sunlight - are associated with a decreased incidence of myopia (near-sightedness). So, if there is a family tendency to be myopic, then at least some time outdoors exposing the eyes to natural light would be in order.

My eye looks different because of my astigmatism. Anything I can do?

Astigmatism, or an out-of-roundness of the eye, does not make the eye look different than the other eye. It can, however, make the 'vision' different from the other eye, usually READ MORE
Astigmatism, or an out-of-roundness of the eye, does not make the eye look different than the other eye. It can, however, make the 'vision' different from the other eye, usually as blurriness. Most astigmatism can be corrected, but it depends on the severity, the cause, and the age of the patient. Without this information, it is not possible to say what can be done. You should probably see a cornea-refractive specialist who can determine the cause and possible treatment. But if your eye 'looks' different to you in the mirror or to other people, this is probably due to something else, not astigmatism.

I can't stand to wear contacts

The most likely cause of contact lens intolerance - what you are describing - is dry eyes. This is by far the most common diagnosis we make when patients are referred to us for READ MORE
The most likely cause of contact lens intolerance - what you are describing - is dry eyes. This is by far the most common diagnosis we make when patients are referred to us for contact lens-related problems. Dry eye has many potential causes so a thorough examination and medical history are essential as it can get progressively worse.

Another cause of contact lens intolerance is allergies to either something external or to the lens or lens solutions or cleaners. This will usually have tell-tale signs on examination so the doctor that prescribed the contact lenses should be able to tell you. If they are not sure you can request to be referred to a cornea specialist.

How do I know if my child has got an allergy or conjunctivitis?

In the early stages, it is often a challenge to tell them apart. Some clues that this is probably allergic conjunctivitis: history of other allergy signs (itchy nose, sneezing, READ MORE
In the early stages, it is often a challenge to tell them apart.

Some clues that this is probably allergic conjunctivitis: history of other allergy signs (itchy nose, sneezing, asthma-like symptoms, constant rubbing of eyes, pets in the house, seasonal occurrence

Clues that this is more likely infectious conjunctivitis: acute (sudden) onset, usually starts in one eye, mucus discharge (pus-like), fairly swollen lids (which may swell shut), extremely bloodshot (might even have splotches due to broken blood vessels, pain, light-sensitivity, cases of pink-eye going around the school or community.

If it is allergic, using topical allergy eyedrops and/or antihistamine like Benadryl, cold compresses, it will usually be better the next day.

If it is infectious conjunctivitis, it will get worse before it gets better, no matter what you treat it with. Note that, although primary care doctors will usually prescribe them, antibiotic drops will not cure most cases of conjunctivitis since they are due to viruses (which are not affected by antibiotics) and not bacteria.

In infants or children under 2, it is not inappropriate to use antibiotics as protection against bacteria which can coexist in infections since children this age don't have the same immunity.

In either case you can use a decongestant/antihistamine drop such as Naphcon-A up to 4 times a day. Again, if it is allergic it will get better pretty quickly. If it is an infection, it will get worse before it gets better and can last up to a week. In severe cases, the eye doctor might prescribe steroid drops but this should be used with extreme caution as it can cause glaucoma and other possible complications.

Children should be kept from school if they have an infection or if the parents aren't sure.

Is there a way to treat cataract without surgery?

If you discover a way to treat cataracts without surgery you would win the Nobel Prize in Medicine, be on the cover of Time magazine, and save the government billions of dollars. READ MORE
If you discover a way to treat cataracts without surgery you would win the Nobel Prize in Medicine, be on the cover of Time magazine, and save the government billions of dollars.

Alas, this is not the case. It is a normal part of aging and cataract surgery has been around since the time of the Egyptians, who would 'couch' or push the cataract into the back of the eye and to the side with a sharp reed (since there was no way to remove it surgically in those days).

Nowadays, it is one of the most common procedures performed in the world and is extremely safe with a very low complication rate. It has also been shown improve the quality of life in elderly people as well as decrease the rates of accidental falls and fractures, as well as depression.

In good hands and at a reputable place, he has an excellent prognosis. If his diabetes is controlled, it usually does not have a bearing in most cases.

My eyes feel very dry after LASIK. Why could this be?

Dry eyes are very common after LASIK and patients with significant dry eye may be advised to have PRK instead of LASIK for that reason. In most cases, the eyes return to their READ MORE
Dry eyes are very common after LASIK and patients with significant dry eye may be advised to have PRK instead of LASIK for that reason. In most cases, the eyes return to their baseline from before surgery but that can take several weeks to months depending on the patient: younger men more quickly, older women more slowly, everyone else in between.

If you are only 10 days out, I would not be overly concerned. You should be using frequent preservative-free artificial tears. And you should be asking your surgeon for recommendations specific to your situation. He or she knows your eyes a lot better than I do!

Does not wearing glasses all the time increase eye power?

The answer to your question depends on what your prescription is and how accurate that prescription is. If the prescription is correct then it is unlikely to cause an increase READ MORE
The answer to your question depends on what your prescription is and how accurate that prescription is.

If the prescription is correct then it is unlikely to cause an increase in your eye power.

If you are near-sighted (myopia) and your prescription is too strong, it is possible for it to contribute to an increase in the eye power if your eye is still developing. This development usually stops around the age of 25.

If you are far-sighted (hyperopia) however, then it probably won't make too much difference. If the prescription is too strong, your eyes won't have to work as hard and they will get used to the glasses as a 'crutch' and you might find that you are more dependent on the glasses than you were before. But that doesn't necessarily mean that your eye power has changed.

Is stopping restasis considered to be dangerous?

A common misconception about Restasis (and Xiidra which works similarly) is that they are interchangeable with other dry eye treatments. These are the only non-steroidal anti-inflammatory READ MORE
A common misconception about Restasis (and Xiidra which works similarly) is that they are interchangeable with other dry eye treatments. These are the only non-steroidal anti-inflammatory medications for the treatment of dry eye due to inflammation. They are not artificial tears and they are not meant to 'soothe' the eye. They are prescriptions medications.

Restasis works by blocking the white blood cells which are involved in inflammatory dry eye disease. Since these cells have about a 90-day lifespan, it can take anywhere from 3 months to 6 months for Restasis to reach a therapeutic level. Sometimes when patients tell me that they tried Restasis and "it didn't work" they were usually not on it long enough for it to count.

Likewise, if you stop Restasis, it might take a month or longer before you know for sure if the effect has worn off.

If you have been on it for years without a problem and now you have an issue with one of the eyes, Restasis is unlikely to be the culprit. But your eye doctor should review what other medications you are on. Again, it is unlikely that you are on something comparable to Restasis already so I would be hesitant to just stop it without doing some investigating as to the cause of your symptoms.

It is also possible that despite being on Restasis that your dry eye disease is nevertheless progressing. There are many contributing factors to dry eye including auto-immune diseases, diet, environment, skin type, genetics, other drug side effects, to name a few. Restasis alone might be insufficient to counteract these other causes.

To answer your question, yes it is safe to stop Restasis. But if your symptoms worsen - and this might not happen for several weeks - and you need to go back on Restasis, just be aware that you will have to start all over again as it can take several months to reach a therapeutic level again.

Is there an age restriction for a refractive surgery?

Refractive surgery, LASIK or PRK, is approved for 18 years and older. Most surgeons like to wait until at least age 21 AND evidence of a stable refraction (prescription) to ensure READ MORE
Refractive surgery, LASIK or PRK, is approved for 18 years and older. Most surgeons like to wait until at least age 21 AND evidence of a stable refraction (prescription) to ensure that the eyes have stopped growing.

In most cases, this applies to patients with myopia (near-sightedness). If she has hyperopia (far-sightedness), this can continue to increase for a longer time and so she might not be a candidate even after she is fully grown because the refraction is not stable.

Exceptions are made in children for when one eye is much weaker than the other and is at risk for losing vision (amblyopia). This is typically done at an academic center after careful consultation and review by pediatric ophthalmologists if all other options have been exhausted.

Can i be affected with two types of cataract in the same eye?

A cataract is the aging of the natural crystalline lens of the eye. Once it is removed it does not grow back (unless you are a salamander). The confusion comes from the fact that READ MORE
A cataract is the aging of the natural crystalline lens of the eye. Once it is removed it does not grow back (unless you are a salamander).

The confusion comes from the fact that most people will develop scarring of the posterior capsule - the sac that holds the intraocular lens implant placed inside the eye. The symptoms are very similarIn the old days this was called an 'after cataract'. Some eye doctors may still use similar terminology but it is not a cataract, simply scar tissue.

It is easily removed with a YAG laser, completely painless, safer than the original cataract surgery and there are no restrictions after the procedure.

What is the safe age for wearing sunglasses?

Honestly, younger children are probably especially sensitive to the harmful effects of UV radiation so I commend you for even thinking about it. No, there is no issue regarding READ MORE
Honestly, younger children are probably especially sensitive to the harmful effects of UV radiation so I commend you for even thinking about it. No, there is no issue regarding age for when they can be used. The real challenge will probably be getting her to keep them on. But if she doesn't mind wearing them, it will certainly be beneficial. Most sunglasses - except for the cheapest ones - are UV-blocking. If you want to be sure, buy them in an optical store where they have a UV-filtering device and they can tell you for sure.

My eyes feel very dry after LASIK. What could be the cause for this?

You are still quite early in the postoperative period and I would expect your symptoms to eventually improve. The LASIK procedure involves creating a flap of corneal tissue, either READ MORE
You are still quite early in the postoperative period and I would expect your symptoms to eventually improve. The LASIK procedure involves creating a flap of corneal tissue, either with a laser or a blade, which results in the 'disconnection' of the nerves which supply the surface of the cornea and are involved in the lubrication process. It is typical for these symptoms to show up around the 2 week mark but can take several weeks to months to recover.

Studies have shown that these nerves regenerate over a period of several months to sometimes as long as a year. This can be more sigfnicant if a patient had a dry eye problem to begin with so most LASIK surgeons will be diligent about identifying those patients with dry eye and treat them aggressively prior to the procedure in order to ensure an optimal outcome. Fortunately it is only a minority of patients who have a persistent, serious dry eye problem after LASIK.

Many cases of dry eye are actually due to an instability of the tear film due to a deficiency of oil due to meibomian gland dysfunction. This is often overlooked by eye doctors who don't specifically look for it. So in addition to using artificial tears - and I would recommend using preservative-free artificial tears for the first several weeks after surgery - you also want to promote adequate oil production from the eyelids.

Some things to try:
- preservative-free artificial tears
- moist heat on the lids (but avoid pressure on or rubbing of the eyelids for the first month)
- take fish oil, flaxseed oil, or black currant seed oil (the latter can be found in a supplement called HydroEye)
- cut wheat out of the diet =3D Paleo Diet. Wheat has been linked to inflammation and autoimmune disorders including dry eye due to decreased tear production
- limit omega-6 oils - these are found in fried foods and most processed foods and listed as hydrogenated oils and fats and are also linked to inflammation
- make sure you don't have a ceiling fan or AC duct blowing on you at night. Even a fan in the corner of your room can be blowing enough to dry your eyes out
- if fans or AC are not an issue, consider using a lubricating gel or ointment at night to keep the eyes from drying out while you sleep
- if you are still struggling, you might benefit from Restasis, a prescription eye drop that decreases inflammation and can increase tear production. Be aware that this medicine can take a few months to reach a therapeutic level.

Bottom line: dry eye is common early after LASIK and usually improves with time. But you should discuss your symptoms and concerns with your surgeon. Untreated dry eye is associated with regression which can lead to undercorrection of your refractive error. So your doctor will want to know so they can address it properly.

Why are my eyes blood red when I wake up?

Redness of the eyes is a 'non-specific' sign indicating that something is bothering or irritating the eyes. And if they are red primarily in the morning, it means that something READ MORE
Redness of the eyes is a 'non-specific' sign indicating that something is bothering or irritating the eyes. And if they are red primarily in the morning, it means that something is bothering them either during the night or late in the day and they are not having a chance to recover.

Some things that can irritate the eyes at night include allergens such as dust/dust mites/animal dander/perfumes or dyes from detergents used on bedding/etc, the eyes cracking open while you are asleep and they are drying out, a ceiling fan or AC blowing on the eyes.

Could it be that the eyes are irritated during the evening? Staying up late watching TV or using the computer? Drinking alcohol late? These would be some other possibilities to consider.

Try to eliminate possible allergic irritants. Put some lubricating gel or ointment in the eyes at bedtime and also consider wearing a sleep mask to keep the eyes from drying out.

If these options don't do the trick, then you should definitely see an eye doctor to rule out other causes.