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Diabetic Eye Disease Awareness Month

November is Diabetic Eye Disease Awareness Month. Approximately 34.2 million Americans have been diagnosed with diabetes, while around 88 million currently have prediabetes, the condition that occurs just before diabetes. Because this disease affects so many people, I thought I’d take a moment to discuss the ways that it can affect a person’s vision.

What is Diabetes?

Before we discuss the eye conditions that can happen as a result of diabetes, let’s look at the disease itself. Diabetes occurs when there’s too much sugar (glucose) in the blood over time and not enough insulin (the hormone that helps cells process sugar) being made to handle these glucose levels. There are three types of diabetes, type 1, type 2, and gestational.

Type 1 diabetes is hereditary and happens as a result of the body not being able to make insulin on its own. Type 2 diabetes is largely preventable and is caused by high glucose levels and a person’s body no longer making enough insulin. Once there’s not enough insulin to handle the amount of sugar in the blood, glucose levels are hard to control. While type 1 and type 2 diabetes are incurable, gestational diabetes is usually a temporary condition that affects some women during pregnancy.

What is Diabetic Eye Disease?

While diabetic eye disease may sound like one condition, it’s actually a group of conditions that those living with diabetes are particularly susceptible to. All of these can negatively impact a person’s ability to see clearly and can potentially cause blindness. Eye conditions that affect those with diabetes include the following:

  • Diabetic retinopathy- Your retina is the portion of your eye that detects light and sends signals through your optic nerve back to your brain. High blood sugar levels can cause the blood vessels to the retina to leak, damaging the eye over time.
  • Diabetic macular edema- This condition is caused by fluid build-up on and around the retina that causes swelling and blurred vision.
  • Cataracts- Cataracts can happen to anyone, but diabetics are more at risk due to the increased sugar in their blood.
  • Glaucoma- Like cataracts, glaucoma can affect many people, but having diabetes doubles your risk for this condition.


As I said before, diabetes causes an increase of sugar in the bloodstream. This causes damage to blood vessels, which in turn can cause a number of other health problems including diabetic eye disease. Controlling diabetes with medication and diet is the first step to preventing diabetic eye disease.

It’s also extremely important that those living with diabetes or at risk for diabetes have a comprehensive, dilated eye exam at least once a year. While there are very few obvious warning signs of diabetic eye disease, a trained eye care professional can spot and help treat problems before they become more serious.

If you are one of the many people currently living with diabetes, find an eye doctor who will work closely with you to prevent these conditions and keep your eyes healthy for life!

Fall Allergies: Cause, Effect, and Solution

Seasons changing are often something to look forward to. Especially when the chill of winter is conquered by the warmth of spring, and the swelter of summer is subdued by the cool crisp of autumn. One of the downsides of changing seasons, however, is the allergens that come along with them. So, let’s talk the causes, effects, and solutions of seasonal allergies and how they can upset your eyes. The focus of this talk? Fall.


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Let’s kick this conversation off with a quick background of your eyes and why they can get the brunt of allergy effects. An article from WebMD gives a good explanation, stating that the layer of skin covering the front of your eyes is “…the same type of skin that lines the inside of your nose. Because these two areas are so similar, the same things can trigger allergic reactions in both places.” Typical eye allergies that affect your eyelids, the layers of skin that cover the front and the inside of eyes, are referred to as allergic conjunctivitis by your Doctor of Optometry (OD).

One of the most common allergy triggers that can bother both your nose and your eyes is ragweed pollen. Ragweed grows across the US and its pollen releases during the fall months, with its highest pollen counts in mid-September. While ragweed does not grow in every single state, it can travel in the wind for hundreds of miles!

Two other common triggers in autumn are mold and dust mites. The leaves that pile up outside your home as they fall gracefully from the trees provide a nice, damp breeding environment for mold. Dust mites are invited to frolic around in homes, schools, and other commonplace indoor locations once heat gets turned on in the fall.

You’d probably never guess how much two things that are vastly loved can play a big hand in eye allergies – body fragrances and bonfires. Have you ever noticed that being around a friend or coworker in the spring and summer is perfectly fine but come fall, you’re constantly sneezing and rubbing your eyes around them? This could be because the perfume or cologne they brand themselves with during the cooler months contains an allergen that irritates your eyes. While bonfires are a fun way to gather under the stars around the warmth of an outdoor fire, wildfire smoke can irritate your sinuses and trigger your eye allergies as well.


The American Optometric Association shares that, “ocular allergies are the abnormal response of sensitive eyes to contact with allergens and other irritating substances.” and notes that eye allergies are, “one of the most common ocular surface diseases in primary eye care.”

When allergens come into contact with eyes’ mast cells, an important part of all immune systems, release histamines and other chemicals that can cause your eyes to become inflamed, red, swollen, itchy and watery in an attempt to fight off the allergen. These responses can also cause your eyes to become sensitive to light.

While we should thank the attempt, the response can be extremely frustrating! So, let’s move on to solutions.


Some solutions are very simple but can still be quite hard to secure. For example, taking a hands-off approach. It’s difficult not to touch your eyes throughout the day, especially when they’re itchy, but rubbing your eyes can only make things worse.

A few other short term simple solutions include avoiding eye makeup, applying a cold compress to your eyes, and wearing sunglasses while outdoors to act as a shield against allergens.

You might also want to consider purchasing a dehumidifier and an air filter, switching your bedding from cotton to naturally hypoallergenic silk which also serves as an inhospitable environment for dust mites, and swapping your contacts with glasses when your eyes are suffering.

While over the counter eyedrops can also be very helpful and soothing, consider scheduling an appointment with one of Cool Springs EyeCare’s practice ODs for a comprehensive eye exam to confirm there are no other causes for the symptoms you are experiencing and to construct a customized plan for you during the allergy seasons!

Can My Eye Really Fall Out?

It was big Olympic news. A long distance swimmer was accidentally struck in the eye by a competitor’s arm or elbow during a swim competition. He immediately “went blind” and thought “his eye had been knocked out.” Bad news for this Olympian-he had sustained blunt trauma to the globe and orbit. Good news for this guy-there is almost no physical way his eye could fall out. I have heard post cataract surgery patients swear that their past doctor took their eye out, removed the cataract and then put the eye back in. Good news for them…they had a cataract removed from inside the eye, replaced by an implant, yet did not have their entire eye removed.

This begs the question. If I am hit in the eye, can my eye really fall out?The answer is theoretically, yes, but practically, no!

The eyeball (globe) is connected in the socket very firmly by many muscles, connective tissue, tendons and the optic nerve. Each of these structures are so tightly connected to the globe that to disengage the eyeball would mean catastrophic trauma that crushes the face, head, skull and more often than not would result in devastating injury or death for the patient. Trauma does occur to the eye, and we treat this all the time in our offices. It can result from racquetballs, fists, motor vehicle accidents, chair and table legs or any number of other possible causes. Fortunately, the soft globe (eyeball) is well designed and protected by the bony orbit surrounding it. Ever get a black eye? The bruising and swelling around the eye is evidence that the protective bones surrounding the eye socket took most of the blow.

In some cases the eyeball itself receives a blunt concussive blow and this coup/contra coup force can cause damage inside the eye. When this occurs, we look for lacerations, torn or dislodged structures, blood inside the eye (hyphema) or retinal problems (swelling, hemorrhage or detachment.) We can even see dislodged or damaged eye muscles, stretched optic nerves and any number of other visually threatening sequelae.

We are here to treat whatever traumatic insult affects your eye, whether abrasions, inflammation, hemorrhage, glaucoma, lens or retinal problems. We have a doctor on call 24/7/365 for those and other reasons.

If you sustain a blow to the eye, it is best to let your eye doctor evaluate, diagnose and advise you of the best treatment to preserve or improve your comfort and vision. Yet be assured, even if it feels like someone knocked your eye out, it will still be inside your head…and you do not have to worry about it falling out!

Dr. Keg

A Tribute to Dr. Dave Brown

Dr. Dave BrownMy former partner Dr. Dave Brown passed away yesterday due to complications caused by COVID. Dave was a dedicated optometrist, good husband and father and all-around fine man. He will be missed by many.

Dave and I became acquainted when I moved to Nashville to run our eye disease center, VisionAmerica. Dave was on the board of directors, made up of leading optometrists from around the area. As was customary, I went to each of the doctor’s offices to meet them and find out how we could better serve their patients. Dave had his practice in downtown Franklin at the municipal building at that time. Over the years we shared patients back and forth between our eye disease center and his practice.

Eventually, I wanted to transition my practice mode into ownership and primary eye care. Dave was the right person, with the right practice, at the right time. My wife Susan and I got to know he and his wife, Mona and over the course of year-long discussions, which ultimately culminating in me becoming a partner with Dave. We started together and renamed the practice Cool Springs EyeCare in 2000.

Dave was a great partner. He was smart, built trusting relationships and was timely in his care. Since I had been practicing eye disease for so long, I had to be reminded of contact lens parameters, fitting and care as well as the subtle nuances of glasses prescriptions. Dave was always gracious with sharing his knowledge and taught me the practical aspects of optometric eye care. His independence likely prohibited him from working for me as the managing doctor, yet I never begrudged him leaving or continuing to practice in the area.

Though our partnership ended in 2004, we remained aware of each other’s pursuits. Dave told me once that “he could not stay retired as he could only pick up sticks in his driveway for so long!” He continued to see patients and do eye exams in the Franklin area for the past years. And of course, his wife Mona was always by his side. During my work with him we would meet regularly for lunch, he, Mona and me. My enduring memory, both during our partnership and through the times afterward, are of Dave and Mona, together as a couple, eating, talking and just being…together.

I am shocked and saddened by Dave’s untimely passing. I value what I learned from him and the times we shared together in practice. I am saddened for his children, whom he expressed so much love and pride for in each of our conversations. And I am of course feeling for Mona. Dave and she shared a special bond, both at home and at practice. They were an inseparable team. I think Dave knew he had out kicked his coverage and was grateful for every day he had with Mona. And I know she felt the same about him. The community has lost a dedicated and faithful original Franklin-ite.

I am thankful for getting to know Dave, and like so many others, will miss him.

Dr. Jeff Kegarise

A Close Up of Presbyopia

beautiful blonde pleased woman reading book while 2021 04 06 06 13 52 utcThrough each stage of life, from infancy through adulthood, your eyes and visual needs will change. One of those changes, and arguably the largest and most frustrating, will come in your early 40’s. Yes, we are referring to the need for reading glasses which is technically referred to as presbyopia.

Presbyopia is the gradual loss of your eyes’ ability to focus on near objects or tasks. The lens inside the eye loses its ability to change shape over time, which is necessary to focus at near. This is, unfortunately, a natural part of the aging process. Symptoms will include blurred vision up close, a tendency to hold reading material further away, or eyestrain after reading or computer work.

There are several ways to combat presbyopia, and the good news is, your optometrist can help!

1. Glasses

There are multiple glasses options available for our presbyopic patients. First, a simple pair of prescription reading glasses may help. With reading glasses in place, close objects will appear more in focus. However, since the distance prescription is now different than the near prescription, these glasses that were specifically designed to help with near, will unfortunately make vision in the distance significantly more blurry. This will result in a constant on and off with the glasses depending on the task at hand. Or, if there is also a need for distance correction, constant switching between distance and near glasses. For those who find this highly frustrating – enter multifocal glasses.

Multifocal glasses simply mean that both distance and near can be seen through the lenses; the top part is designated for distance, and the bottom for near. Even these come in two styles: blended or non-blended. The blended style is the most common and referred to as a progressive lens. The progressive lens gives clear vision at all ranges (far, intermediate, and close) and is more ideal for those who spend several hours on the computer throughout the day. The non-blended style is referred to as a bifocal. This style still gives distance in the top but has a small box in the bottom nasal corner of the lenses for reading. There is no intermediate/computer area in these lenses.

2. Contact Lenses

Several contact lens options exist for presbyopic patients as well! There are multifocal contact lens options which incorporate distance prescription as well as near prescription into the lenses. There is also an option referred to as monovision, where the dominant eye is set to see far and the nondominant eye is set to see close. Both multifocal and monovision contact lenses can take some getting used to, but after adapting, most patients do well with one of these options.

3. Surgery

Although traditional LASIK does not correct for presbyopia, LASIK can be performed in the monovision format – where one eye is corrected for far and the other eye is corrected for near. Since not all patients adapt well to monovision, it is wise to test this out for several months in contact lenses before opting for surgery. Furthermore, when it is time for cataract surgery, there are multifocal implant options now available.

4. Other Options

Hold tight for other presbyopic treatments in the pipeline! Vision focused pharmaceutical companies are working on clinical trials for the development of eyedrops to treat presbyopia. When this option is ready and available, we’ll make sure our patients are of the first to know!

Written by Dr. Aimee Jacobs

As I See It—Podcast!

As I See It

Our doctors not only wrote the book on patient care, but now they’ve launched a growing podcast that is starting a patient revolution!

As I See It is hosted by Dr. Jeff Kegarise and Cole Evans. They discuss, in depth, a variety of topics, such as frequently asked questions about eye care, at what age you should start bringing your child to the eye doctor, understanding how they can see signs of diabetes through an eye exam, how long you can really wear contact lenses, and so much more.

Dr. Jeff invites guests on from across the country to help bring insightful, valuable discussion and eye care education directly to his patients!

Listen to an episode here!

Sunglasses: Protect Your Peepers

June brings with it, not only the first day of summer, but also National Sunglasses Day (6/27). In keeping with these two annual milestones, let’s chat about the importance of wearing sunglasses! Many people simply think of sunglasses as a summertime fashion accessory but don’t stop to consider the benefits of wearing the proper sunglasses or the dangers associated with leaving your eyes unprotected.

As you look for the perfect pair of shades, it’s important to remember that all sunglasses are not created with the same technology or ultraviolet protection. The sun’s rays, when unfiltered, can be quite harmful to the human eye. Thus, it is important to consider the percentage of damaging radiation that the sunglasses block. Ideally, you’re looking for a lens that will block 100 percent of both UV-A and UV-B radiation. This goes hand in hand with the next point to consider: coverage.

You want to be sure you are selecting sunglasses that offer plenty of eye and facial coverage, fitting your face shape or specific activity for which they will be used. This will ensure that minimal amounts of harmful radiation reach your eye, and that the tender skin around your eyes is protected. Proper coverage, along with a UV-filtering lens, can reduce the chances of skin cancer developing here. Those with light-colored eyes are even more susceptible. So, whether you’re planning on wearing the sunglasses every day or for a specific activity like running, hopping on the bike, or working in the garden, coverage is important!

We’ve all seen them: impulse-buy-sunglasses at the checkout counter, likely at your local convenience store or gas station. While these may seem like a quick solution to protect your eyes in a pinch, they could actually be doing you more harm than good. These sunglasses likely do not have proper UV-filtration technology, are often not polarized*, and are certainly not fitted to you by an optical professional to determine coverage. These sunglasses tend to simply shade the eye, still letting in that harmful radiation and glare.

*Polarization: the process by which a lens filters horizontal glare before it reaches the eye. This could come from the surface of water, a wet road, or a dew-covered golf course in the morning!

Summer is here, and we at Cool Springs Eye Care want to make sure you have the proper eyewear to keep your eyes safe while you have fun in the sun — and look great doing it! Schedule an appointment with us today at our Franklin, TN office, and we look forward to seeing you soon!

May is Healthy Vision Month

What does that mean for you? It means that now is the time to schedule a comprehensive eye exam.

While these are one of the exams we may often let fall by the wayside, they are extremely important to maintain our eye health. Comprehensive eye exams serve several purposes. During these exams, pupils, the circular black area in the center of the eye where light enters, are widened with eye drops or viewed without dilation through a special camera. This allows your Eye Doctor to check for vision problems and eye diseases, verify what stage of diseases your eyes may be in, and helps determine if you need glasses, contacts or other treatments.

Comprehensive eye exams are crucial for all ages, here’s why:

Pediatric exams test for visual acuity, lazy eye, color vision, ocular health, and more. These are extremely important to test for the school years ahead.

For older children and teenagers, myopia (nearsightedness) is one of the biggest concerns that comprehensive eye exams detect. Myopia affects the eye’s ability to see distant images clearly. It is important to identify and treat early with glasses or contacts as children and teens begin to learn in larger spaces, play sports, and drive.

Adult exams are recommended at least every two years, or as recommended by your eye care specialist. Exams for adults are necessary to catch eye conditions that can cause vision loss and even lead to blindness. Some of these conditions are cataracts, diabetic retinopathy, glaucoma, and age-related macular degeneration.

There are several other conditions that comprehensive eye exams can expose that may not be found without a visit to your optometrist.

Outside of eye exams, here are 5 ways you can help protect your vision:

  1. Healthy Eating. You know this! Healthy eating helps every part of your body. For your eyes, make sure to add dark, leafy greens and seafood that is high in omega-3 fatty acids to your plate. A great excuse to treat yourself to sushi! We’re adding a spicy sake maki roll to our cart… for delivery.
  2. Protective eyewear. Whether you’re chopping wood for the bonfire pit, mowing the lawn, painting your bedroom walls, or riding your motorcycle around town, protective eyewear is key. Blue-light protection glasses should also be considered to protect your eyes from all the time spent in front of computer screens.
  3. Sunglasses. Much like protective eyewear, sunglasses help protect your eyes from ultraviolet radiation delivered by sun. Not all sunglasses provide the same level of protection. Let us help you pick the best pair!
  4. Clean hands. Wash your hands before putting your contacts in and before taking your contacts out, simply to avoid infection.
  5. Stop smoking. Smoking is known to cause several diseases, but it can also lead to vision loss. It can increase the risk of age-related macular degeneration, cataracts, and more. Mark your calendar for your comprehensive eye exam and mark it as the day to stop smoking.

Happy healthy vision month! Get your appointment in the books with us today.

Krispy Kreme or Dunkin’……What is Your Doughnut?

January his Glaucoma Awareness Month and we want to make sure that you know all about your doughnut!

Now, why would I talk about doughnuts in relation to glaucoma awareness month? First, it is not because I love doughnuts (which I do). It is because the name of the game in glaucoma diagnosis and treatment is to protect the optic nerve. I like to tell our staff that everybody’s optic nerve resembles a glazed doughnut. There is the edible part, which we want a lot of and a hole in the middle. In the optic nerve of each eye, we don’t actually have a hole, but we do have a central depression that’s called the “cup”. During your eye exam (this is during every eye health and vision exam for every patient we see-all ages) we measure the healthy optic nerve (edible doughnut) and estimate the size of the central cup.

Central cupping varies due to genetics, refractive error (eyeglass prescription), race, and a few other factors. In general, if we average everyone in America 33% of the full nerve is represented by the cup. Therefore, another way to look at this is that the average doughnut hole is 33% the size of the doughnut. In general, smaller is better larger is worse.

What is most important, is for us to be measuring and monitoring the size of the cupping (doughnut hole) over time. If the cup increases over time; meaning the edible part of the doughnut is becoming thinner, it is very likely that the patient may be developing glaucoma.

The true definition of glaucoma is vision loss, characterized by loss of healthy optic nerve tissue over time. We monitor that with an OCT for structure and visual field for function. There are a number of evidence-based medicine tests which help us monitor patients who are suspicious for developing glaucoma in the hope that we can prevent, or catch, an early transformation from “suspect” to true glaucoma.

So, in this month of glaucoma awareness I ask you… Do you know what size your doughnut is? The next time you drive by Krispy Kreme, Dunkin, Cool Springs, or Donelson Eyecare, I want you to ask yourself, “How’s my doughnut?”

If you have any questions, call or email me or one of our doctors. We are here to help protect, correct, and enhance your vision and minimizing the risk of glaucoma is foremost in our mind during every eye health and vision exam we perform.

The K2 Way Book Announcement

A book! A book from your eye doctor now available on Amazon?

It is true! Dr. Susan and I have authored a book called One Patient at a Time: The K2 Way Playbook for Healthcare and Business Success. You should be very familiar with many of the writings in this book. The book started as a service manual to reinforce our service to patient mentality and our dedication to relationship-based approach to patient care. As the service standards and teachings grew, the manual also grew. Eventually many people suggested, “We like what you do so much, we wish other people and other doctors do the same. Why don’t you make your approach into a book….so we did.

K2 way playbook contains (8) chapters and (135) easily digestible lessons for healthcare practitioners and offices of any kind. We have consulted with emergency room physicians, pediatricians, ophthalmologist, optometrists, breast cancer specialist…you name it. What Dr. Susan and I believe is that the elements of healthcare delivery are very similar. The specific specialties have their own unique languages, approaches and expertise. Yet when you combine excellent clinical care knowledge with excellent care delivery, you receive the type of courteous healthcare experience each of us as patients deserve.

So, in our (8) chapters we focus first on the patient, leadership, culture, team building / employees, systems, marketing, and efficiency. Essentially a little taste in all areas of finance, operations and marketing, the (3) fundamental components to running any business successfully.

If you would like an advance copy, they are available for purchase at our Cool Springs and Donelson offices. You can also order pre-sale directly on Amazon or Barnes and Noble. We expect the official delivery date to be the 3rd week of August.

Dr. Susan and I are proud to put in writing what we believe, practice and teach every day. We want you to experience more than a good eye care visit….a great healthcare experience.

Thank you for being a patient and holding us to the high standards that we set for ourselves, our staff and other healthcare offices and doctors.

Dr. Kegarise