Vision Technology Review with Dr. Greg Evans
By Mike Bundrant

Keeping up with the advancement of technology is nearly impossible. The average person does well to stay up to speed in a few areas, but certainly not in all of them.  If you haven’t been aware of the latest developments in the field of eye care, you’ll be amazed at what is happening and how it can help when you are in need. This article is part one of a series, based on my conversation with Dr. Greg Evans of Evans Eye Care in Palm Desert.

HT: Which of the latest technologies in eye care stick out in your mind?

Dr. Evans: Technological advancements now help us do a better job as far as the eye examination goes.  The biggest thing that sticks out in my mind is wavefront technology.

At Evans Eye Care we use wavefront aberrometry.  Aberrometers are sort of like auto-refractors, but they measure - they use wavefront technology to measure the individualized fingerprint of the optics of the eye.  This helps us do a lot of things.  It helps us in the diagnosis mode, for example, if we have a patient that has media problems and the most common one I see is early cataracts.

The other ones would be advanced dry eye, corneal scarring; anything that’s going to interfere with the quality of the optic.  A great example is post-Lasik.  They always have significant higher order aberrations. Higher order aberrations are more complex vision errors than lower order aberrations, which have more familiar names such as nearsightedness, farsightedness and astigmatism.

Higher order aberrations have relatively unfamiliar names such as coma, spherical aberration and trefoil. These types of aberrations can produce vision errors such as difficulty seeing at night, glare, halos, starburst patterns and so forth.

Anyway, wavefront technology scans the optics of the eye helps us assess it. These are issues we don’t normally correct for in a lower aberration lenses, which are the lenses that have been in use for the last 200 years. Those lenses correct for short sightedness, astigmatism, far-sightedness.  Now we can not only measure the higher order abberrations, but we can incorporate that into an individualized wavefront lens. 

The research shows us that not only do patients see better as far as visual acuity, but that their night driving recognition is improved. If they are driving at fifty-five miles an hour (it’s hard to get people to go that slow nowadays) they can see and recognize objects twenty feet sooner than they normally could, just by using wavefront technology.  The other thing they see is medium, low and high contrasts.  The low contrast signs at nighttime or at dusk or dawn - they see better for all of those things. 

HT:  Wow.

Dr. Evans:  Let’s talk about other technologies that help us manage other conditions, such as macular degeneration, the number one leading cause of irreversible vision loss in patients over fifty-five.  Macular degeneration has a few risk factors: Female, family history of macular degeneration, smoker, body mass index over thirty, and a macular pigment score that is low, or low macular pigment density. 

As of last year we have the ability to measure macular pigment density.  That’s predictive, or correlates to who gets early macular degeneration.  So, not only can we look at that risk factor, but we can go in and modify it.  The macular pigmentation is really lutein and xanthene.

Those are the master pigments. If we can just put the patients on supplements that have high concentrations of lutein and xanthese, we can take their macular pigment risk and minimize or eliminate it in about four to six months.  They can do the same thing with diet.  And that goes back to what your publication is all about - healthy living and prevention.  Here is something that we can actually go in and treat in a preventive way.  To me, that’s really exciting.

Now for patients that have macular degeneration already, the most common type of dry macular degeneration, the same type of supplements we recommend for patients with low pigment density, they follow what’s called the ARMD formula and that stands for Age-Related Macular Degeneration.  All the retinal specialists follow that.  It’s been proven to reduce the five-year vision loss is patients with dry macular degeneration by about thirty percent.  Now, it’s not one hundred percent; it’s not ninety percent, but it’s better than nothing.  It’s all we have right now for those patients. 

So, if they have dry macular degeneration we put them on supplements and that will reduce their risk of vision loss.  That’s a little prevention as well.