The Best News In Sight – Eye Exams On Your Home Computer

Eye Exams on Your Home Computer?

I was contacted last month by Yahoo news regarding a new technology that allows patients to take a vision test and check for glasses via their home computer. The company, Opternative, was designed to create an easier way to obtain a prescription.  The website asks several questions of the user, including age and general health questions, then asks you to measure 10 feet from the computer, which is where you stand when the vision exam is administered.  Within 24 hours a licensed optometrist in your state dispenses a digital prescription for glasses.

The questions posed to me were: can a computer evaluate your eyes as well as a real doctor?

My answer – it depends.

The refraction exam when well performed detects nuances in the speed the patient answers and adjusts for squinting and lighting conditions, which the computer cannot do. Of course, the computer cannot administer a medical eye examination which screens for conditions such as glaucoma, dry eyes and diabetic eye disease.

At this point, while the concept is interesting and innovative, I still recommend having your eye examinations done by an eye care professional.  A computer is simply not a substitute for a doctor.

See the full article:

Dr. Michelle Akler





Michelle Akler, MD
Detroit Area LASIK Surgeon

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Diabetic Drug Metformin May Lower the Risk of Glaucoma

Lowering Your Risk of Glaucoma

Glaucoma is a condition in which the optic nerve is progressively damaged by elevated eye pressure and/or reduced blood flow to the optic nerve.  It is a leading cause of blindness worldwide.  One of the major risk factors for glaucoma development is advancing age – or as I like to tell patients – the longer you are alive the more likely it is to develop.

Metformin is a medication that is commonly used to treat diabetes.  It is a drug that mimics caloric restriction; this class of drugs has been shown to reduce risk of other diseases associated with advancing age.  A research team based at the University of Michigan decided to investigate whether patients on metformin have a reduced risk of developing glaucoma.

Over 150,000 diabetic patients over age 40 years with no history of glaucoma were studied.  After 10 years, 4% of the patients developed glaucoma.  The patients who were taking the highest dose of meformin had a 25% reduced risk of developing glaucoma compared to those who did not take metformin.  The research team estimated that taking a standard dose of metformin (2 grams per day) for 2 years would reduced the risk of developing glaucoma by 21%.

This data applies only to diabetics as this was the population studied.  Taking metformin to prevent glaucoma if you are not diabetic can cause complications such as low blood sugar.  Further studies are planned to see if this result can be extended to non-diabetics and if oral metformin can prevent glaucoma progression in those with the disease.

Source:  JAMA Ophthalmology, Association of Geroprotective Effects of Metformin and Risk of Open-Angle Glaucoma in Persons with Diabetes Mellitus.  August 2015 pp 915-23


Dr. Michelle Akler





Michelle Akler, MD
Detroit Area LASIK Surgeon

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Are Contact Lenses Safe? What You Need To Know To Protect Your Vision

Healthy Habits for Contact Lens Wearers

Health-Magazine-Logo1Recently, I was contacted by Health Magazine to comment on the safety of extended wear contact lenses.  The trending story that prompted the interview was regarding a 39 year old man who wore extended wear contact lenses and woke one morning with eye pain and very blurry vision.  He was seen by an eyeMD and was diagnosed with an infection of the cornea caused by Pseudomonas aeruginosa.  This organism causes a severe, rapidly progressive ulcer in the cornea, the clear window on the front of the eye. Corneal scarring and reduced vision is the usual result despite treatment with antibiotics.  The patient in question will likely require a corneal transplant to regain his sight.

The American Academy of Ophthalmology released a statement regarding extended wear contact lenses in 2013.  Although the lenses are FDA approved for overnight use, studies have shown a 10-15% increase in corneal infection in these lenses compared to daily use lenses.  Further, patients who wear these contact lenses are more likely to not properly take care of the lenses or remove them at the recommended intervals.  Patients who choose these lenses must be properly educated about the importance of good hygiene and proper cleaning methods.  Overnight lenses should be removed and not worn overnight once weekly.  When I encounter patients who have been less than perfect with their contact lens regimen, I remind them that LASIK vision correction is safer than their current contact lens habits.

To read the full article in Health Magazine, visit this link.


Dr. Michelle Akler





Michelle Akler, MD
Detroit Area LASIK Surgeon

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Simplifying Postoperative Cataract Surgery Procedures

Simplifying our patient’s postoperative cataract regimen with “Near Dropless” cataract surgery


When discussing cataract surgery with patients, I used to counsel that taking all of the eyedrops afterwards was the hardest part of the procedure. The eye drop regimen was confusing and expensive, requiring 3 different drops be taken four times daily for up to 4 weeks after cataract surgery.  I am pleased to report that a new technique has allowed us to dramatically reduce the number of drops used after surgery.

TriMoxi is a combination of antibiotic (moxifloxacin) and steroid (triamcinolone) that is injected into the eye at the conclusion of the cataract surgery.  Delivering this medication into the back part of the eye (vitreous body) allows prevention of both infection and inflammation after cataract surgery without the use of multiple eye drops.


This technique has been safe and effective for our patients.  Our current regimen is to use only one non-steroidal anti-inflammatory drop for 3 days prior to surgery and 2 weeks after surgery.  This has been especially well-received in our elderly population who previously would have had to rely on family members to administer their drops multiple times daily.  Of course, inflammation may still develop in a small percentage of patients who would then require additional drops.

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How Diet Can Prevent Age-Related Macular Degeneration

How Diet Can Prevent Age-Related Macular Degeneration

The National Institute of Health (NIH) conducted a landmark study called the Age-Related Eye Disease Study (AREDS) that followed nearly 5,000 patients for more than a decade.  The patients’ dietary habits were examined as part of the research.  Patients eating the highest amounts of leafy greens such as kale, collard greens and spinach had a 40% reduction in the likelihood of developing age-related macular degeneration (ARMD). Further, the same risk reduction was found in those patients eating fish high in omega-3 fatty acids such as salmon at least twice a week.

Lutein and zeaxanthin are members of the carotenoid family and are present in large amounts in leafy greens.  These compounds are concentrated in the macula, the part of the retina needed for sharp central vision.  Omega-3 fatty acids are present in the macula as well.  Interestingly, for those of you wondering about carrots and eye health, no beta-carotene was found in the retina, debunking the myth that eating carrots is good for your eyesight.

In patients with macular degeneration, taking a supplement that contains lutein and zeaxanthin (AREDS-2 formula vitamins) reduces the risk of the macular degeneration progressing.  There has not been a study that shows that omega-3 supplements prevent macular degeneration, although eating fish can.

In those patients without macular degeneration wanting to keep their eyes healthy, a diet rich in leafy vegetables and fish containing omega-3 fatty acids is recommended.

Source:  The Relationship of Major American Dietary Patterns to Age-Related Macular Degeneration, American Journal of Ophthalmology, July 2014.

Dr. Michelle Akler

Akler Eye Center, Michelle Akler, M.D.


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Our Time At ASCRS Conference 2015

Dear Patients, Friends and Family,

I just returned from the annual meeting of the American Society of Cataract and Refractive Surgeons (ASCRS). One of my favorite parts of the meeting is the Innovator Session, where cutting edge research from around the world is presented. In this issue, I will share some of these exciting developments with you.

An Update From ASCRS

The Charles D. Kelman Innovator’s Lecture is named for the physician who created the original phacoemulsification machine; this device is the basis of modern cataract surgery. This year the lecture was given by an outstanding Japanese ophthalmologist, Shigeru Kinoshita, MD, PhD. The talk was titled “Novel Treatment Dimensions for Corneal Endothelial Dysfunction”.

The cornea is the clear window on the front of the eye. The light must pass through the cornea and the lens before focusing on the retina in the back of the eye. On the back layer of the cornea there are endothelial cells. The job of these cells is to pump water out of the cornea, thus maintaining its clarity. If there are not enough cells, the cornea becomes cloudy. Currently, the only way to replace corneal endothelial cells is with a surgery called a corneal transplant.

Dr. Kinoshita has developed a growth media for corneal endothelial cells in the lab that allows him to reproduce these cells. He has injected these reproduced cells into the eyes of human subjects, and the cloudy corneas became completely clear. He can reproduce enough cells from one donor cornea to treat 199 patients with cloudy corneas who would otherwise require a corneal transplant.

This represents an amazing development in the treatment of patients with Fuch’s Dystrophy and other conditions causing corneal blindness. I look forward to the technology being introduced in the US.
Source: ASCRS Innovator’s Session, April 20, 2015

Akler Eye Center and the Community
Dearborn Heights Spirit Festival
Join Us June 10th, 10am – 2pm
Canfield Community Center

Dr. Michelle Akler




Michelle Akler, MD

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Presbyopia Treatment in the Detroit Area, A Remedy For Reading Glasses?

Learn about your options for presbyopia treatments at our Detroit area eye surgery centers

When it comes to reading glasses, you do have options in Michigan with Akler Eye Center

Welcome spring!  I hope the weather soon catches up with what the calendar is telling us!  I did see a crocus on a walk the other day – always welcome after all that cold and snow!  This month I’ll be sharing information about a new treatment for presbyopia – the loss the ability of our eyes to focus up close as we age.

One of the commonest eye conditions I discuss in the office is the blurry near vision that all of us experience at some point after age 40.  This condition, known as presbyopia, is caused by the lens inside the eye becoming less flexible as we age.  This creates difficulty seeing up close for near tasks including reading, using cell phones, and seeing computer screens clearly without reading glasses.

A thin ring-like device known as a corneal inlay is being investigated in the United States to reduce the dependence on reading glasses in presbyopic patients. The ring is called a KAMRA inlay and is 3 mm in diameter with a 1.6 mm hole in the middle.  The device is implanted in the cornea, the clear tissue on the front of the eye in a 10 minute outpatient procedure.  The inlay acts like a camera aperture, adjusting the depth of field so both near and far can be seen without wearing reading glasses.

KAMRA corneal inlay next to a contact lens

In a study of 507 patients with presbyopia, the ring was implanted and the patients were followed for 3 years.  In 83 percent of eyes the patients were able to see 20/40 or better both at distance and reading.  This is considered the standard for being able to read a newspaper and drive a vehicle without glasses. The device can be removed should complications occur.

The KAMRA and several similar devices are available in other countries such as Europe and Asia but are not yet FDA approved for use in the US.

Source:  American Academy of Ophthalmology 118th Annual Meeting, October 2014




Michelle Akler, MD
Detroit Area Presbyopia Surgeon

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A New Year…Looking Into 2015

As any frequent reader of my blog knows, I love to start with a quote.  This year I’ve chosen to go simple with a quote from Charles Kettering – “Every time you tear a leaf off a calendar, you present a new place for new ideas and progress”.  In this age of electronic devices, that calendar leaf is probably on your iPhone or Android, but the idea resonates.

winter 1_1

I am very excited to be entering my 4th year at Akler Eye Center and my 16th year practicing ophthalmology.  Our practice is constantly evolving and changing, and the new year gives us a chance to both look back at what has been accomplished and look forward to what we can achieve.  In the last 4 years I have integrated femtosecond LASER technology into both my LASIK and cataract practice resulting in excellent visual results for my patients.  In the coming year I hope to continue to be a leader in the Metro Detroit area in both LASIK and cataract surgery.  Akler Eye Center will also continue to offer comprehensive care in all ophthalmic areas including diabetic eye examinations, glaucoma management, macular degeneration management and management of dry eyes.

I have written before that the greatest gift the practice of medicine has given me is the ongoing relationships I have developed with my patients.  I hope 2015 affords me the chance to enjoy the relationships I have as well as forge many new ones.  I wish all of you a happy and healthy new year!

Michelle E. Akler, MD

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Dry Eyes in Detroit’s Fall Weather? LASIK is still an Option

Lasik for dry eyes in detroitI love the early fall – the colors, apple cider, the crisp air.  As the humidity drops, though, dry eyes become more problematic for many patients, especially contact lens wearers.

In our Detroit LASIK Surgery practice, one of the most common questions asked is whether having dry eyes eliminates the possibility of LASIK vision correction.  The answer is: generally LASIK can be successful even in patients with dry eyes.

At Akler Eye Center, we perform a comprehensive LASIK evaluation that includes obtaining detailed information about dryness in the eyes, eye allergies, and contact lens intolerance.  During the examination, a test called a Schirmer tear film test is performed to assess the amount of tears being produced.  The cornea (clear window on the front of the eye on which LASIK is performed) is carefully examined for dry spots and the tear film is assessed.

Once the evaluation is complete, I will review all of the findings with you to determine which procedure is best suited to your eyes based on the examination.  Generally speaking, if the dryness is mild to moderate, LASIK can usually be done.

Although worsening of dryness is a common side effect of LASIK, it is usually temporary, and patients are often more comfortable afterwards than they were in their contact lenses.  If the dryness is more severe, sometimes treatments are recommended preoperatively to improve the tear film and corneal surface.

These can include punctual plugs (tiny plugs placed in the part of the eyelid that drains the tears from the eye) or Restasis, a prescription eye drop that increases the tear production.  If the dryness is unresponsive to treatments, patients may opt to have a surface treatment (PRK) instead of LASIK.  PRK is a safe alternative to LASIK which is associated with less long-term dryness than LASIK.

I have been performing LASIK since 1999, and I never tire of seeing all the happy faces at the 1 day postoperative appointments.  It is a life-changing procedure, and with all the advances in care is an option even for patients who in the past may have been told they were not candidates.

Enjoy this lovely fall weather before winter sets in.  Let’s hope this one is more forgiving than last year! If you suffer from dry eyes, contact our Detroit area laser eye surgery location in Dearborn or Sterling Heights office today for a free consultation.

Michelle E. Akler, MD

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Throwback Thursdays – Appreciating our Teachers

MEA&Dr.JohnsonIn my mind, I’m still about 21 years old – hip, current, on top of all the trends.

However, learning to function in today’s world of social media has taught me again and again that I’m not as current as I would like to believe.

What does TBT mean anyway?  It took my receptionist, currently a college student, to set me straight.  #Throwback Thursdays!!  So that’s the reason for all the baby pictures!

It has been 15 years since I completed my ophthalmology training at the University of Colorado Health Sciences Center, now known as the Rocky Mountain Lions Eye Institute.  I will always be grateful to all my mentors who gave me the foundation on which my practice rests today.  They patiently guided me from a novice doctor to a confident surgeon and instilled in me the importance of lifelong learning.  In a field that’s changing at such a rapid pace, the best lesson taught to me was to never become set in my ways and to be open to new ideas.

As for my #Throwback Thursday photo, here is one of me and David W. Johnson, MD, my program director in Colorado, circa 1999.  Thank you for believing in me and growing me into the physician I am today.  Now, back to the future – off to learn how to use #Tumblr!

Michelle E.  Akler, MD

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