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Glaucoma 101

Kiss Dry Eye Goodbye

Don't Lose Sight of Diabetic Control

Bye-Bye Blue Light

Kiss Dry Eye Goodbye

November 2017

As a Michigander, I have grown up with a love for the fall season!  It means it is harvest time, a time when mother nature shows her beautiful colors, a time to pull out cozy sweaters, and a time to prepare for the holidays with family.  The downside is it means dry eye symptoms worsen from time spent aside the fire, furnaces kicking on, and ultimately drying out the air in our homes.  I am here to offer some tips on how to conquer your dry eye symptoms!

There are different kinds of dry eye, and each require their own treatment to relieve symptoms.  Did you know that there are three layers to your tear film?  They consist of an outermost oily layer, middle watery layer, and inner mucousy layer.  The three combined provided a protective coating over the front surface of our eyes.  Evaporative dry eye invovles a deficiency in the outermost layer of the tear film.  Aqueous deficient dry eye involves the middle layer.  You eye doctor can determine which type of dry eye you suffer from with a comprehensive dry eye assessment.

With all forms of dry eye, there are some environmental modifications you can make to provide relief of your symptoms.  The first is to evaluate your home:

*Do you sleep with a ceiling or stand fan on at night?  

*Do you heat your house with wood?  

*Do you have excessively dry air in your home?

*Do you sleep with your eyes partially open?  

All of the above factors can greatly contribute to dry eye symptoms.  Some modifications you can make include redirecting ceiling fans away you at night to prevent excess air from increasing dryness. I would also encourage purchasing a humidifier to increase the moisture in your house, which in turn will help maintain appropriate moisture of your eyes.  Oftentimes, if you sleep with your eyelids partially open, a thicker tear supplement, such as a gel eyedrop, can provide added protection from exposure to air.  Your eye doctor can prescribe this for your eyes and help you feel more refreshed and moisturized to start your day off right!

Another often forgotten component to look at is your electronic device usage.  Do you regularly use a computer, tablet (iPad), or cell phone?  Oftentimes when using these devices, our blink rate greatly decreases.  Without a steady, regular blink rate, the tears are not able to spread equally over the surface of the eyes.  This leads to dry spots or widespread dryness.  I would recommend an artificial tear, such as Refresh Optive Advanced or Systane Ultra to be used prior to and immediately following electronic device use.

By implementing some of the changes mentioned above, you can greatly improve your dry eye symptoms.  Michigan this time of year is beautiful, and I hope you are able to conquer your dry eye to enjoy the season!

My best,

Dr. Hannah Rillema, O.D.






Don't Lose Sight of Diabetic Control

The holidays are among us!  Beautiful decorations hung about, holiday parties left and right, and temptations from sweet treats can distract us, causing us to lose track of our dietary goals.  This busy season is especially difficult for patients diagnosed with diabetes.  This blog offers education for patients with diabetes on the consequences of over-splurging.  It will help you stay motivated in maintaining good health for

your entire body and your eyeballs! 

Diabetes involves juggling blood sugar, blood pressure, and cholesterol to ensure the body remains healthy for a lifetime.  Diabetes is a disease of the small blood vessels, which are the carriers of oxygen and nutrients to the body.  The longer a person has diabetes, and the more blood sugar levels fluctuate damages the small blood vessels of the body, causing them to leak blood and fluid in many organs of the body.  The term given to damaged blood vessels in the eyes is diabetic retinopathy, and it has various stages graded by your eye doctor.  The mild form oftentimes leaves patients with no symptoms, but can quickly advance to moderate and severe stages.  The most advanced stage of diabetic retinopathy is when the retina, which is the first part of the eyeball that processes vision, is severely deprived of oxygen and it starts to grow new, small blood vessels attempting to overcome the problem.  However, these small blood vessels are very delicate and are prone to leaking, disrupting the smooth, clear visual pathway. The new vessels also extend a framework of tissue which can contract and cause a retinal detachment, leading to rapid, permanent vision loss.  The pictures below are a representation of vision manifestations from mild, moderate, and severe diabetic retinopathy.

What can you do to prevent these visual consequences and stay healthy?  Conquering control of your blood sugar is the first step.  Keeping a consistent log of your blood sugar levels upon awakening and tracking after meals is crucial to management.  Without knowing the ‘numbers’ you will not have a frame of reference as to how well or how poorly your control is.  You can still enjoy the tasty treats of the holiday season as long as you enjoy them in moderation.  Keeping a food journal can be a helpful tool to staying on track.  Simply writing down your food intake for the day can help you realize just how many cookies snuck their way into your tummy.  Swapping a few treats for a healthy substitute can help tremendously as well.  Rather than endulging in another sugar cookie or other high sugar / high carbohydrate snack, swap for vegetables and dip or something with more protein content such as a handful of nuts.  Be sure to check with your primary care physician, endocrinologist, and/or nutritionist before making drastic changes or if your health will be impacted negatively by the aforementioned recommended changes.

The second step in control is conquering your blood pressure.  Hypertension is defined as consistent blood pressure readings >130mmHg systolic / >80mmHg diastolic with new regulations implemented fall of 2017.  High blood pressure is the evil relative of diabetes, and when both act up, it amplifies negative effects on your health and your vision.  Maintaining good control is best managed by medication taken as prescribed, and consistently.  For those wanting to conquer without the use of medication, reducing stress by utilizing yoga / meditation / deep thinking, lowering your salt content in your diet, and exercising with cardio and strength training are all beneficial.  Make sure again to check with your primary care physician and fellow doctors for further clarification/clearance.  In my clinical experience, patients who are diligent about making changes, even if small to start, have the best results.

Maintaining healthy cholesterol levels is similar to controlling blood pressure.  Medication prescribed by your physician taken as prescribed and consistently is beneficial.  Exercising good dietary judgment and control, as well as implementing an exercise routine can help tremendously too.

The last piece of diabetic control is to have a yearly, dilated, comprehensive diabetic eye exam with your eye doctor.  Recognizing concerns in your ocular health can raise flags to problems in your kidneys (nephropathy), feet (neuropathy), and in many other organs of the body.  Recognizing these detriments early on is critical to make changes for resolution and to prevent further progression.  Additional exams may be necessary depending on whether diabetic retinopathy is found, or if you are pregnant.  Our doctors are thorough with examining the small blood vessels of the retina with every dilated exam, so you can rest assured we are on your side with protecting your vision and ocular health!

Take time to enjoy the holiday season, and make a conscious effort to stay balanced for the best health on the upcoming new year!  

My best,

Dr. Hannah Rillema, O.D.








Mild Diabetic Retinopathy

Moderate Diabetic Retinopathy

Severe Diabetic Retinopathy

Many of our patients are aware of the harmful effects of ultraviolet (UV) light on vision and ocular health.  However, many of our patients are still unaware of the impact visible blue light is proposed to have.  Children 8 and younger are anticipated to spend an average of 2 hours and 19 minutes a day with screen media in 2018.  American adults devote more than 10 hours and 39 minutes a day to screen time, and that number continues to grow according to recent research from fall of 2017.  The doctors, opticians, and technicians at our office have recently been trained on blue light blocking technology available in spectacle lenses to protect your eyes from harmful blue light.  We are excited to offer these products with our knowledge to our patients updating eyewear!

The clear windshield of the eye known as the cornea, and the white part of the eye called the conjunctiva and sclera are capable of blocking some ultraviolet and blue light from reaching the back of the eye called the retina. However, recent research suggests visible blue light of certain wavelengths can still reach the retina.  Chronic exposure to visible and ultraviolet blue light is proposed to increase chances of developing macular degeneration, an ocular disease that permanently deteriorates central vision.  As specialists in eye care, we are determined to offer premium products targeting this harmful blue light to protect your precious vision sustainable through a lifetime.  Some of the lenses and coatings we offer at our practice specifically block blue light from entering the eye, thus preventing its negative effects on the sensitive retina.

Blue light from electronic devices including cell phones, tablets, laptops, computers, and televisions are known to cause eye fatigue for many patients.  The added benefit of our blue light blocking lenses is that they contain a smart filter to selectively block harmful blue light rays from entering the eye.  Our doctors prescribe these lenses primarily for patients working for prolonged periods of time on an electronic device.  This includes many of our patients who work on a computer, students, and even children using electronic devices more often.  However, these lenses are proving to be beneficial to all patients, as it can help regulate the body’s normal sleep and wake patterns, and some studies suggest it improves concentration.

The big ticket question:  How exactly do these lenses work?  The figure included at the bottom of this page shows how the blue light blocking lenses and coatings are designed to selectively reflect harmful blue light rather than transmit it through the lens.  Some of the coatings can be noticeable in appearance to those looking at your glasses with a slight blue hue to the lens surface. This noticeable feature proves the lenses are working to keep your eyes healthy!  

We are excited to share this technological advancement with our lenses.  We always strive to provide you with premium products that fit your lifestyle and the growing demands of your eyes!  We look forward to sharing our knowledge and fitting you with these lenses at your next visit!

My best,

Dr. Hannah Rillema, O.D.


Did you know there is a silent threat to vision?  Did you know your eye doctor can detect it early and help prevent it from progressing?  This threat to vision has a name, and it is called Glaucoma.  In this blog post, we will discuss the risk factors, forms of testing to detect it, and the forms of treatment for managing the condition to preserve your precious vision.  

Glaucoma is a group of eye disorders that leads to progressive damage to the optic nerve.  The optic nerve is the cable cord that carryies the visual information the eye collects to the brain for processing.  The optic nerve contains nearly 1 million individual nerve fibers!  The most prevalent form of Glaucoma is Primary Open-Angle Glaucoma, which results from an increase in pressure in the eye, which presses on the nerve fibers, resulting in fiber damage / death, and ultimately vision loss.  

Glaucoma, unfortunately, does not have one test that can easily diagnose a patient; rather a series of different tests must be conducted to ‘piece together the puzzle’ of Glaucoma.  We have many of these tests available in our office, including a visual field to map the depth and overall coverage of visual defects, corneal pachymetry to measure corneal thickness and determine if pressures measured in office are accurate / need adjustment, and optic nerve examination with dilation by your doctor and photos for future comparison.  If your doctor warrants further testing, an OCT, which takes a scan of the back of the eyes and essentially gives a cell count on the number of nerve fibers in the optic nerve, can provide more definitive information / guide treatment.

Many of our patients are familiar with the label, “Glaucoma Suspect,” which simply means you are at a higher risk of developing Glaucoma, but it is not yet a definitive diagnosis.  This label helps the doctors watch you even more closely for development of Glaucoma.  Some patients can remain suspects for many years, others may show signs of progression / changes in test results that point to the diagnosis of Glaucoma sooner.  There are several known factors that can increase your risk of developing Glaucoma, which include age over 60 years, being of African American race, having a family history of glaucoma, having health conditions such as diabetes, high blood pressure and heart disease, physical injuries to the eye(s), or prolonged corticosteroid use.

Although there is no known cure for Glaucoma, there are different forms of treatment available that can help prevent progression to advanced stages.  The key to stabilization of vision is compliance with the treatment regimen your doctor prescribes you.  Keeping follow-up appointments, not missing doses of drops, and seeing a specialist for further management are the most important pieces to do your part in maintaining stability of your Glaucoma.  Your doctor will evaluate the risk factors mentioned previously with the results of your Glaucoma testing to determine whether eyedrop therapy is necessary to control the disease.  These drops work by lowering the pressure inside the eyes, and depending on the medication are instilled once daily or more frequently.  Again, the key to control is regular use of the eyedrops.  If this method proves to be ineffective, the doctors will refer you for evaluation by a Glaucoma specialist to consider alternative methods, such as laser therapy or surgery.

The doctors and staff at our office highly encourage you to maintain a minimum yearly routine, unless the doctors specify otherwise, to protect your vision and ocular health.  If you have any questions regarding Glaucoma, please make sure to ask us at your next exam.  We are honored to serve as your eye care provider.

My best,

Dr. Hannah Rillema, O.D.


Resources:  https://www.aoa.org/newsroom/glaucoma-the-sneak-thief-of-sight-may-strike-without-pain-or-other-symptoms




We have exciting news!  We are officially fitting digital lens technology at our practice.  Why is this exciting you may wonder?  The term digital refers to an advanced manufacturing process in which the prescription determined by your doctor is optimized with computer-controlled surfacing equipment that is more precise.  This gives you a wider field of vision to provide the most accurate and sharpest vision possible.

Digital, sometimes referred to as free-form, technology lenses are surfaced at our lab in incremements of 0.01 steps compared to 0.125 to 0.25 D increments in traditional lens surfacing.  With digital lenses, aberrations, or distortions common in traditional designs are eliminated.  Thus, when you as a wearer are wearing your glasses and look to the side rather than straight through the center of the lens, distortions are noticeably minimized.  This allows better peripheral vision, improved image quality, and of course, overall improved crisp vision.

The good news is that these digital lenses are available in single vision and in progressive (no-line bifocal) designs.  The single vision design takes a patient’s vision from a small, dime-sized center to larger than a half dollar crisp center, with improvement even outside this zone.  Progressive lens wearers can anticipate a much wider distance, intermediate and near zone, virtually making the entire lens a “sweet spot” for optimum viewing.  There is also an added zone for progressive lenses, one calibrated to help you achieve the best vision for cell phone range.  Clarity and comfort are maximized in these lenses with the perfectly matched anti-reflective coating, which helps with reducing night glare, and computer / cell phone / electronic device glare.  Our opticians would be delighted to fit you in these lenses as prescribed by your eye care provider.

Many of our patients appreciate the improvement in vision with digitally surfaced lenses as soon as they put them on.  One patient described the change as “switching from an old pixelized television to ultra HD television,” immediately upon picking them up from our optical department.  We are continually overjoyed to hear the positive comments from our patients.  Our staff also has appreciated the improvements with digital technology - ask them when you’re in and they would be happy to tell you!

We anticipate this technology to continue to advance, and we are proud to have had our entire staff thoroughly trained to confidently fit these lenses to provide you with the best vision possible.  We will continue to educate ourselves as new advancements are made!

My best,

Dr. Hannah Rillema, O.D.






Wider field of vision for more natural viewing conditions with your glasses.

Traditional vs. digital (freeform) technology.  More crisp vision!