Dr. Friedman's Office: (210) 880-3000


Happy Holidays

December 24th, 2013

Just want to take a moment to wish you and yours a very Happy Holidays and a Happy New Year. Keep those eyes healthy in 2014.

Duncan Friedman
San Antonio, Texas

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Be Healthy and Have Healthy Eyes at the Same Time

September 8th, 2013

A thought occurred this weekend while swimming with my daughter . . . indoor pools are a great opportunity for people with dry eyes. In the dry Texas climate, people with dry eye disease are at a disadvantage. Still, there is hope.

If you have dry eye and are looking for a means to exercise, water aerobics might just be your thing. Not only do you get a workout to keep your body healthy, but the humid and moist environment of an indoor pool also helps fight the drying effects of the outdoor heat. I personally like that kind of two-for-one deal.

Duncan Friedman
San Antonio, Texas

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Why is this eye bigger than the other?

August 7th, 2013

A recent encounter reminded me of a good point to make about the eyes.  If you ever note that one pupil is bigger than the other, you should be examined by an eye care provider immediately.  That is not to say that all instances of uneven pupils are emergencies, but they can indicate an emergency.  Some of the more dangerous conditions associated with uneven pupils include an aneurysm or a dissection of the carotid artery.  A good rule of thumb is that if the uneven pupils are accompanied by a headache, head to an emergency room. 

Otherwise, the pupils still need to be examined immediately by your eye doctor to rule out these bad situations.  Other causes for uneven pupils include dilating medicines accidentally getting into the eye, lung or neck tumors, eye trauma, and sometimes it happens because the nerves to the iris (the colored part of the eye) are not acting as strongly as they should.

Interestingly, about 10-20% of the population has slightly uneven pupils, known as physiologic anisocoria.  Still, if the unevenness to the pupils is something new in your life, you should have it examined.

Duncan Friedman
San Antonio, Texas

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Good Contact Lens Habits

July 7th, 2013

Sorry for the delay in updates, but the official move to Texas has occurred. Here is the next entry.

Summer is here.  It’s time to get outside, have fun, and enjoy common summer activities. These may include water sports, outdoor recreation, road trips, or gardening.  Summer is a great opportunity to take off the glasses and enjoy all the benefits of contact lenses.
I wanted to take this time to re-emphasize some good contact lens hygiene.  Contact lenses are excellent means of correcting eyesight problems, but they need to be treated well or else they can cause serious problems to the eye surface.

One of the biggest problems is “over-wear” of the lenses.  Everybody has a certain amount of time that their corneas (the surface of the eye) can tolerate wearing contacts.  Some eyes are more tolerant of contact lenses than others, but there are two problems with overwearing. The first problem is that the cornea’s surface needs oxygen.  Although contact lens material is getting better at allowing oxygen to reach the surface, it is still a barrier.  This is why it is important to give your eyes a rest from contacts every so often.

The other problem with contact lenses is that they are a surface for bacteria to grow and stick to.  After prolonged wear, the contact lenses start growing colonies from the natural bacteria that live on the eye surface.  They also collect dust and dirt from daily exposure.  Without proper care, contacts can cause scratches on the eye, dry eye, and even corneal infections.  There will be other sections of patient education devoted to each of these subjects in the future.

I want to emphasize a couple of recommendations that I always make for contact lens wearers.   The first and most important is for those people that sleep in their contacts.  The contact lens manufacturers make contacts that they claim you can wear at night.  Some even make a 30-day pair that you just throw away at the end of the month.  I personally have a hard time recommending this practice.  As my personal eye care professional quoted to me, it greatly increases your risk of getting a corneal infection.  I don’t like playing those odds when it is just as easy for me to take out the lenses at night right before sleep and put them back in when I wake up.  You won’t be using the contact lenses while you sleep, so why put your eyes at risk?  Trust me, a corneal ulcer can be a sight threatening problem, and that is not a risk I like to take.

A second recommendation I tend to make is regarding swimming in contact lenses.  If you are going to expose your eyes to freshwater lakes or rivers during the summer, I would recommend changing the contacts after you finish.  Certain bacteria and micro-organisms love fresh water, so be careful.

Finally, some common sense recommendations:  don’t wash your contacts with tap water or any “homemade” solution.  Wash your hands before you touch your eyes to put in or take out your contacts. And, you should only use contacts prescribed by eye care professionals as these are measured to specifically fit your eyes (in other words, beware “cosmetic” contacts because they can cause some serious eye surface damage . . . trust me, I’ve seen it).  I hope everyone is enjoying their summers and the fun that comes along with it.

Duncan Friedman
San Antonio, Texas

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Diabetic Resources

June 9th, 2013

Diabetic Eye disease is a prominent problem in the field of ophthalmology and especially in the subspecialty of retina. Since diabetes is such a common disease, many people have the diabetic retinopathy that goes along with it. I will be devoting an entire patient education page to diabetic eye disease in the near future. The purpose of this post is to provide some resources that people with diabetes can use for both their general health and eye disease.

Recently the American Society of Retina Specialists started a website to educate the public about diabetic eye disease. I recommend that you visit www.DiabetesEyeCheck.org for an animated walk-through of what is involved in a diabetic eye exam. Further, it provides a link to find an eye care provider in your area that can perform a diabetic eye exam.

One of our ophthalmology periodicals also published a short article on diabetic resources. Although it mostly focused on how eye care providers should be taking active roles in their patient’s diabetes monitoring, it also provided a number of useful websites. These included:

www.hormone.org/FindAnEndo/ for finding an endocrinologist,

www.diabetesselfcare.org/find-an-educator/ for finding a diabetes educator,

www.integrateddiabetes.com/ for patient education about diabetes in general,

and a link to an online community for people with diabetes, www.DiabeticConnect.com

Finally, for those with smartphones I have recently come across an app (although there are many) that allows you to monitor your glucose and keep a personal log instead of just writing it down. If you search for “Glucose Buddy” by the company Azumio, the application seems pretty easy to use.

N.B., I do not get any funding from any of these sites. These are only recommendations based on my playing around with the sites on the web.

Feel free to contact us with feedback about each of these resources and if they were helpful, and stay tuned for more eye related information.

Duncan Friedman, MD
Ophthalmologist - San Antonio, TX

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June 7th, 2013

I just finished watching the new James Bond movie Skyfall, and although there aren’t any cool, eye related gadgets in this one like a retinal scan, there is at least one scene where the villain reveals an eye-related deformity. Thinking back to the most recent Bond films, the villain in those movies also have problems with their eyes . . . Admittedly, I might be a bit biased as I am looking for things like this. Still, I recently had an encounter with a stye in my practice which of course leads to the pun in this blog post.

So what is a stye? Medically referred to as a chalazion on hordeolum, a stye is a problem of the eyelids where one of the glands is backed up. There are a lot of ways of classifying styes, but for all purposes, when one of the oil glands or extra tear glands gets stopped up, the gland itself becomes red and inflamed. This ends up looking like a big, red bump on the edge of the eyelid. People with dry eye disease tend to get styes. We also see a lot of styes in children who are predisposed to them. Maybe it is a tear chemical imbalance; maybe it is a hormonal imbalance, no matter what, styes don’t feel great and they look bad. The good news is that they should usually go away with the right treatment.

Whenever I see someone with a stye, I start off with conservative treatment. I recommend the same treatments as I would for anyone with dry eye disease. Start with warm washcloths on the eyelid for about 5-10 minutes with gentle massage, 2 times a day. Wash the eyelids with a mixture of baby shampoo and warm water 2 times a day, and use artificial tears if your eyes feel dry. If after 2 weeks of this treatment the stye isn’t getting any better, you might need to have an ophthalmologist perform a minor surgery (usually in the office) to open it up and let the gland drain on its own. Obviously, if the stye is getting significantly bigger, more painful, or worse, see your eye doctor sooner, but conservative treatments are a good start.

As for the Bond villains, they have bigger things to deal with.

Duncan Friedman, MD
Ophthalmologist - San Antonio, TX

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So What’s the Deal with Eye Vitamins?

May 26th, 2013

Recently, I was giving a community talk when a question on eye vitamins arose. I actually make a habit of going to the “over-the-counter” aisles in grocery stores and drug stores to see what is on sale so I can advise patients if I see any special deals on eye drops or other eye medication. So, the eye vitamin question is a good one and hopefully this post will give you a little insight.

Let’s start with the purpose of eye vitamins. These supplements are made for people with a diagnosis of age related macular degeneration (ARMD). Most “eye vitamins” are compounds of specific ingredients based off of a formula that was tested in a large-scale study, the Age Related Eye Disease Study (AREDS). If you go to the eye vitamin aisle, you will find a lot of brands that say they are “AREDS formulary”. So, which people with macular degeneration should be taking these vitamins? Interestingly, the original AREDS study found a modest benefit for people with moderate or severe “dry” macular degeneration.

As an aside, I will be writing more about ARMD on the patient education portion of this website, so if you do not know the difference between “wet” and “dry” macular degeneration, start there. The benefit of taking these vitamins is that fewer people on the vitamin formulary progressed to the worse, wet ARMD than those not taking the vitamin. The standard formula contained a mixture of Vitamin C, Vitamin E, beta-carotene, zinc and copper. I’m not stating the exact formula because there has been a recent update . . . AREDS 2.

AREDS updated the formula after five years for a variety of reasons. There has been a lot of debate over the years as to what makes a good eye vitamin. Some brands have incorporated other supplements such as lutein and zeaxanthin. Some researchers and clinicians believe that omega-3 fatty acids (the ones found in fish oils) had a beneficial effect on preventing worsening ARMD. Also, beta-carotene was associated with an increased risk of lung cancer in people who took the vitamins and smoked (although smoking is never a good idea in general . . . trust me, it is bad for your eyes and your general health). Finally, the zinc in the original formula caused some people to have stomach cramps, so the investigators in the AREDS 2 study decided to sort out the details.

The investigators released their findings at the most recent Association for Research in Vision and Ophthalmology (ARVO) meeting in May 2013. The official press release can be found here, but this is what they found

1) Omega-3 fatty acids did not improve the outcomes of people with ARMD overall
2) The addition of lutein and zeaxanthin had no additional benefit compared to the first formulary
3) But . . . if you take away the beta-carotene (cancer causing component), and put in the lutein and zeaxantin instead, the benefits are slightly better.

The science behind this is a little more in depth, but the take-home points are these. People with moderate or severe dry macular degeneration should likely be on these supplements to help prevent new blood vessels and/or bleeding in the retina. These supplements should contain the following:

1) 500 milligrams of Vitamin C
2) 400 international units of Vitamin E
3) 80 milligrams of zinc
4) 2 milligrams of copper
5) 10 milligrams of lutein and
6) 2 milligrams of zeaxantin

Some additional thoughts . . . Smoking is likely a bad idea if you have macular degeneration as inflammation caused by smoking causes retinal inflammation which can cause dry macular degeneration to become wet macular degeneration. Also, although omega-3 fatty acids are not proven to add benefit to your eye health, there are some pretty good studies that show that they can help with your heart health and cholesterol. Ask your primary doctor if you should be taking these supplements (or maybe just getting a good dose of fish each week).

Finally, let’s get back to the vitamin aisle at the drug store. The question always comes up, “which vitamin should I use?” The answer to that question is that you should use the one that fits your budget and only if you actually have enough macular degeneration in your retinas to justify it. Only a good eye exam will answer that question. Otherwise, save your money.

Duncan Friedman, MD
Ophthalmologist - San Antonio, TX

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May 20th, 2013

Launch!!! Welcome to The Eyes of Texas. The website is up and running after much trial and error. Stay tuned for more updates and news. Consider this the "blog" portion of the page where we will try and give little updates in the world of ophthalmology as they arise. Thanks for visiting, and feel free to contact us with the ophthalmology related content you want us to talk about.

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