Dr. Friedman's Office: (210) 880-3000
News/Blog 2014-2019
December 12th, 2019 - Eye Strain
January 5th, 2015 - AMD Home Monitoring
October 3rd, 2014 - Costume Contacts
September 7th, 2014 - New Medications
June 22nd, 2014 - Diabetic Macular Edema
I have many patients that come to my office saying that their eyes are feeling more dry than normal. Admittedly, we live in Texas, and the fact that it is 70 degrees and sunny in December might contribute to that fact. Still, one of my first questions for any patient with dry eye is, “when do you feel that your eyes become the most irritated?” Routinely, patients will tell me that they start to experience their symptoms after staring at their computer for work (or some other form of a screen for a prolonged period). Whether it is our smart phone, desktop computer, or television, the fact that we are interacting with “screens” plays an important role in your eye health.
When we are focused on screens, our blink rate inevitably slows. In fact, you blink about one third of the normal rate when you are staring at that screen. This contributes to the eyes drying out and becoming more “tired” and “strained”.
In these situations, I like to remind patients to take blink breaks. I know it sounds hokey, but I’m serious. Every 20 minutes, you should take a little time to stare away from the screen at something off in the distance. I also recommend that you actually take a Post-It note and put it on your work screen. Write the word, “BLINK” in big letters on the Post-It. Subconsciously, it will remind you to blink.
One final and very effective way to help avoid the effects of screen strain is to use artificial tears. Look at my webpage on Dry Eye Syndrome to read all about it. I hope these tips can help you avoid too much eye strain while staring at your screens.
Duncan Friedman
Retina Specialist
San Antonio, TX
Welcome back to our webpage, and my sincerest apologies for not updating in a while. It has been a busy few years, but there is lots of news.
First, I am now a partner with my practice of Braverman-Terry-Oei Eye Associates. Not much has changed in the respect of location, hours, etc., but we are likely to make a few updates to the clinic in the upcoming months. I am a big advocate of efficient medicine, and I hope to see how that works in making my clinic more efficient.
Second, I am saddened by recent events at our practice as our senior partner, Dr. Sheldon Braverman, passed away last year. He established our prominent and well-known practice in San Antonio and cared for many people over the years. His legacy is embedded in how I continue to deliver care, and his reputation will last for years to come.
Finally, I am happy to announce that I have been selected by my peers in the San Antonio to the Super Doctors® Rising StarsSM list for the second year in a row. I am honored by this acknowledgement and hope to continue to live up to their standards.
As a promise to my patients and all who seek more eye related knowledge, I am going to work to keep this website updated with new and exciting news. I pride myself on staying up to date on innovations and announcments in all fields of ophthalmology, and I hope I can continue to share this information with you. Thanks for visiting, and see you again real soon.
Duncan Friedman
Retina Specialist
San Antonio, TX
The American Academy of Ophthalmology recently held its annual meeting which I was privileged to attend. There, the great minds of all aspects of ophthalmology meet and discuss practice trends, innovations, research, and all aspects of ophthalmology.
In addition, many new technologies make their debut on the exposition floor. I have so say that I am quite impressed with how far ophthalmology has come. There are new and improved surgical machines, innovative software, and simple devices to make the daily practice of ophthalmology even more precise than it has been in recent years.
One particular exciting innovation I happened upon on the floor is new home monitoring software for macular degeneration. There is a device called ForseeHome which allows patients with moderate macular degeneration to monitor their disease from home. Think of it as an alarm system for macular degeneration. Patients have a computer based interaction with a device that sends the results to a central company that monitors your status. If you have a change in your visual status (as reflected by the at-home test), the company will alert you and your doctor of the change such that you can make an appointment to further evaluate. It seems like an excellent screening tool. It is definitely an upgrade from the typical Amsler grid that we give most of our patients to stick on their walls and refrigerators in hopes that they self-monitor. I also like this device because it is substantiated by a study that showed an earlier rate of detection of wet macular degeneration than people not using the machine. This means that we are able to treat leaking retinal vessels earlier with medication which usually means a better visual outcome.
In the interest of full disclosure and transparency, I have no . . . none . . . zero financial or business relations to this product or its company. I simply felt that this is a really good product and a possible wave of future management for macular degeneration.
I hope everybody had an excellent holiday season and a Happy New Year. More updates to come in 2015.
Duncan Friedman
Retina Specialist
San Antonio, TX
Halloween is coming up at the end of the month . . . one of my family’s favorite holidays. It is a great time for people to get dressed up and have a spooky/scary night. A new, interesting trend has evolved over the past few years: colored contact lenses.
Although these sound like a fun idea to enhance your costume, be forewarned. The possible problems associated with these contact lenses can be a lot scarier. They can cause eye infections, scratches, and injuries. This year, the American Academy of Ophthalmology has developed a public service announcement to help educate people about costume contact lenses. For more information, please go to: www.geteyesmart.org.
Duncan Friedman
Retina Specialist
San Antonio, TX
In a follow up to the previous blog post, there are actually two new medications that have recently been approved to treat diabetic macular edema.
Through the same effects of blocking vascular endothelial growth factor (VEGF), a medication known as aflibercept (brand name Eylea) has received FDA approval for treatment of diabetic eye disease. Eylea is promoted as an eye injection that lasts longer than the other previously mentioned injections (i.e., Avastin and Lucentis). Whether it truly makes a difference will play out in the results of an upcoming study comparing the 3 drugs.
The second drug is a long acting steroid pellet known as Ozurdex. As stated before, steroids for diabetic macular edema have shown very good results and many retinal specialists use steroids alongside anti-VEGF injections. This steroid pellet is a slow release device that has routinely been shown to work anywhere between 3-6 months. Problems with using steroids in the eye include the fact that they accelerate cataract formation and can cause the eye pressure to rise which can cause glaucoma. With these side effects (and the low side effect risks associated with other injections), the injections of steroid tend to be a secondary therapy if anti-VEGF injections fail.
We will see how physicians incorporate these new medicines into their practices, but still, it is pretty exciting news.
Duncan Friedman
Retina Specialist
San Antonio, TX
I had an interesting question this week from a patient about how we treat diabetes when it gets to the eyes. It brought me back to the fact that a lot of physicians take their day-to-day treatments without giving much of a second thought. I went through my normal talk of why we use medicine in the eye to combat diabetic retinal swelling, but the patient quickly followed it up with the question: “Is there any literature on this?”
In cases like these I tend to turn to the pamphlets provided by the American Academy of Ophthalmology, as this usually lends insight and description to the disease process and treatment, but the material I had available in my office that day was . . . well, lacking. So, in order to remedy this situation, here is diabetic treatment in a nutshell.
In diabetes, the retinas are affected because of a lack of good blood flow. When the retina lacks oxygen/blood, it starts to produce a chemical messenger known as vascular endothelial growth factor (VEGF). This messenger can make the blood vessels under the center of vision start to leak and causes something known as diabetic macular edema (DME). For a long time, ophthalmologists treated this problem by using a laser to shut down the culprit, leaky blood vessels based off of a study known as the Early Treatment of Diabetic Retinopathy Study (ETDRS).
Since the time of the original study (and others that followed), new drugs have come out that block VEGF in the eye. The two, injectable drugs used by ophthalmologists currently are bevacizumab (Avastin) and ranibizumab (Lucentis). Some ophthalmologists also inject steroids for diabetic edema, but I will save that discussion for another blog post. Depending on doctor and patient preference, either drug can be used. I will also say that there have been good studies that validate the use of both Avastin and Lucentis for DME.
The medicines tend to wear off after about 1 month, so uncontrolled DME will often require re-injection of the medicine. I say “often” because as a person’s blood sugars become better controlled, the retina can start to recover a little. As seen in other studies, people with diabetes tend to have a 2-5 year period where the disease in their eyes can be pretty debilitating, but it tends to level out after some time. Vision might not return to completely normal levels even with adequate treatments, but left unchecked the diabetic eye disease can cause severe permanent visual loss. This is why it is very important to check both your eyes from time-to-time when you have diabetes just to make sure there has not been a sudden change.
I could go on and on about the differences between the drugs and all of the details of diabetic eye disease (which I will sooner or later do in the patient education section), but for this brief post . . . and for the purposes of answering the initial question, these injectable anti-VEGF drugs are probably the most effective means of combatting DME that we currently have.
Duncan Friedman
Ophthalmologist
San Antonio, TX
Have you ever taken a look in the mirror and found that one of your eyes is REALLY red? You didn’t realize you even had a red eye. It does not hurt, itch, or burn, but everybody keeps pointing it out to you. Although a red eye can occur for many different reasons, one of the most common is a subconjunctival hemorrhage.
Basically, I like to tell people that this is a “bruise of the eye”. Either you rubbed the eye the wrong way, strained a little too hard, or it happened spontaneously, but something caused a blood vessel under the skin of the eye to burst. If you had normal skin over the eye, it would look black and blue, but since the skin of the eye is clear, you see the “blood red” appearance of all of the underlying bleeding.
Fortunately, there is not much that has to be done. These hemorrhages/bleeds stop themselves and go away in a few days. Some can stick around for up to a couple of weeks. I usually recommend the use of over the counter artificial tears, but only if the eyes feel irritated. Again, if the eye starts to hurt, burn, itch or the vision changes, this is likely not a subconjunctival hemorrhage and should be looked at by an eye doctor. I will try and add a picture of a subconjuctival hemorrhage in the near future for reference. Until next time, feel free to send along any questions.
Duncan Friedman
San Antonio, Texas
Ophthalmologist
1100 N. Main Ave
San Antonio, TX, 78212
Dr Friedman's office phone (210) 880-3000
Dr Friedman's office email SanAntonioEyeDoctorMD@gmail.com
