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Steroids are a broad, versatile group of drugs that effectively reduce inflammation anywhere from the lungs to the skin. If you have asthma, COPD, or even seasonal allergies, you may rely on inhaled or oral steroids to keep you feeling your best. But a recent study links steroids to the development of cataracts, and it’s something that we want our cataract surgery patients here in New Jersey to be aware of.

What the Study Found

The study followed more than 3,600 adults over the course of a decade. The study found that the risk of cataract development was significantly elevated in people who met all of the following criteria at the beginning of the study:

  • Had ever used inhaled steroids
  • Had used oral steroids for at least 1 month
  • Had no pre-existing cataracts

Why You Shouldn’t Be (Too) Worried

Only 10 people involved in the study fit these criteria, but 7 of them had developed cataracts by the end of the study. That’s more than a chance relationship, and you would be right to conclude that using both inhaled and oral steroids has a significant.

Steroid use is more closely associated with a specific type of cataract called a subcapsular cataract. This type of cataract occurs farther toward the rear of the eye, as opposed to nuclear cataracts (the most common variety) that develop around the nucleus of the lens. Subcapsular cataracts do cause the same symptoms, including cloudy visual disturbances, increased nighttime glare, and less vibrant colors.

While these results are concerning, it’s also not yet safe to say that anyone who uses a combination of oral and inhaled steroids will eventually develop cataracts. That said, if you regularly use both oral and inhaled steroids, we recommend seeing your ophthalmologist to further evaluate your risk.

At that point, you’ll need to weigh the benefits of continuing to take the steroids against your chances of developing cataracts. This is not meant as a recommendation to stop taking them — we simply wanted to bring it to our patients’ attention. Do not stop taking any medications unless you’ve spoken with your doctor.



Cataract surgery is one of the safest and most effective procedures available today, thanks to advances in surgical techniques. But a new study confirms the findings of earlier research: Men using Flomax to treat symptoms caused by enlarged prostate are 2 times more likely to experience complications during and immediately after cataract surgery.

About 3 out of 4 men are diagnosed with an enlarged prostate or benign prostatic hyperplasia (BPH) by the time they reach age 70. Flomax is one of the most commonly prescribed medications used for treatment. Flomax works by relaxing the muscles in the prostate and the bladder. That’s the most common use, but physicians also prescribe Flomax for some women experiencing urinary problems, relying on the same principle of relaxing the muscles in the bladder.

Flomax is part of a class of medications called alpha-blocker drugs. In addition to their effects on the prostate and bladder muscles, alpha blockers also keep the hormone norepinephrine from tightening the muscles in the walls of smaller arteries and veins. This causes those smaller blood vessels to remain open and relaxed.

That’s also the source of the problem for cataract surgery patients. Blood vessels that remain opened even when the body needs to close them off to heal the areas of the eyes affected by cataract surgery can lead to complications. The American Society of Cataract and Refractive Surgery (ASCRS) and the American Academy of Ophthalmology (AAO) both recommend that it’s best to undergo cataract surgery before beginning treatment with Flomax.

A 2005 study also found that men taking Flomax or other alpha-blockers before cataract surgery were more likely to experience complications during and immediately after the procedure.

The new study showed that 7.5 percent of the men who had taken Flomax in the 2 weeks before cataract surgery had a serious complication, compared with 2.7 percent of those who had not taken the drug. That makes it a 2.3 times greater risk.

Studies like this also make it especially important to disclose your full medical history as accurately as possible. Knowing that a patient is taking Flomax (or any other alpha blocker) — or even if he or she used it in the past — is very important before an eye surgeon performs cataract surgery. Our experienced eye doctors in Princeton and Hamilton, New Jersey can prepare for alpha-blocker patients differently by adjusting our surgical techniques in those cases, which can lead to much lower complication rates and optimal results.

If you’re being treated with Flomax and are planning on having cataract surgery, discuss your condition with the physician who prescribed the medication. You should never simply stop taking an alpha-blocker without talking to your doctor.


Learn about the most common things that affect your eyes and your vision as you gracefully navigate through your senior years. Dr. Colleen Coleman, a board certified Ophthalmologist and Glaucoma specialist at Outlook Eyecare will touch on dry eye, refractive cataract surgery, macular degeneration prevention, and glaucoma prevention.

The Aging Eye Talk
Presented by Dr. Colleen Coleman

Two Opportunities:

When: Wednesday, October 19, 2016 at 3 to 4 p.m.
Where: Lawrenceville Library, 2751 Brunswick Pike, Lawrenceville, NJ

When: Wednesday, November 2, 2016 at 2 to 3 p.m.
Where: Hopewell Branch Library, 245 Pennington-Titusville Road, Pennington NJ

Registration suggested. To register, visit the library online or call 609.989.6920.





Most women approaching menopause begin thinking about hormone therapy to mitigate the most common symptoms that accompany “the change,” which can range from uncomfortable hot flashes to more serious conditions like osteoporosis. When women begin to look into hormone therapy, though, questions about the treatment’s potential risks emerge, which a clinical trial identified several years ago. Those health risks include heart disease, stroke, and even breast cancer.

Our eye doctors in the Hamilton Township and Princeton, N.J. areas say you can add cataracts to that list.

A study of more than 30,000 postmenopausal women in Sweden found that using hormone replacement therapy (HRT) may make it significantly more likely for women to need cataract surgery in the future, compared to women who never undergo HRT. A cataract is the thickening and clouding of the eye’s natural lens that can occur as men and women age.

There’s reason to be cautious about HRT. The essence of the study’s findings boils down to 2 important points:

1. The longer a woman used HRT, the greater her chances of developing cataracts.

2. Women who consumed more than 1 alcoholic drink per day while taking HRT had nearly double the risk of having cataracts, compared to women who didn’t drink or use HRT.

This is the first large study to reach these conclusions. Earlier studies exploring the potential link between HRT and cataracts performed in the U.S., Australia, and Europe yielded mixed results. There are some shortcomings to the Swedish study’s conclusion, though: The study didn’t identify the type of hormone replacement treatment being used (there are different types of HRT), offer details on the type of cataract the study’s subjects developed, or consider their exposure to sunlight (which is itself a risk factor for cataracts.)

Additionally, the Swedish participants nearly all had the same ethnic background, which could influence the outcome. As we mentioned in an earlier blog post about cataracts, certain ethnicities appear to have a higher risk for developing cataracts than the general population. If you have Scandinavian heritage, the findings may prove more relevant to you, but it’s hard to say because the study didn’t prove (or disprove) that the homogeneity of its participants was a factor.

In that same blog post, we outlined that there are simple things you can do to actually lower your risk of developing cataracts, such as wearing sunglasses that block UV rays and eating more foods rich in vitamin C. It’s also clear that women and men who don’t smoke are less likely to develop cataracts at a younger age. Those little changes to your habits and lifestyle can add up to healthier eyes.

Hormone replacement therapy is no longer routinely prescribed for menopausal women, as doctors learned about the potential risks associated with the treatment, but it may still be beneficial for some women. Certain types of HRT remain the most effective treatment for postmenopausal symptoms, and the decision of whether to have HRT is one you should discuss thoroughly with your doctor.



In this day and age, it seems we are surrounded by digital screens that vie for our attention constantly. And for most of us, they are hard to resist because they have become affordable, accessible, and portable. Think TVs, laptops, tablets, and smartphones. Together, they’re a major factor in ocular health for the Princeton patients who visit our optometrists and eye care professionals.

As a society, we have become hungry for information — be it useful or mostly irrelevant. Other than reading e-books, this also means extended viewing of our emails, the latest YouTube videos, or our friends’ posts on Facebook and Instagram. We are so attached to our smartphones that a mere few hours apart from it can give us anxiety.

What Causes Digital Eyestrain?

Prolonged Exposure

Every eye doctor in Princeton, New Jersey and throughout the country will tell you that digital eye strain is a serious issue. A new study by the Vision Service Plan (VSP) shows that by the time an American teenager turns 17, that teenager has spent a third of his or her life staring a digital device. That’s almost 6 years — or about 50,000 hours. And because of this amount, eye care specialists are witnessing a growing number of patients suffering from digital eye strain.

So please, encourage your kids to lead an active lifestyle, teach them to enjoy the outdoors and maybe even read a book or 2 during the summer (the old-fashioned way, that is).

Reading Too Close

According to another report published in 2011, we have a tendency to stay closer to digital screens when reading than we do when reading something in print. About 20% closer, to be exact. Reading from devices up close places heavy demands on the eyes, since you are forced to focus harder and your eyes actually angle inward towards each other.

The next time you are staring at a digital screen, try reading from farther away — and if that’s not possible, there’s nothing wrong with increasing the font size.

Reduced Blinking

We also blink less when staring at a digital screen than we do when reading a printed page, which in turn results in our eyes becoming dry and sore.

On a personal note, I think my nephew forgot how to blink entirely when he got his new racing game and started playing it on the big screen TV. So remember to take breaks — and please don’t forget to blink.

Artificial Blue Light

Artificial blue light also plays an important part in contributing to digital eye strain. All the LCD and LED screens that surround us emit it. Due to its short wavelength, our eyes are not very good at blocking blue light. Therefore, it penetrates all the way to the retina. Prolonged exposure to these digital screens will adversely affect the health of the retina, and it can possibly lead to macular degeneration. I will talk in more detail about blue light and its adverse short-and-long-term effects in my next blog post.

How to Protect Your Eyes

Remember, the easiest way to minimize digital eye strain is to reduce overall exposure to digital displays and to take breaks in between. When that’s unavoidable, here are a couple rules of thumb to live by:

1) Follow the 20-20-20 break plan: Take a 20-second break every 20 minutes and look at something 20 feet away.

2) For every inch of screen size you should be 2 ½ times as far away from it. So you should be about 10 feet (i.e., 120 inches) away from a 50-inch HD screen.

Have more questions about how best to take care of your eyes? Leave us a question in the comments below!


Glaucoma is a disease that causes damage to the eye’s optic nerve because of a fluid buildup inside the eye. Damage to the optic nerve can slowly lead to loss of vision and blindness. Unfortunately, there is nothing a patient with glaucoma can do on their own to prevent their eye pressure from rising. While there is no cure for glaucoma, there are many different treatment options that help prevent the loss of eyesight caused by high eye pressure. These treatment options include eye drops, oral medications, lasers, and surgeries.

It has been a goal to develop methods to lower eye pressure with the least amount of side effects and risk.

Dr. Coleman, a fellowship-trained glaucoma specialist here at our Princeton, NJ, ophthalmology practice, is now performing a new, state-of-the-art technique to safely lower eye pressure in patients with certain types of open angle glaucoma. The iStent trabecular micro-bypass stent is a new surgical therapy for glaucoma. iStent is the smallest medical device ever approved by the FDA and is placed in your eye during cataract surgery.

In order to maintain a normal pressure in the eye, there is fluid constantly being made and drained from inside the eye. People with glaucoma have increased resistance in their eye’s drainage system, causing a buildup of fluid in the eye. The iStent is used to bypass the highest resistance point in the drainage system, allowing fluid to drain more easily. Patients who undergo iStent implantation during cataract surgery may be able to decrease their glaucoma drop burden or even get off glaucoma drops altogether.

The iStent is so small, you won’t be able to see or feel it after surgery but it will be continuously working to help reduce your eye pressure. It stays in the eye for a patient’s lifetime.

These are very exciting times for glaucoma therapy. New, safe techniques are emerging for lowering eye pressure to help preserve a patient’s vision throughout their lifetime. Most of these techniques deal with bypassing the eye’s drainage system or decreasing fluid production in the eye.

To learn more, contact us and one of our helpful staff will schedule your appointment with Dr. Coleman.


Children waving sparklers on the 4th of July is as American as apple pie and baseball. Few of us know, however, that those small wands shooting out sparks sizzle at temperatures of up to 2,000 degrees and, along with other fireworks, cause thousands of eye injuries each year.

Watching fireworks with family and friends on Independence Day is a time-honored tradition, but the reality is that eye injuries caused by fireworks have doubled in recent years, resulting in about 1,200 visits to emergency rooms across the nation in 2014. Outlook Eyecare, with eye doctors in Hamilton Township, Princeton, and Mercerville, NJ is highlighting this fact to help prevent fireworks-related eye injuries this year.

Video Courtesy of the American Academy of Ophthalmology

To help New Jersey residents stay safe this Independence Day, we’ve compiled some tips that will help keep your celebrations free of eye injuries:

  • Never allow children to ignite fireworks. Yes, that includes sparklers and other small, seemingly harmless products. Small doesn’t equal safe. They can even pose more danger because people are less vigilant in supervising kids lighting these fireworks. Even tiny poppers or snappers can ricochet and burn the eyes of toddlers or small children.
  • Be extra cautious handling “duds.” That’s because fireworks that appear defective and are thought to be extinguished are unpredictable. Anyone igniting fireworks or handling them after they’ve been lit should wear protective eyewear to avoid accidents.
  • Even spectators need to be cautious. Just because you’re not the one lighting the firework doesn’t mean you are out of the firing line. Half of those suffering eye injuries caused by fireworks were bystanders, according to an international study. Of those, 1 out of 6 victims sustained severe vision loss.
  • Explosive fireworks that shoot projectiles into the air are illegal for a reason. Bottle rockets and other explosive fireworks are extremely dangerous and should not be used.
  • Attend a community-sponsored fireworks show. These family-friendly events can become a new 4th of July tradition. Go just for the show, or make it a daylong outing with family and friends. Leaving the fireworks to the professionals is the safest way to enjoy the Fourth.

Remember, you should get immediate medical attention if you do suffer an eye injury and avoid rubbing or applying pressure to the eye. If you know or suspect there’s an object in your eye, don’t remove it, apply ointments, or take pain medication before getting medical help.


June is Cataract Awareness Month, an observance created by the American Academy of Ophthalmology to raise awareness of this important eye health issue. At Outlook Eyecare, we see this as an opportune time to educate you about this very common condition. Our eye doctors in Princeton treat patients from surrounding cities like Hamilton Township and other central New Jersey communities, but because it is such a widespread concern, we feel everyone can benefit from learning more about cataracts.

Cataracts occur as we age and the eye’s natural lens thickens and becomes cloudy. They are the main cause of vision loss for men and women older than 55 and, according to the American Academy of Ophthalmology, about 25 million Americans have cataracts. Here are 3 important facts about cataracts that many people might not know.

  • Lifestyle’s role as risk factor: Lifestyle and behavior can influence how early or late in life you develop cataracts, and how the condition will progress. Age is the most common risk factor associated with cataracts, but recent studies indicate that other factors play a role in the timing and severity of developing cataracts. For example, diabetes, extensive exposure to the sun, smoking, and obesity can all contribute to an increased risk of cataracts. High blood pressure and certain ethnicities have also been linked to having a higher risk of having cataracts than the general population. Eye injuries, previous eye surgery, and using steroid medication over a long period can also result in cataracts.
  • You can lower your risk: Cataracts cannot be prevented, but you can take steps to decrease the risk of developing cataracts. Protecting yourself from sun exposure by wearing sunglasses with lenses that block UV rays and using wide-brimmed hats can help. Several studies concluded that people who eat more foods rich in vitamin C lower their risk of developing cataracts at younger ages. Women and men who don’t smoke cigarettes are also less likely to develop cataracts until much later in life.
  • Improved vision is just one benefit of surgery: During cataract surgery, your eye surgeon replaces the natural, clouded lens with an intraocular lens, an artificial lens made of plastic, silicone, or acrylic. There are a range of lenses to choose from, and each provides unique benefits. More than just improving your vision, cataract surgery has been shown to improve patients’ quality of life and reduce the risk of falling.

If you’ve noticed your vision becoming less clear, cataracts could be the cause. Cataract Awareness Month is a good time to request a consultation at one of Outlook Eyecare’s 3 locations. Or call one of the offices at (609)409-2777 (Monroe Township), (609) 419-1920 (Princeton), or (609) 587-4700 (Mercerville), to schedule an appointment.



Dry eye syndrome is one of the most common conditions eye doctors treat on a daily basis, both here in the Hamilton and Princeton, NJ area and nationwide. It is a very common disorder, affecting approximately 30% of the population. Tears adhere to the surface of our eyes in order to protect and keep them moist. Dry eye is the result of either decreased tear production or increased tear evaporation.

There are multiple risk factors for dry eye. I find that environment plays one of the largest roles. Cold, dry winters, heaters and air conditioners, smoke, and dust are some of the factors that can aggravate dry eye. Certain medications such as antihistamines, beta blockers, and antidepressants can cause a decrease in tear production. Additionally, diseases such as rheumatoid arthritis, Sjogren’s syndrome, and lupus can have a severe impact on dry eye.

Patients with dry eye will experience symptoms such as a gritty or sandy feeling in their eyes, redness, blurry, fluctuating vision, and light sensitivity. Interestingly, patients may also experience tearing, which is a reflex secretion due to dryness.

In mild cases of dry eye where a patient has minimal symptoms, artificial tears used as needed provide relief. In more moderate to severe cases, patients will require regular use of artificial tears along with anti-inflammatory drops. RESTASIS® is a wonderful medicine for patients with moderate symptoms who need long-term treatment.

Dry eye is caused by inflammation of the glands that make tears, resulting in less production and a poor quality. RESTASIS helps to prevent this inflammatory process and improves the amount and quality of tears. Omega-3 supplements have also been shown to have an anti-inflammatory effect on the eyes, allowing for better tear production. There is even a simple and easy procedure that can be performed in the office to block the tear ducts, which prevents tears from draining out of the eyes, keeping them moister.

Although a very common disease, dry eye can be very debilitating if left untreated. Fortunately, over the years, wonderful new medicines and therapies have arisen for treating dry eye. Patients who have dry eyes should feel reassured that with the appropriate treatment, their symptoms can be dramatically improved and even completely resolved.

Do you think you may have dry eye syndrome? I urge you to contact us to find out some strategies for improving your vision, your comfort, and your quality of life.


At some point in our lives, almost all of us experience at least some degree of floaters or flashing lights in our vision. As eye doctors, we tend to get questions about them often from our Hamilton and Princeton, NJ patients. There are various causes for these phenomena, and I will try to shed some light on this topic.

First I will start with flashes and floaters caused by problems within the eye and retina.

The inside of our eye contains a jelly called the vitreous. For most of us, there is debris within this jelly.  When light enters the eye, it hits this debris and casts a shadow on the retina, which in turn causes us to see floaters. This is a very benign condition, and although it can be annoying at times, it will not damage or harm our eyes or vision. There is also much variability from patient to patient with how noticeable these floaters are. Some patients will never notice them, while others see them constantly.

As we get a little older, the vitreous starts to contract and tugs on the retina. As it begins to tug, patients will often notice a flash of light. This flash usually lasts 1 or 2 seconds and is white in color. Eventually the vitreous will tug hard enough and separate from the retina, which is called a vitreous detachment. This leads to a different kind of floater and one that is usually larger and often looks like a circle or cobweb. This too can be very annoying but is harmless to our eyes. Over time, this floater will usually settle below our line of sight so we don’t see it as much. In certain cases, as the jelly separates from the retina, it will cause a rip or tear in the retina, which can lead to a retinal detachment. This is a more serious condition that requires prompt attention to prevent damage to the retina and vision loss. When this occurs, patients will typically notice more flashing lights, a greater number of floaters, and sometimes a veil or curtain over their vision.

In addition to flashes and floaters caused by problems to the retina, patients can experience these phenomena from other non-eye related conditions. Our eyes are an extension of the brain, so if something is disrupting the parts of the brain responsible for our vision, we can experience a number of different visual symptoms.

Transient ischemic attacks (TIAs), more commonly referred to as mini strokes, are an event in which the brain lacks proper oxygen for a timeframe of less than 24 hours. The most common cause for this is when an embolus, or blood clot, restricts the flow of blood to the brain. Depending of which part of the brain is affected, symptoms can include: weakness on one side of the body, difficulty speaking, confusion, and even visual symptoms such as loss of vision or flashing lights. There are even times when a patient can experience a mini stroke and have only these visual symptoms. Depending on where the blood clot is, these visual symptoms could affect one or both eyes. They can be described as a loss of vision, dimming of vision, or flashing lights. When patients see flashing light from a TIA or even a complete stroke, the flashes tend to last for minutes to hours, versus the retinal flashes that last for a few seconds as described earlier. This difference in duration of the flashes is important and helps to distinguish if the flashes are caused by something in the retina or brain.

In addition to mini strokes and strokes, flashes can also be a result of migraines. This type of flash is referred to as a migraine with “aura.” These flashes will often sparkle and grow in size then shrink. They will generally occur for minutes to an hour. Oftentimes, a headache will follow after the visual symptoms subside, but there are times where no headache will follow and the only symptoms are visual.

Typically, when patients come to see me complaining of flashing lights, the first concern they immediately think of is a retinal detachment. However, there are a number of different causes for flashing lights. My general advice to patients is to alert their eye care professional if they notice new flashes, floaters, or any changes to their usual floaters.

Do you have questions about floaters or flashes? Leave them for us in a comment.

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Monroe Township
Outlook Eyecare
5 Centre Drive #1B
Monroe Township, NJ 08831
Phone: (609) 409-2777

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Outlook Eyecare
100 Canal Pointe Boulevard #100
Princeton, NJ 08540
Phone: (609) 419-1920

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