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Thyroid Eye Disease

Individuals with thyroid problems often have eye manifestations. There are 2 types: Hyperthyroidism and Hypothyroidism.

  • Hyper-Thyroidism: is when the thyroid gland produces too much thyroid hormone, causing your body’s metabolism to speed up.
  • Hypo-Thyroidism is when the thyroid gland produces too little thyroid hormone. Individuals feel sluggish and become fatigued easily. The most common treatment is medication (Synthroid [synthetic thyroid hormone] or Levothyroxine, the generic form of the medication.

HyperThyroidism or Grave’s disease, cause inflammation of the muscles that move the eyes and tissue surrounding the eyes. It causes the eyes to appears as though they are bulging out and can cause double vision.

Common symptoms include irritation or a gritty feeling, as though something is in the eye. It can cause excessive tearing, dry eye, swelling or puffiness of the eyelids, redness of the white part of the eye (conjunctiva), or eye pain.

Graves’ disease affects about one in every 200 people, according to the National Institutes of Health. Risk factors for thyroid eye disease include:

  • A history of smoking: Cigarette smoking raises your risk and can also lead to more severe cases of thyroid eye disease.
  • Gender: Women are much more likely to develop thyroid eye disease than men.
  • Age: Middle-aged people are more likely to develop this condition, too.

Hypothyroidism (low thyroid function) may cause swelling around the eyes and a loss of the eyebrow hair. The lids may droop, and the eyes and face may become puffy. The eyes can feel dry or gritty or feel like something is in the eye.

Untreated hypothyroidism can cause obesity, joint pain, infertility and heart disease. Other common symptoms are fatigue, cold sensitivity, constipation, dry skin, and unexplained weight gain. Facial expressions become dull, the voice may be hoarse, speech is slow,

Treatment for thyroid eye disease is effective. We are happy to help you manage your condition and preserve your vision.

Special Multifocal Contact Lenses Slow Myopia Progression in Children

A study that was just published (August 11, 2020) showed that children who wore multifocal contact lenses had slower progression of their myopia (nearsightedness). This study was funded by the National Eye Institute, which is part of the National Institutes of Health. Investigators of the Bifocal Lenses In Nearsighted Kids (BLINK) Study published the results August 11 in JAMA.

Myopia (nearsightedness) increases the risk of retinal detachment, cataracts, glaucoma and macular degeneration, later in life. In this study, nearsighted children ages 7-11 showed that special contact lenses slowed myopia progression and eye growth.

More kids are becoming nearsighted at earlier ages, and that means that when they become adults, they will be even more nearsighted than the average we currently see. The higher the nearsightedness, the more likely you are to have sight-threatening complications as an adult, such as retinal detachment, glaucoma, and macular degeneration. The point is that anything we can do now to slow the progression of nearsightedness could ultimately benefit patients.

Myopia occurs when light cannot focus directly on the retina. The special contact lenses change how light focuses on the peripheral retina.

Illustration describing multifocal contact lenses

The common approach by most doctors has been to increase the eyeglass prescription each year, but that just is a stopgap measure. In our office we offer non-surgical ways to treat myopia progression, including vision therapy, orthokeratology (ortho-K), soft multifocal lenses, atropine, etc. We can discuss the virtues of each

Contact us if you are concerned about your child becoming more and more nearsighted each year. You can reach us at 732-679-2020.

Our office, Family Eye Care in Old Bridge, also serves the surrounding communities of Aberdeen, East Brunswick, Manalapan, Matawan, Marlboro, Monroe, Parlin. Sayreville, South Amboy, South River, Spotswood, Lawrence Harbor, Cliffwood Beach, and throughout New Jersey.

To learn more about myopia, visit

What are the Complications of Myopia?

An article was published this week in the journal Investigative Ophthalmology & Visual Science. The authors reviewed other studies to determine the relationship and risk between how nearsighted someone is, and several sight-threatening eye problems.

The review concluded that low, moderate, and high myopia were all associated with increased risks of

  • myopic macular degeneration (MMD),
  • retinal detachment (RD),
  • posterior subcapsular cataract,
  • nuclear cataract,
  • open-angle glaucoma.

For each condition above the likelihood increased with severity of myopia. This means that the higher the nearsightedness, the worse these problems. The purpose of the study was also to address: what can we do to prevent a child or an adult from becoming more nearsighted, so they can PREVENT these problems from happening.

As someone becomes more nearsighted, the length of the eye increases. Longer eye- length, higher myopia degree, and age >60 years were associated with greater risk of visual impairment. The risks associated with low, moderate, and high myopia should alert parents, policymakers and healthcare professionals of the importance of measures to prevent and treat myopia.

In the past, the only advice doctors had was to increase the eyeglass prescription. This merely addresses the short term problem of not being able to see clearly, but does not solve the underlying problem. Fortunately, there are answers to this problem and we can prevent the increase in myopia. In our office, Family eye Care in Old Bridge, NJ, we offer several alternatives.

  • Vision Therapy (see more on this in our website)
  • Special bifocal eyeglasses when indicated
  • Orthokeratology or Ortho-k for short (see more on this in our website)
  • -Special Contact Lenses designed for myopia control
  • Atropine eye drop medication.

If your child is becoming more nearsighted, and you want to prevent this progression, call our office at 1-732-679-2020. We frequently see patients from Old Bridge, East Brunswick, Marlboro, Manalapan, Matawan, Aberdeen, South River, South Amboy,

Below is a summary of the study


A systematic review and meta-analyses of studies published before June 2019 on myopia complications. Odds ratios (OR) per complication and spherical equivalent (SER) degree (low myopia SER < -0.5 to > -3.00 diopter [D]; moderate myopia SER ≤ -3.00 to > -6.00 D; hi-gh myopia SER ≤ -6.00 D) were calculated using fixed and random effects models.


Low, moderate, and high myopia were all associated with increased risks of Myopic Macular Degeneration

MD (OR, 13.57, 95% confidence interval [CI], 6.18-29.79; OR, 72.74, 95% CI, 33.18-159.48; OR, 845.08, 95% CI, 230.05-3104.34, respectively); RD (OR, 3.15, 95% CI, 1.92-5.17; OR, 8.74, 95% CI, 7.28-10.50; OR, 12.62, 95% CI, 6.65-23.94, respectively); posterior subcapsular cataract (OR, 1.56, 95% CI, 1.32-1.84; OR, 2.55, 95% CI, 1.98-3.28; OR, 4.55, 95% CI, 2.66-7.75, respectively); nuclear cataract (OR, 1.79, 95% CI, 1.08-2.97; OR, 2.39, 95% CI, 1.03-5.55; OR, 2.87, 95% CI, 1.43-5.73, respectively); and OAG (OR, 1.59, 95% CI, 1.33-1.91; OR, 2.92, 95% CI, 1.89-4.52 for low and moderate/high myopia, respectively). The risk of visual impairment was strongly related to longer axial length, higher myopia degree, and age older than 60 years (OR, 1.71, 95% CI, 1.07-2.74; OR, 5.54, 95% CI, 3.12-9.85; and OR, 87.63, 95% CI, 34.50-222.58 for low, moderate, and high myopia in participants aged >60 years, respectively).


Although high myopia carries the highest risk of complications and visual impairment, low and moderate myopia also have considerable risks. These estimates should alert policy makers and health care professionals to make myopia a priority for prevention and treatment.


Children becoming more nearsighted is linked to smartphone use, study says

Myopia and children tablet usage

Children who are nearsighted use twice as much smartphone data each day as their non-nearsighted peers, a recent study found.

Does digital connectivity from such a young age exacerbate the risk of children becoming more nearsighted? A recently published study in the journal Clinical and Experimental Optometry, found that the increase in nearsightedness was associated with increased smartphone data usage. Children who were more nearsighted tended to spend more time on digital devices. The findings raise concerns over the next generation of Americans-iGen or Gen Z-growing up with a preponderance of digital devices.

“Based on the results from both studies, the risk for myopia development and progression may be higher in this pandemic situation.”

those that were born after 1996 are known as Gen Z and have no memory of a world before smartphones. In fact, 95% of american teems own or have access to a smartphone and nearly half say they’re online on a near-constant basis.

As digital device use has skyrocketed in recent years, so, too, has myopia prevalence and age of onset. In just four decades, U.S. myopia prevalence has gone from 25% of Americans to about 42%.

Smartphone usage associated with myopia

Students spent an average of four hours of time on the phone each day, mostly spent using social media apps (Snapchat, Instagram and Facebook). Researchers found that myopes spent longer on their phones than non-myopes but also were more likely to believe screen use could affect their eyes.

“The lifestyle habits of children and teenagers today have undeniably changed with advancements in technology and while the prevalence of myopia has been increasing for decades, the increased level of near visual stimulation from smartphones may pose an additional independent risk for myopia,” the authors note.

“Smartphones differ from traditional reading in various aspects such as wave-length, distance from the eye, size, contrast, resolution, temporal properties and spectral composition, all of which merit investigation. Aside from this, children and adolescents now spend more (time) than ever using a smartphone that demands proximal attention, which may compete with other more protective activities such as time outdoors.”

Corroborating evidence

Other studies have found an association between myopia and smartphone use as well. This was different, however, when comparing the same data to television viewing or after-school study.

Yi Pang, MD, OD, PhD., associate dean for research at Illinois College of Optometry, says there is a trend that more children are spending more time on digital devices, and research has shown that longer time on near work and/or shorter working distance can increase myopia progression. This should be a red flag as schoolchildren only recently concluded months of distance learning on handheld devices or computerizes due to the pandemic lock down.

“With the COVID-19 pandemic, the time on electronic devices dramatically increased in children because of remote learning and fewer opportunities for kids to do other activities,” Dr. Pang says. “Based on the results from both studies, the risk for myopia development and progression may be higher in this pandemic situation.” However, Dr. Pang notes, both studies only found an association with myopia and not a causation, which should be grounds for future studies. Dr. Pang adds: “Eye care practitioners should be aware of this issue and be ready to address parents’ and patients’ concerns.”

For more information on how we can help your child from becoming nearsighted, or becoming increasingly more nearsighted, please call our office at 1-732-679-2020, Family Eye Care in Old Bridge, NJ

Do you suffer from Vertigo and Dizziness?

Do you suffer from Vertigo and Dizziness?

There may be an underlying vision problem.

Do you find that the room begins to spin when you stand up, or your vision becomes blurry, or if you see double at times? There may be an underlying vision problem.

Vertigo can lead to broken bones and head injuries in people over 55. It can lead to head fractures and loss of cognitive function due to internal bleeding and brain injuries. Vertigo is a common complaint and at times, is an indicator that you are at risk of stroke. In the very least, vertigo can make you anxious and worried about what is happening.

Doctors may suggest that vertigo, dizziness or other balance problems are caused by something like:

  • Ménière’s, vestibular neuritis or labyrinthitis disease
  • Low blood pressure
  • Infection
  • Medications side effects
  • Migraine and headaches

…or similar causes.

Often, there is an underlying Vision problem, that causes an imbalance between the visual input for each eye and how the brain puts that together with information from the vestibular (balance) system. The two systems have to work together. When there is a problems with eye coordination, and then visual perception, and integrating that with the visual system, the answer is Vision Therapy.

Vision Therapy addresses the underlying reason for the vertigo, dizziness, and balance issues. At times special prism eyeglass lenses can help and may be needed. These answers are completely natural and require no medications or surgery. Once learned, most or all of the problems are resolved.

Sometimes people think that vertigo and dizziness are a normal part of aging. It does not necessarily have to be, although these symptoms CAN become more pronounced as people get older.

An easy way to demonstrate how much your visual system impacts your ability to even just stand straight is to do this: Balance on one foot or put one foot heel-to-toe in front of the other. Do this with your eyes open first. Then do this with your eyes closed. What happened?

At times, Vertigo can be a result of another disease, such as Ménière’s, vestibular neuritis and labyrinthitis. Often even doctors have no answers as to what causes these diseases. At times doctors say that Ménière’s causes vertigo and then state that vertigo is the main symptom of Ménière’s. There can be other reason that bring this about, such as trauma (for example, a car accident or a hit to the head), a stroke, or a neurological problem such as Lyme Disease, Multiple Sclerosis, or Cerebral Palsy.

Many people have tried medications and surgery to address vertigo and dizziness, and it that has solved the problem, great. Unfortunately, few people benefit from vertigo medications and surgery. Side effects are common, and include.

  • Dry mouth
  • Drowsiness
  • Nausea and vomiting
  • Blurred vision
  • Confusion
  • And most ironically: DIZZINESS!!!

As symptoms become worse, it can impact driving, and the fear of driving. It can bring on a car accident. It can then lead to isolation.

It can be embarrassing if people stare when you go to a restaurant, for example.

Vertigo is attributed to several factors, but the most common one is a miscommunication between the balance system in the ears and eyes. Both the eyes (visual system) and ears (vestibular system) send information to your brain. When there is a mis-match between the two, that results in vertigo, dizziness, and balance issues.

That’s why people sometimes fall down when they close their eyes

It is common for people to tilt their head if they have a vertical imbalance. This is a sign that there is an underlying vision issue that impacts your dizziness and balance.

Look in the mirror. Is your head tilted? Do you sometimes feel a neck ache?

Your visual system inputs information from the world around you and sends that to your brain. Your brain then sends that information to the rest of your joints and muscles.

It skews the balance between your eyes and ears. Your ears feel like your body is positioned in one way while your eyes perceive your position in a different way.

Vision Therapy addresses input from your eyes and creates a better match with your vestibular system. You will find that your head will be rightly positioned. Your eyes and ears will more closely “agree” and you will then no longer feel the vertigo and dizziness. Vision Therapy addressed the underlying visual problem that is often at the core of balance problem.

The benefits are that you will be more self-confident because you are steadier on your feet.

This requires your input and only you can change your situation. This is not a quick fix and will require work on your part. It can however help you address that fear of falling down without a warning or dreading breaking a bone.

Vertigo doesn’t usually kill people, but thousands do die every year from head injuries after falling. Thousands more lose cognitive function due to internal bleeding.

If you have some or all of these symptoms, we can help. Family Eye Care is in Old Bridge, NJ. In addition to those ho live in Old Bridge, we help patients who live in the surrounding area that includes Aberdeen, Sayreville, East Brunswick, South Amboy, South River, Matawan, Monroe, Manalapan, Marlboro, and throughout Ne Jersey.

We offer TeleMedicine and TeleTherapy for those that have difficulty in physically visiting our office. You can reach us at 1-732-679-2020 or on our website:


Therapeutic Benefits of Blinking Exercises in Dry Eye Disease

Dry Eye Disease (DED) has become much more common and impacts patient quality of life.

When we spend time on digital devices; computer, cell phone, tablet, etc., we tend to blink less often and less completely. The blink is like the windshield wiper in your car and the tears are like windshield wiper fluid.

The blinking action stimulates our tear glands to produce tears that obviously keep the eye moist. When we blink less, that affects how the tears are distributed and how stable the tear film is. When that is reduced, it leads to Dry Eye Disease (DED). This study evaluated if we can change or improve that by doing special blinking exercises.

the study evaluated people who had dry eye symptoms. They were then given instructions to do a 10 second cycle of blinking exercises every 20 min during waking hours for 4 weeks. Their symptoms were then assessed using a 5 question Dry Eye Questionnaire and Ocular Surface Disease Index. Blinking patterns were measured at the start, using special sophisticated parameters and instruments. Those same factors were measured again 28 days later.

The results indicated that blinking exercises were able to modify poor blinking patterns, and improve patient’s dry eye symptoms. This helped protect against the impact of digital device use on tear film quality and DED.

If you feel that your eyes are dry when spending a lot of time on computer, please call us so we can determine what the problem is and different way we can help you solve your problem.


Keywords: Behaviour modification; Blinking exercise; Computer vision syndrome; Dry eye disease; Incomplete blinking; Lifestyle.

Myopic (nearsighted) Children: Study shows …

A review on the epidemiology of myopia in school children worldwide

    Myopia (nearsight) has become increasingly more prevalent and it is studied by epidemiologists. Children with early onset are at particular risk of LONG TERM complications that are associated with myopia. As myopia progresses, it can result in high myopia and in myopic macular degeneration. There are both genetic and environmental factors that play a role in the increasing prevalence of myopia. The aim of this recent study was to review the current literature on epidemiology and risk factors for myopia in school children (aged 6–19 years) around the world.

    PubMed and Medline were searched for the following keywords: prevalence, incidence, myopia, refractive error, risk factors, children and visual impairment. English language articles published between Jan 2013 and Mar 2019 were included in the study. Studies were critically reviewed for study methodology and robustness of data. Eighty studies were included in this literature review.

    • Myopia prevalence remains higher in Asia (60%) when compared to those in Europe (40%).
    • The rate in East Asia is (73%) and in North America it is (42%).
    • In African and South American children, the rate was considerably lower: under 10%.

    The risk factors for myopia in schoolchildren are:

    • low outdoor time
    • near work,
    • dim light exposure,
    • the use of LED lamps for homework,
    • low sleeping hours,
    • reading distance less than 25 cm and
    • living in an urban environment.

    Low levels of outdoor activity and near work are well-established risk factors for myopia.

    The good news is that Myopia Control and Prevention can help your child who is becoming more myopic. Treatments include:

    1. Treating the underlying cause, through Vision Therapy,
    2. Treating the outcome, through Orthokeratology (Ortho-K)
    3. Special prescribed eyeglasses
    4. Special Multifocal soft contact Lenses
    5. Atropia

    The good news even further, is that these treatments are offered at Family eye Care in Old Bridge. You can reach us at 1-732-679-2020.

    We frequently see patients from Old Bridge, East Brunswick, Aberdeen, Sayreville, South River, and South Amboy. We also see many patients who live in
    Matawan, Monroe, Marlborough, Manalapan.


    We, at Family Eye Care, are here to help you for Visits During the COVID-19 Pandemic

    Your visit to our office, like nearly everything else, will be different the COVID-19 era.

    covid er pic.jpg

    The Governor has now given his OK to resume comprehensive eye examinations, but it is important to know that we are always here for any eye emergency. Yearly eye examinations were delayed in an effort to slow the spread of coronavirus that causes COVID-19. If you feel your vision is worsening or you develop any other eye symptoms, you can certainly call us for medical advice and care.

    Eye Telemedicine

    Our standard of care for eye and vision TeleHealth is the same as in-person care. There are certainly limitations of TeleHealth and you have the option of in-person care. It may not appropriate for an initial diagnosis or establishing the doctor-patient relationship. As both patients and doctors adapt to COVID-19, TeleHealth has become the cornerstone of non-urgent healthcare. Whenever possible, we “see” patients virtually to assess and manage visual problems and eye conditions.

    Comprehensive Examinations

    Image of 20 year old smiling behind phoropter

    Routine Yearly Comprehensive Examinations have now resumed as the current at-home orders have been relaxed. We have modified our schedules so expect stream-lined service and less wait time. You can now go to our website, to complete your history, insurance information, enter the medications you are taking, etc. In the interest of limiting exposure, and to adhere to social distancing, we ask that

    1. You wear your mask
    2. You come alone, or at most, bring 1 family member and only if you have to.
    3. Children should be accompanied by only 1 parent and siblings will be scheduled for their own appointment.

    Our staff will also be wearing a mask or a face shield. We usually like to hear about what is happening in your life and what is important, but you can expect less chatting than usual. To protect you, we ask that our patients limit conversation during exams to decrease potential coronavirus exposure.

    Chronic Eye Conditions

    Some chronic eye conditions can be monitored remotely through Telehealth. Call our office to see if we can schedule that for your problem. For some, effective monitoring may require the use of specialized equipment, such as instruments to monitor eye pressure. Certainly call our office 1-732-679-2020 if you have any symptoms of pain or vision change. At times we may need you to come in to the office.

    Urgent Eye Symptoms

    • Are your eyes crusty or itchy eye?
    • Are your lids swollen or red?
    • Is there any eye pain, loss of vision or new sensitivity to light?

    Many of these sudden and uncomfortable symptoms can be evaluated and managed via telehealth. We may you to send pictures or use a videoconferencing app to meet you virtually. Some urgent eye conditions can usually be managed virtually include bumps or growths along the eyelids, dry eyes, inflamed or swollen eyelids, and eye infections. If your symptoms get worse or do not get better after the Telehealth visit, please call us 1-732-679-2020.

    Eye Emergencies

    Eye emergencies require in-person treatment, even during a pandemic. If you experience sudden vision loss, eye pain, double vision, then call us immediately. Anyone who experiences a blow or trauma to the eye should also seek immediate medical care. Do not let fear of the coronavirus keep you from calling us. Some people are concerned about going to a hospital emergency room for fear of contracting COVID-19.

    We certainly would not want you to ultimately have vision loss or permanent eye damage. We are here to help you manage your immediate eye condition as well as full vision care. Call us at 1-732-679-2020 and ask about virtual appointment options, including phone, email and video.

    Am I Safe From COVID When I Am Outside?

    Health experts say people are significantly less likely to get the coronavirus while outside. This is comforting as warmer weather approaches and many want to venture out to beaches and parks that have been closed during the COVID-19 pandemic. It is important however to:

    1. continue avoiding crowds and
    2. maintain social distancing (6 feet) from others to minimize exposure to the virus.
    3. avoid activities such as beach volleyball because multiple people touching the same equipment can spread the virus.
    4. Playgrounds may pose a danger for the same reason.

    Evidence shows that the coronavirus spreads much more readily indoors than outdoors. The virus is harder to transmit outdoors because the droplets that spread it are more easily disturbed or dispersed outside in the elements than in a closed, confined, indoor setting.

    Tom Frieden, the former director of the Centers for Disease Control and Prevention advocates that people. “Enjoy nature. It’s good for us, and it has very low risk of spreading the virus. Parks, beaches — as long as they’re not cheek to jowl, cycling, walking, this is good.” Studies suggest activities held outdoors as temperatures warm pose lower COVID risk than those done in confined indoor spaces.

    It is OK to go outside for daily exercise and pass by someone. Simply passing someone for a split second outdoors presents a low risk. The virus can’t magically teleport. It needs a cough or sneeze or something, singing, talking, spitting. Each person must decide for themselves as to their own risk tolerance. Indoor spaces such as barbershops are certainly higher risk, though. There are more shared surfaces that could transmit the virus, such as the barber’s chair. Another danger, especially in the summer, is air conditioning, which can circulate the virus through the air.

    Dr. Roth at Family Eye Care is always available to help you should you have any eye emergency. Please call 1-732-679-2020.

    Myopia, (near-sight): A Growing Childhood Epidemic.

    Myopia, (nearsight) is a growing childhood myopia epidemic.

    In these times of increased online education and entertainment, protecting children’s vision is more important than ever. Parents may not be fully aware that myopia, or nearsightedness, is a condition that can lead to other serious eye diseases. These result from an abnormal elongation of the eyeball during a child’s eye development and can lead to blurring of objects viewed at a distance. Below is a new infographic that equips parents with an efficient and effective overview of the disease and next steps for protecting your child’s sight.

    Various sizes are available on for digital and print use.

    Pediatric eye health is often overlooked by parents as a recent survey by the Global Myopia Awareness Coalition (GMAC) found.1 Myopia, which can cause vision impairment and even blindness. It has doubled in children in the United States over the past 30 years2 and has been deemed as a global epidemic by the World Health Organization.3 Today, one in four parents has a child with myopia.4

    This simple comprehensive infographic helps our patients to understand myopia. Myopia is becoming more prevalent in the U.S. and around the world. Myopia has long-term complications. The good news is that there are treatment options. Eyeglasses don’t prevent a child from becoming more nearsighted. They don’t address the underlying reason why someone’s eyeglass prescription gets worse each year. Eyeglasses simply compensate for the nearsightedness. Eyeglasses do not “correct” the problem.

    As we spend more screen time; both children that are now doing schoolwork at home during the COVID crisis, or when they are in school, or when they will ultimately be in the workforce, the problem becomes worse.

    There are treatment options for myopia management that are available today:

    • Vision Therapy
    • Orthokeratology
    • Special Soft Lenses
    • Medical pharmacologic interventions

    Parents, it is in your control. The first step is scheduling an exam in our office; Family Eye Care, in Old Bridge, NJ.

    “Myopia is a highly prevalent and silent disease occurring during a child’s eye development that can lead to a lifetime of poor vision. The Brien Holden Vision Institute estimates that half the world’s population could have myopia by 2050 and that 1 billion could develop high myopia, placing them at the greatest risk for the most devastating consequences related to this disease (glaucoma, cataracts, myopic maculopathy and retinal detachment),” said Raul A. Trillo, MD. The time to act is now.”


    You can reach us at 732-679-2020 or