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OPTOMETRISTS, 720 n cahuenga Boulevard, Los Angeles, CA (2026)

06/05/2026

On the cover: “Traumatic Macular Hole
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from a Foam Dart Toy” by Ella J. Gehrke, MD, Ian C. Han, MD, Dana L Zach (Photographer) (University of Iowa, Iowa City, Iowa). Equipment: Zeiss Clarus 500 Fundus Camera.

Published in the June 2026 issue of Ophthalmology Retina.

06/05/2026

TRUE COLOR TRANSFORMATION: HOW LENS COLORS CHANGE THE WAY YOU SEE THE WORLD

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While most people choose lenses based on appearance alone, lens color can significantly influence visual comfort, contrast sensitivity, glare reduction, mood perception, and overall viewing experience.

Understanding how different lens tints affect vision can help you choose eyewear that not only looks great but also enhances your daily activities.

🔹 DEEP GREY – THE EVERYDAY CLASSIC

Grey lenses are among the most popular choices because they reduce overall brightness while preserving natural color perception.

Benefits:
• Maintains true color accuracy
• Reduces glare in bright conditions
• Ideal for driving and everyday outdoor use
• Comfortable in strong sunlight

Best for:
Daily wear, commuting, driving, and general outdoor activities.

🔹 MOCHA BROWN – WARM & COMFORTABLE

Brown lenses increase contrast and depth perception while providing a warmer visual experience.

Benefits:
• Enhances contrast and visual detail
• Creates a softer, more comfortable view
• Excellent for prolonged outdoor use
• Often preferred for photography and scenic viewing

Best for:
Travel, hiking, and extended outdoor activities.

🔹 OLIVE GREEN – NATURAL BALANCE

Green lenses offer an excellent balance between color preservation and contrast enhancement.

Benefits:
• Reduces eye strain
• Enhances contrast without excessive color distortion
• Provides a relaxed viewing experience
• Suitable for changing light conditions

Best for:
Sports, outdoor recreation, and everyday use.

🌸 SAKURA PINK – SOFT & STYLISH

Pink-tinted lenses have gained popularity due to their unique aesthetic appeal and comfortable visual experience.

Benefits:
• Softens harsh lighting
• Improves visual comfort in moderate brightness
• Enhances facial appearance in photographs
• Provides a modern, fashionable look

Best for:
Lifestyle wear, social events, and casual outdoor activities.

💜 LAVENDER PURPLE – DISTINCTIVE & TRENDY

Purple lenses combine style with subtle visual enhancement.

Benefits:
• Offers a unique appearance
• Helps improve object definition against certain backgrounds
• Creates a refined visual experience
• Ideal for those wanting something different

Best for:
Fashion-conscious wearers and urban environments.

🌊 OCEAN BLUE – FRESH & RELAXING

Blue lenses provide a cool, crisp visual impression.

Benefits:
• Reduces glare
• Delivers a refreshing viewing experience
• Comfortable for prolonged wear
• Creates a clean and modern appearance

Best for:
Leisure activities and bright outdoor settings.

🧡 CORAL ORANGE – ENERGETIC & VIBRANT

Orange-tinted lenses can make surroundings appear brighter and more vibrant.

Benefits:
• Enhances contrast
• Improves visual perception in hazy conditions
• Creates a lively viewing experience
• Popular among active outdoor users

Best for:
Recreational activities and variable weather conditions.

💛 AMBER YELLOW – CONTRAST BOOSTER

Amber and yellow lenses are well-known for improving contrast, especially in low-light or overcast environments.

Benefits:
• Enhances depth perception
• Improves visibility on cloudy days
• Increases contrast and detail recognition
• Reduces visual fatigue

Best for:
Driving, cycling, and outdoor sports in moderate light.

🤎 COCOA BROWN – SUBTLE & RELIABLE

A darker brown tint offers a calm, comfortable viewing experience.

Benefits:
• Gentle on the eyes
• Reduces brightness effectively
• Improves contrast naturally
• Suitable for extended daily wear

Best for:
Commuting, outdoor work, and everyday activities.

☀️ BEYOND COLOR: WHAT REALLY MATTERS?

Regardless of lens tint, quality eyewear should provide:

✅ UV400 Protection
Blocks harmful UVA and UVB radiation.

✅ True Color Vision
Maintains visual clarity and accurate perception.

✅ Comfortable Lightweight Design
Reduces pressure during long-term wear.

✅ Adaptive Light Performance
Helps maintain comfort across changing lighting conditions.

👁️ Final Thought

There is no single "best" lens color—only the best color for your lifestyle.

The right lens tint can improve comfort, reduce glare, enhance contrast, and make outdoor activities more enjoyable. Whether you prefer the timeless performance of Deep Grey, the warm contrast of Mocha Brown, or the vibrant style of Sakura Pink, understanding lens colors helps you make a smarter eyewear choice.

Which lens color is your favorite and why? Let us know in the comments! 👇

06/05/2026

Understanding Glaucoma: Stages of Optic Nerve Damage 👁️

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Glaucoma is a group of eye conditions that damage the optic nerve, often caused by increased intraocular pressure (IOP). It is one of the leading causes of irreversible blindness worldwide. Early detection and monitoring are critical, as vision loss from glaucoma is permanent and often progresses silently.

Our infographic illustrates the progression of glaucomatous optic nerve damage, broken down into three key stages:

• Normal Optic Nerve Head
At this stage, the optic disc is healthy with a small, well-defined physiological cup. The neuroretinal rim is intact, indicating normal nerve fiber health. Patients typically have no visual symptoms.

• Early Glaucomatous Cupping
Mild to moderate optic disc excavation begins. The neuroretinal rim starts to thin, which may initially go unnoticed during routine vision checks. Detecting these early structural changes through fundoscopy or imaging is crucial for timely intervention.

• Advanced Glaucomatous Cupping
Severe optic atrophy develops, with the optic cup expanding dramatically in a “bean-pot” shape. The neuroretinal rim is significantly thinned or absent, often resulting in substantial peripheral and central vision loss. At this stage, treatment can only slow progression; lost vision cannot be restored.

Key Takeaways:

• Glaucoma is often asymptomatic in early stages, making routine eye exams essential.
• Fundus photography and optic nerve imaging help track cupping and neuroretinal rim changes over time.
• Early detection and IOP-lowering treatments can prevent irreversible vision loss.
• Lifestyle and systemic health factors, such as controlling blood pressure and avoiding eye trauma, play a supportive role in management.

By recognizing the subtle changes in optic nerve anatomy before vision is affected, eye care professionals can preserve sight and improve long-term outcomes.

Regular eye check-ups, particularly for individuals over 40 or with a family history of glaucoma, are your best defense against this “silent thief of sight.”

06/05/2026

Glaucoma: The Silent Threat to Your Vision 👁️

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Glaucoma is often called the "Silent Thief of Sight" because it can gradually damage the optic nerve without causing noticeable symptoms in its early stages. By the time vision loss becomes apparent, the damage is often permanent.

The infographic above demonstrates how the optic nerve changes as glaucoma progresses—from a healthy optic disc to advanced glaucomatous cupping.

🔹 Stage 1: Normal Optic Nerve Head

✅ Healthy optic disc
✅ Physiological cup present
✅ Intact neuroretinal rim
✅ Normal visual function

At this stage, the optic nerve appears healthy and there is no evidence of glaucomatous damage.

🔹 Stage 2: Early Glaucomatous Cupping

⚠️ Moderate optic disc excavation
⚠️ Enlargement of the optic cup
⚠️ Neuroretinal rim thinning
⚠️ Vision may still appear normal

This stage is particularly important because structural damage often occurs before patients notice visual symptoms. Regular eye examinations can detect these early changes.

🔹 Stage 3: Advanced Glaucomatous Cupping

❌ Severe optic atrophy
❌ Marked loss of neuroretinal rim tissue
❌ "Bean-pot" excavation of the optic disc
❌ Significant and irreversible visual field loss

Advanced glaucoma can severely affect quality of life and may eventually lead to blindness if left untreated.

🚨 Who Is at Risk?

• Age over 40 years
• Family history of glaucoma
• Elevated intraocular pressure (IOP)
• Diabetes and hypertension
• High myopia (nearsightedness)
• Long-term steroid use
• Previous eye injury

👀 Early Warning Signs

• Often no symptoms initially
• Gradual peripheral vision loss
• Difficulty seeing in dim light
• Halos around lights
• Blurred vision
• Eye pain in some forms of glaucoma

💡 Protect Your Vision

✅ Schedule regular comprehensive eye examinations
✅ Monitor eye pressure and optic nerve health
✅ Follow prescribed treatment plans
✅ Maintain systemic health conditions such as diabetes and hypertension
✅ Seek prompt evaluation if visual symptoms develop

❤️ Remember: Vision lost from glaucoma cannot be restored, but early diagnosis and treatment can slow or prevent further damage.

📢 Don't wait for symptoms to appear. A simple eye examination today could protect your vision for years to come.

06/04/2026

Which part of this reminds you of your clinic 😂

Fortunately, I got to work early at the eye clinic and had plenty of time to get everything ready for the day.

Unfortunately, the coffee machine was broken, and half the staff looked like zombies before 8:00 AM.

Fortunately, the first patient arrived cheerful and right on time.

Unfortunately, he forgot his glasses and couldn’t read a single line on the sign-in sheet.

Fortunately, we got him checked in anyway.

Unfortunately, he sat in the wrong waiting room and accidentally joined a cataract surgery consultation.

Fortunately, he thought the doctor was very informative.

Unfortunately, he wasn’t even there for cataracts.

Fortunately, the OCT machine powered up normally.

Unfortunately, it immediately displayed a mysterious error message that nobody had ever seen before.

Fortunately, after a reboot, it started working again.

Unfortunately, it decided to stop working again five minutes later.

Fortunately, the IT department answered the phone.

Unfortunately, they asked if we had tried turning it off and on again.

Fortunately, a patient brought homemade cookies for the staff.

Unfortunately, they were sugar-free, gluten-free, dairy-free, and somehow flavor-free.

Fortunately, everyone smiled and thanked her.

Unfortunately, nobody ate a second cookie.

Fortunately, the next patient was excited to get new glasses.

Unfortunately, he insisted his current prescription was perfect despite walking into three chairs on the way to the exam room.

Fortunately, the doctor found a prescription that improved his vision dramatically.

Unfortunately, he immediately asked if it could also help him see next week’s lottery numbers.

Fortunately, the morning clinic stayed on schedule.

Unfortunately, twenty patients arrived at exactly the same time.

Fortunately, we managed to keep the waiting room organized.

Unfortunately, one patient kept wandering around asking everyone if they’d seen his wife.

Fortunately, his wife was easy to find.

Unfortunately, she was sitting right beside him the entire time.

Fortunately, a child came in for an eye exam wearing the cutest superhero costume.

Unfortunately, he refused to remove the superhero mask.

Fortunately, his mother convinced him that superheroes need eye exams too.

Unfortunately, he spent the entire exam making laser sound effects.

Fortunately, the doctor enjoyed the entertainment.

Unfortunately, the visual field test took twice as long.

Fortunately, lunchtime finally arrived.

Unfortunately, nobody actually got to eat lunch.

Fortunately, there was a brief cancellation.

Unfortunately, three emergency add-on patients appeared immediately.

Fortunately, one patient was thrilled because her vision improved after cataract surgery.

Unfortunately, she hugged everyone in the clinic, including a confused delivery driver.

Fortunately, the delivery driver was a good sport.

Unfortunately, he now thought he worked there.

Fortunately, the afternoon started smoothly.

Unfortunately, someone spilled dilating drops on the floor.

Fortunately, nobody slipped.

Unfortunately, everyone walked around that spot like it was radioactive.

Fortunately, a nervous patient relaxed after we explained every step of the exam.

Unfortunately, he then asked 137 follow-up questions.

Fortunately, we answered all of them.

Unfortunately, the next three patients had been waiting.

Fortunately, a patient complimented the entire staff.

Unfortunately, she did it while accidentally recording a video of the ceiling instead of us.

Fortunately, the doctor finished charts faster than expected.

Unfortunately, the computer decided that was the perfect time to install updates.

Fortunately, the updates only took fifteen minutes.

Unfortunately, they felt like fifteen years.

Fortunately, the last patient of the day arrived.

Unfortunately, he arrived one minute before closing with a list of concerns that began with, “This will only take a second.”

Fortunately, everyone stayed positive.

Unfortunately, that “second” lasted forty-five minutes.

Fortunately, the patient left happy.

Unfortunately, we still had cleanup to do.

Fortunately, the clinic looked great when we finished.

Unfortunately, we noticed the coffee machine was still broken.

Fortunately, it was finally time to go home.

Unfortunately, tomorrow was another clinic day.

Fortunately, we all loved working in eye care.

Unfortunately, that’s exactly why we’d be back bright and early to do it all again.

Fortunately, there would be plenty of patients to help see better.

Unfortunately, there would probably also be at least one patient who forgot their glasses.

06/04/2026

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06/04/2026

Maddox Wing Test: A Simple Yet Powerful Tool for Near Phoria Assessment

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Binocular vision plays a crucial role in comfortable reading, studying, computer work, and other near tasks. Even small misalignments between the eyes can lead to symptoms such as eyestrain, headaches, blurred vision, intermittent diplopia, and reduced reading performance.

One of the most widely used clinical instruments for evaluating these hidden eye deviations at near is the Maddox Wing Test.

What Is the Maddox Wing Test?

The Maddox Wing Test is a subjective dissociation test designed to detect and measure latent ocular deviations (phorias) at a near working distance of approximately 33 cm.

The test uses a handheld device containing septa and viewing plates that present different images to each eye. This dissociation prevents normal binocular fusion and allows the examiner to measure the patient's natural tendency for the eyes to drift inward, outward, upward, or downward.

How Does It Work?

The Maddox Wing separates visual input between the two eyes:

• Right Eye: Views the white horizontal arrow and red vertical arrow (pointers).

• Left Eye: Views the horizontal and vertical number scales.

Because each eye sees different targets, the patient's response reveals the amount and direction of any latent deviation.

What Does It Measure?

Horizontal Phorias

These indicate inward or outward tendencies of the eyes.

• Orthophoria: No latent deviation (arrow points to 0).

• Exophoria: Eyes tend to drift outward when fusion is broken.

• Esophoria: Eyes tend to drift inward when fusion is broken.

Vertical Phorias

These indicate vertical misalignment between the eyes.

• Left Hyperphoria: Left eye tends to sit higher than the right eye.

• Right Hyperphoria: Right eye tends to sit higher than the left eye.

Cyclophoria

Some Maddox Wing models also allow assessment of torsional deviations, helping evaluate rotational misalignment of the eyes.

Clinical Procedure

1️⃣ Position the Maddox Wing at the standard near distance (33 cm).

2️⃣ Ask the patient to look through the device.

3️⃣ Ask:
• "Which number does the white arrow point to?" (horizontal measurement)
• "Which number does the red arrow point to?" (vertical measurement)

4️⃣ Record the findings directly from the scales.

The test is quick, simple, and usually takes less than a minute to perform.

Why Is the Maddox Wing Important?

The Maddox Wing remains a valuable tool in binocular vision assessment because it:

✔ Detects horizontal and vertical phorias rapidly.

✔ Helps identify binocular vision anomalies.

✔ Assists in evaluating symptomatic patients with asthenopia (eye strain).

✔ Supports diagnosis of convergence insufficiency and other vergence disorders.

✔ Can contribute to AC/A ratio assessment in clinical practice.

Recording Results

Results are typically recorded in Prism Diopters (Δ).

Examples:

• 4Δ Exophoria at near
• 2Δ Esophoria at near
• 1Δ Left Hyperphoria

Accurate documentation helps monitor progression and evaluate treatment outcomes.

Clinical Pearls

🔹 The Maddox Wing is specifically designed for near vision assessment.

🔹 It measures horizontal, vertical, and, in some models, torsional deviations.

🔹 Patient responses determine the final result, making proper instructions essential.

🔹 Findings should always be interpreted alongside other binocular vision tests such as cover testing, NPC, vergence ranges, and stereopsis assessment.

Take-Home Message

The Maddox Wing Test is one of the simplest and most effective methods for assessing near phorias. Despite its straightforward design, it provides valuable information about binocular alignment and visual comfort, making it an indispensable instrument in optometric and orthoptic examinations.

Understanding how to perform and interpret the test correctly can greatly improve the diagnosis and management of binocular vision disorders.

06/04/2026

OCT Review: Are you looking at a full-thickness or partial defect?

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When evaluating the macula, structural depth changes everything. While both conditions highlighted in 160771.mp4 can cause blurred or distorted vision, their clinical presentations look very different on an OCT scan:
💥 Full-Thickness Macular Hole: A complete tear through all retinal layers, requiring careful monitoring and often surgical consideration due to a distinct drop in central acuity.

🔹 Lamellar Macular Hole: A partial-thickness defect where the deep photoreceptor layers are often spared, meaning symptoms usually remain much milder.
Because early-stage lamellar holes only cause subtle blur or slight distortion when reading fine print, early diagnostic screening is the ultimate key to proper management before any further progression occurs.

06/04/2026

MADDOX ROD TEST: A SIMPLE YET POWERFUL TOOL FOR PHORIA ASSESSMENT

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Have you ever wondered how eye care professionals detect hidden eye misalignments that aren't obvious during routine observation?

One of the most widely used clinical procedures for this purpose is the Maddox Rod Test—a simple, quick, and highly effective method for evaluating ocular alignment and binocular vision status.

🔍 What Is the Maddox Rod Test?

The Maddox Rod Test is a subjective test used to detect and measure latent deviation (phoria) by dissociating the eyes using a Maddox rod lens.

📚 Principle of the Test

A Maddox rod converts a point source of light into a line of light.

When the Maddox rod is placed before one eye:

• One eye sees a light (spot)
• The other eye sees a line
• This dissociates both eyes and reveals latent deviations

The relative position of the line and light indicates the direction of the phoria.

🎯 Why Is It Important?

✅ Detects horizontal & vertical phorias
✅ Simple and quick clinical test
✅ Useful in binocular vision assessment
✅ Helps in prescribing prism correction

👁️ How Is It Performed?

1️⃣ Place Maddox rod in front of one eye

2️⃣ Ask the patient to look at a point light source

3️⃣ Ask: "Where is the line relative to the light?"

4️⃣ If necessary, use prisms to neutralize the deviation and determine its magnitude.

📊 Interpretation
(Assuming Maddox Rod Is Placed Over the Right Eye)

Horizontal Deviations

• Line passes through the light → Orthophoria
• Line left of the light → Exophoria
• Line right of the light → Esophoria
Vertical Deviations
• Line below the light → Right Hyperphoria
• Line above the light → Left Hyperphoria (or Right Hypophoria)

⚠️ Important Clinical Note

Results are reversed if the Maddox Rod is placed over the left eye. Always document which eye is viewing through the rod before interpreting findings.

💡 Clinical Insights

• The orientation of the red line is perpendicular to the cylinders.
• Ensure you note which eye is viewing the red line.
• Perform the test at both distance and near fixation.
• Prism neutralization allows accurate quantification of the deviation.

🏥 Common Clinical Uses

The Maddox Rod Test is frequently used when assessing patients with:

• Asthenopia (eye strain)
• Headaches associated with visual tasks
• Intermittent diplopia
• Reading difficulties
• Suspected binocular vision disorders
• Patients requiring prism correction

🔑 Take-Home Message

The Maddox Rod Test remains one of the most valuable and widely used tools for assessing binocular vision and latent ocular deviations. Despite its simplicity, it provides important information regarding ocular alignment and helps clinicians diagnose and manage phorias effectively.

Correct interpretation depends on understanding the principles of dissociation and accurately documenting which eye views through the Maddox rod. When combined with prism neutralization, the test becomes a powerful clinical tool for both detection and measurement of binocular vision anomalies.

06/03/2026

Satisfying and disturbing at the same time.
ILM peeling. Can you tell the indication/necessity of this procedure?
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OPTOMETRISTS

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