Eye Health Tips

Simple Tips for Healthy Eyes

Your eyes are an important part of your health. You can do many things to keep them healthy and make sure you’re seeing your best. Follow these simple guidelines for maintaining healthy eyes well into your golden years.

Have a comprehensive dilated eye exam. You might think your vision is fine or that your eyes are healthy, but visiting your eye care professional for a comprehensive dilated eye exam is the only way to really be sure. When it comes to common vision problems, some people don’t realize they could see better with glasses or contact lenses. In addition, many common eye diseases, such as glaucoma, diabetic eye disease, and age-related macular degeneration, often have no warning signs. A dilated eye exam is the only way to detect these diseases in their early stages.

During a comprehensive dilated eye exam, your eye care professional places drops in your eyes to dilate, or widen, the pupil to allow more light to enter the eye—the same way an open door lets more light into a dark room. This process enables your eye care professional to get a good look at the back of the eyes and examine them for any signs of damage or disease. Your eye care professional is the only one who can determine if your eyes are healthy and if you’re seeing your best.

Know your family’s eye health history. Talk to your family members about their eye health history. It’s important to know if anyone has been diagnosed with an eye disease or condition, since many are hereditary. This information will help to determine if you’re at higher risk for developing an eye disease or condition.

Eat right to protect your sight. You’ve heard that carrots are good for your eyes. But eating a diet rich in fruits and vegetables—particularly dark leafy greens, such as spinach, kale, or collard greens—is important for keeping your eyes healthy, too.ⁱ Research has also shown there are eye health benefits from eating fish high in omega-3 fatty acids, such as salmon, tuna, and halibut.

Maintain a healthy weight. Being overweight or obese increases your risk of developing diabetes and other systemic conditions, which can lead to vision loss, such as diabetic eye disease or glaucoma. If you’re having trouble maintaining a healthy weight, talk to your doctor.

Wear protective eyewear. Wear protective eyewear when playing sports or doing activities around the home. Protective eyewear includes safety glasses and goggles, safety shields, and eye guards specially designed to provide the correct protection for the activity in which you’re engaged. Most protective eyewear lenses are made of polycarbonate, which is 10 times stronger than other plastics. Many eye care providers sell protective eyewear, as do some sporting goods stores.

Quit smoking or never start. Smoking is as bad for your eyes as it is for the rest of your body. Research has linked smoking to an increased risk of developing age-related macular degeneration, cataract, and optic nerve damage, all of which can lead to blindness.^{ii, iii}

Be cool and wear your shades. Sunglasses are a great fashion accessory, but their most important job is to protect your eyes from the sun’s ultraviolet rays. When purchasing sunglasses, look for ones that block out 99 to 100 percent of both UV-A and UV-B radiation.

Give your eyes a rest. If you spend a lot of time at the computer or focusing on any one thing, you sometimes forget to blink and your eyes can get fatigued. Try the 20-20-20 rule: Every 20 minutes, look away about 20 feet in front of you for 20 seconds. This short exercise can help reduce eyestrain.

Clean your hands and your contact lenses—properly. To avoid the risk of infection, always wash your hands thoroughly before putting in or taking out your contact lenses. Make sure to disinfect contact lenses as instructed and replace them as appropriate.

Practice workplace eye safety. Employers are required to provide a safe work environment. When protective eyewear is required as a part of your job, make a habit of wearing the appropriate type at all times, and encourage your coworkers to do the same.

References

ⁱ Age-Related Eye Disease Study Research Group. The relationship of dietary carotenoid with vitamin A, E, and C intake with age-related macular degeneration in a case-control study. Archives of Ophthalmology 2007; 125(9): 1225–1232.

ⁱⁱAge-Related Eye Disease Study Research Group. Risk factors associated with age-related nuclear and cortical cataract. Ophthalmology 2001; 108(8): 1400–1408.

ⁱⁱⁱ U.S. Department of Health and Human Services, Office of the Surgeon General. The Health Consequences of Smoking: A Report of the Surgeon General (Washington, D.C., 2004).

Adapted from National Eye Institute

Health Across Lifespan

Infancy and Childhood (Birth to Age 18)

In the United States, the most prevalent disabling childhood conditions are vision disorders including amblyopia, strabismus, and significant refractive errors. Early detection increases the likelihood of effective treatment; however, less than 15% of all preschool children receive an eye exam, and less than 22% of preschool children receive some type of vision screening. Vision screening for children scored on par with breast cancer screening for women. Other eye diseases affecting this age group include retinopathy of prematurity (ROP), congenital defects, diabetic retinopathy (DR), and cancers such as retinoblastoma.

Adults Younger Than Age 40

Vision impairments in people younger than age 40 are mainly caused by refractive errors, which affect 25% of children and adolescents, and accidental eye injury. Approximately 1 million eye injuries occur each year, and 90% of these injuries are preventable. More than half (52%) of all patients treated for eye injuries are between ages 18 and 45 and almost 30% of those are 30–40 years (McGwin, Aiyuan, & Owsley, 2005). Additionally, diabetes affects this age group and is the leading cause of blindness among the working-age group 20–74. Racial disparities occur in prevalence and incidence of some eye conditions. For example, among specific high-risk groups such as African Americans, early signs of glaucoma may begin in this age group, particularly if there is a family history for glaucoma. Lifestyle choices adopted during this period may adversely affect vision and eye health in later years (e.g., smoking, sunlight exposure).

Adults Older Than Age 40

American adults aged 40 years and older are at greatest risk for eye diseases; as a result, extensive population-based study data are available for this age group. The major eye diseases among people aged 40 years and older are cataract, diabetic retinopathy, glaucoma, and age-related macular degeneration. These diseases are often asymptomatic in the early treatable stages. The prevalence of blindness and vision impairment increases rapidly with age among all racial and ethnic groups, particularly after age 75 (Prevent Blindness America, 2002). Although aging is unavoidable, evidence is mounting to show the association between some modifiable risk factors (i.e., smoking, ultraviolet light exposure, avoidable trauma, etc.) and these leading eye diseases affecting older Americans. Additional modifiable factors that might lend themselves to improved overall ocular health include a diet rich in antioxidants and maintenance of normal levels of blood sugar, lipids, total cholesterol, body weight, and blood pressure combined with regular exercise.

References

Bailey RN, Indian RW, Zhang X, Geiss LS, Duenas MR, Saaddine JB (2006). Visual impairment and eye care among older adults—five states. MMWR 2005:55:49; 1321–1325.

Centers for Disease Control and Prevention. Prevalence of disabilities and associated health conditions among adults—United States. MMWR 2001:50(7):120–5.

Prevent Blindness America, National Eye Institute. Vision Problems in the U. S.—Prevalence of Adult Vision Impairment and Age-Related Eye Disease in America 

Common Eye Disorders

Approximately 11 million Americans 12 years and older could improve their vision through proper refractive correction. More than 3.3 million Americans 40 years and older are either legally blind (having best-corrected visual acuity of 6/60 or worse (=20/200) in the better-seeing eye) or are with low vision (having best-corrected visual acuity less than 6/12 (<20/40) in the better-seeing eye, excluding those who were categorized as being blind). The leading causes of blindness and low vision in the United States are primarily age-related eye diseases such as age-related macular degeneration, cataract, diabetic retinopathy, and glaucoma. Other common eye disorders include amblyopia and Strabismus.

For basic eye anatomy demonstration click here. 

Refractive Errors

Refractive errors are the most frequent eye problems in the United States. Refractive errors include myopia (near-sightedness), hyperopia (farsightedness), astigmatism (distorted vision at all distances), and presbyopia that occurs between age 40-50 years (loss of the ability to focus up close, inability to read letters of the phone book, need to hold newspaper farther away to see clearly) can be corrected by eyeglasses, contact lenses, or in some cases surgery. Recent studies conducted by the National Eye Institute showed that proper refractive correction could improve vision among 11 million Americans 12 years and older.

(Click here to see demonstration)

Age-Related Macular Degeneration

Macular degeneration, often called age-related macular degeneration (AMD), is an eye disorder associated with aging and results in damaging sharp and central vision. Central vision is needed for seeing objects clearly and for common daily tasks such as reading and driving. AMD affects the macula, the central part the retina that allows the eye to see fine details. There are two forms of AMD, wet and dry.

Wet AMD: when abnormal blood vessel behind the retina start to grow under the macula, ultimately leading to blood and fluid leakage. Bleeding, leaking, and scarring from these blood vessels cause damage and lead to rapid central vision loss. An early symptom of wet AMD is that straight lines appear wavy.

Dry AMD: When the macula thins overtime as part of aging process, gradually blurring central vision. The dry form is more common and accounts for 70-90% of cases of AMD and it progresses more slowly than the wet form. Over time, as less of the macula functions, central vision is gradually lost in the affected eye. Dry AMD generally affects both eyes. One of the most common early signs of dry AMD is drusen.

Drusen: Drusen are tiny yellow or white deposits under the retina. They often are found in people over age 60. The presence of small drusen is normal and does not cause vision loss. However, the presence of large and more numerous drusen raises the risk of developing advanced dry AMD or wet AMD.

It is estimated that 1.8 million Americans 40 years and older are affected by AMD and an additional 7.3 million with large drusen are at substantial risk of developing AMD. The number of people with AMD is estimated to reach 2.95 million in 2020. AMD is the leading cause of permanent impairment of reading and fine or close-up vision among people aged 65 years and older.

(Click here to see demonstration)

Cataract

Cataract is a clouding of the eye’s lens and is the leading cause of blindness worldwide, and the leading cause of vision loss in the United States. Cataracts can occur at any age due to a variety of causes, and can be present at birth. Although treatment for the removal of cataract is widely available, access barriers such as insurance coverage, treatment costs, patient choice, or lack of awareness prevent many people from receiving the proper treatment.

An estimated 20.5 million (17.2%) Americans 40 years and older have cataract in one or both eyes, and 6.1 million (5.1%) have had their lens removed operatively. The total number of people who have cataracts is estimated to increase to 30.1 million by 2020.

(Click here to see demonstration)

Diabetic Retinopathy

Diabetic retinopathy (DR) is a common complication of diabetes. It is the leading cause of blindness in American adults. It is characterized by progressive damage to the blood vessels of the retina, the light-sensitive tissue at the back of the eye that is necessary for good vision. DR progresses through 4 stages, mild nonproliferative retinopathy (microaneurysms), moderate nonproliferative retinopathy (blockage in some retinal vessels), severe nonproliferative retinopathy (more vessels are blocked leading to deprived retina from blood supply leading to growing new blood vessels), and proliferative retinopathy (most advanced stage). Diabetic retinopathy usually affects both eyes.

The risks of DR are reduced through disease management that includes good control of blood sugar, blood pressure, and lipid abnormalities. Early diagnosis of DR and timely treatment reduce the risk of vision loss; however, as many as 50% of patients are not getting their eyes examined or are diagnosed too late for treatment to be effective.
It is the leading cause of blindness among working-aged adults in the United States ages 20–74. An estimated 4.1 million and 899,000 Americans are affected by retinopathy and vision-threatening retinopathy, respectively.

(Click here to see demonstration) 

Glaucoma

Glaucoma is a group of diseases that can damage the eye's optic nerve and result in vision loss and blindness. Glaucoma occurs when the normal fluid pressure inside the eyes slowly rises. However, recent findings now show that glaucoma can occur with normal eye pressure. With early treatment, you can often protect your eyes against serious vision loss.

There are two major categories “open angle” and “closed angle” glaucoma. Open angle, is a chronic condition that progress slowly over long period of time without the person noticing vision loss until the disease is very advanced, that is why it is called “sneak thief of sight". Angle closure can appear suddenly and is painful. Visual loss can progress quickly; however, the pain and discomfort lead patients to seek medical attention before permanent damage occurs.

(Click here to see demonstration.)

Amblyopia

Amblyopia, also referred to as “lazy eye,” is the most common cause of vision impairment in children. Amblyopia is the medical term used when the vision in one of the eyes is reduced because the eye and the brain are not working together properly. The eye itself looks normal, but it is not being used normally because the brain is favoring the other eye. Conditions leading to amblyopia include; strabismus, an imbalance in the positioning of the two eyes; more nearsighted, farsighted, or astigmatic in one eye than the other eye, and rarely other eye conditions such as cataract.

Unless it is successfully treated in early childhood, amblyopia usually persists into adulthood, and is the most common cause of permanent one-eye vision impairment among children and young and middle-aged adults. An estimated 2%–3% of the population suffers from amblyopia.

Why is Vision Loss a Public Health Problem?

Recently, Saaddine, Venkat Narayan & Vinicor (2003) posed five criteria that define whether vision loss is a pubic health problem they are 1. Does vision loss affect a lot of people? 2. Does vision loss contribute a large burden in terms of morbidity, quality of life, and cost? 3. Has the problem recently increased and will it increase in the future? 4. Is vision loss perceived to be a threat by the public? 5. Is it feasible to act on the condition at a community or public health level? The answer to each of these questions is “yes.”

1. Does vision loss affect a lot of people?

Yes. More than 3.4 million Americans aged 40 years and older are blind (having a visual acuity of 20/200 or less or a visual field on 20 degrees or less) or visually impaired (having a visual acuity of 20/40 or less). Other estimates of “vision problems” range as high as 21 million, and a total of 80 million Americans have potentially blinding eye diseases. The major causes of vision loss are cataracts, age-related macular degeneration, diabetic retinopathy, and glaucoma.

2. Does vision loss contribute a large burden in terms of morbidity, quality of life, and cost?

Yes. People with vision loss are more likely to report depression, diabetes, hearing impairment, stroke, falls, cognitive decline, and premature death. Decreased ability to see often leads to the inability to drive, read, keep accounts, and travel in unfamiliar places, thus substantially compromising quality of life. The cost of vision loss, including direct costs and lost productivity, is estimated to exceed $35 billion (Rein, Zhang, Wirth, et al., 2006)

3. Has vision loss recently increased and will it increase in the future?

Yes. As the population of older people continues to accelerate, the number of people experiencing vision loss will continue to increase. And as the population of people experiencing diabetes increases, consequent increases will occur in diabetic retinopathy and other eye diseases. Prevent Blindness America estimates that the population of people experiencing blindness and visual impairment will double by 2030 unless corrective actions are taken.

4. Is vision loss perceived to be a threat by the public?

Yes. Vision loss ranks among the top ten causes of disability in the United States, and it is a condition feared by many.

5. Is it feasible to act on vision loss at a community or public health level?

Yes. Scientific evidence shows that early detection and treatment can prevent much blindness and vision impairment. Efficacious and cost-effective strategies to detect and treat diabetic retinopathy are available, but among people with diabetes, screening is received only by about two-thirds of persons for whom the exam is recommended and varies significantly across health care settings. Cataract removal surgery can restore vision, and this surgery is cost effective; however, among African Americans, unoperated senile cataracts remain a major cause of blindness. Glaucoma can be controlled, and vision loss stopped by early detection and treatment. Nevertheless, half the people with glaucoma are not diagnosed, and glaucoma is still the number one blinding disease among African Americans.

Public health serves to address each of these questions by conducting population-based investigations to determine the population, characteristics, circumstances, and trends of vision loss, as well as developing and implementing evidence based, cost-effective interventions to assure access to vision care and health behaviors to prevent the onset of vision loss and to improve the health and quality of life for those who have lost vision.

Several thoughtful papers have articulated public health dimensions of vision loss. These include the following:

Saaddine JB, Venkat Narayan KM, Vinicor F. Vision Loss: A Public Health Problem? Ophthalmology, 2003:110(2); 253–254.

Rein DB, Zhang P, Wirth KE, et al. The economic burden of major adult visual disorders in the United States. Arch.Ophthalmol 2006;124(12):1754–1760. Summary | Abstract

Gohdes DM, Balamurugan A, Larson BA, Maylahn C (2005). Age-related eye diseases: an emerging challenge for public health professionals. Preventing Chronic Disease: Public Health Research, Practice, and Policy 2005:2(3); 1–6.

Ferris FL Tielsch JM. Blindness and visual impairment: a public health issue for the future as well as today. Archives of Ophthalmology 2004:122; 451–452.

Crews JE. (2003). The role of public health in addressing aging and sensory loss. Generations 2003:27(1); 83–90.

Crews JE, Kirchner C, Lollar DJ. The view from the crossroads of public health and vision (re)habilitation. Journal of Visual Impairment and Blindness 2006:100; 773–779.

Thyroid Eye Diases

Graves eye disease, also known as thyroid related ophthalmopathy, is an autoimmune condition affecting the thyroid gland along with the muscles and connective tissue around the eyes.  It is characterized by rapid heartbeat, sweating, high blood pressure, irritability, fatigue, weight loss, heat intolerance, and hair loss. Eye symptoms can range from mild to severe. When the eyes are affected, they may appear more prominent. Sensitivity to light, a dry gritty feeling and tearing are common complaints. Double vision and sometimes even loss of vision can occur on rare occasions.

Approximately one million Americans are diagnosed with Graves eye disease each year. Women are five to six times more likely than men to get the condition. Cigarette smokers are at significantly increased risk.

Initial treatment includes the use medications to control the thyroid but the condition can progress even with properly maintained thyroid function.  Most patients experience relief from dry eyes by using artificial tears daily and gels or ointments at night. Some patients also use patches at night or tape their eyes shut to keep them from becoming dry if the eyelids do not close properly. Occasionally surgery, oral steroids or radiation treatments are necessary.

The symptoms described above may not necessarily mean that a person has Graves eye disease.  Proper monitoring and treatment of the symptoms is necessary to maintain healthy vision for years to come.

What exactly is a cataract?

Top: Clear Lens Bottom: Cataract Lens

A cataract is a clouding of your natural lens, located behind your pupil. The lens contains protein that degenerates with age. When you are about 45 years-old, this change in the lens protein makes the natural lens firmer and that’s why reading glasses are needed at that time. Later, the lens protein begins to change color which makes the lens cloudy. The result is a cataract and blurred vision.

Can You Develop an Allergy to Contact Lenses?

While it sounds like quite a mouthful, giant papillary conjunctivitis (GPC) is a common eye condition. It’s actually an allergy to contact lenses. It generally occurs in patients who have worn contact lenses for years. They come in concerned that their contacts are no longer comfortable and that they have a slight discharge from their eyes. “But I’ve worn contacts for years without problems” is their response when told of the diagnosis. It’s precisely that long duration of wear that triggers the condition.

Patients with asthma, hay fever or animal allergies may be at greater risk of developing GPC. This condition is believed to be a reaction to protein deposits building up on the contact lenses. The name comes from what we see when we flip the upper eyelid: 1-2 mm bumps called “giant papillae”.

The key to treatment is decreased lens wear time, frequent replacement of the contacts and diligent cleaning of the lenses each day. Disposable contacts help because they are discarded before the protein builds up. Sleeping in contacts has to stop. Besides the above, treatments may include allergy drops or non-steroidal anti-inflammatory drops. Once the GPC clears up, the patient may want to consider LASIK vision correction to avoid a recurrence.

Dry Eyes and Contact Lenses

While worse in the winter, dry eyes can make contact lens wear uncomfortable all year long. The symptoms of dry eyes are usually worse towards the end of the day. Many also notice fluctuating vision and redness around the iris (colored portion of the eye). Their contacts may even curl around the edges when they remove them.

The problem is due to a decrease in tear production over time and a more rapid evaporation of the tear film in dry environments. The result is a drying out of many types of soft contact lenses. But if you have been experiencing any of theses problems, we may have a solution for you.

Recent technology has produced a new type of soft contact lens to prevent dry eye symptoms with contacts. These silicone soft contact lenses are designed to be healthier for the cornea (the front surface of the eye) and lessen the dryness problem.

Some of the contact lens options are: Acuvue Advance, Oasys, O2Optics, Focus Night and Day, and Purevision lenses. There are even options for those of you with astigmatism or who are wearing bifocal contacts.

Other contact lens option, other treatments for dry eye include the placement of tiny punctual plugs which decrease the drainage of tears from the eyes, the use of tear supplements and prescription products such as Restasis that increase the quality of your tears. If you have dry eyes you may have to admit that contact lenses are not for you.  The contacts make your eyes more dry by absorbing your tears, leaving less moisture to coat the eye.  Many patients consider LASIK vision correction when this occurs.

Proper Contact Lens Care

Contact lenses are a safe and effective way to correct your vision BUT you need to be sure you are taking care of them correctly. Poor contact lens care can lead to severe infections and scarring that could permanently impair your vision.

There are many different types of contact lenses so be sure you know how long you should wear your particular type. It varies from one day to until they are uncomfortable. With rare exceptions, you should not sleep in your contacts lenses. This is because your eyes become deprived of oxygen during the night when a contact is in. The result may be an inability to fight off an infection.

Besides not sleeping in your contacts, you also should not wear them from the minute you wake up until bedtime that night. This also is to let the cornea, the front part of the eye, breath and stay healthy. You should wear your glasses at least 1-2 hours per day.

Care products vary depending on the type of contact lens. Be sure you clean your contacts daily and replace the solution in the case each day. The contact lens case should be air dried after a thorough rinsing each day.

If your eyes are uncomfortable, take the contacts out. Let your eyes rest but if the discomfort does not improve, you need to be seen. Everyone who wears contacts needs a pair of glasses also for situations like this.

With a few simple steps,you can maintain the health of your eyes and great vision with contacts. Don’t take a chance when your vision is at stake.

Swimming and Contact Lenses

Can’t see without your glasses and love your contacts, so why not swim in them?  The answer is that you should NOT swim in contact lenses because it increases your risk of eye problems from mild irritation to severe eye infections.  Most contact lenses are at least 50% water.  So if you are swimming in a pool with chlorine, that chlorinated water is going to penetrate your contacts and stay in contact with the surface of your eye for up to an hour after swimming.  This can irritate the surface of your eye and increase your risk of infection.


While mild eye irritation goes away in a day or so, a severe eye infection can result in permanent eye damage.  Even in the best maintained pool or spa, bacteria can be present. In lake water, a severe pathogen called acanthamoeba may be present that causes a difficult to treat corneal ulcer.  This protozoa penetrates the cornea rapidly and often requires specially formulated eye drops to save the eye. Beaches may also present the possibility of a fusarium fungal infection.

So if you want to swim and see without glasses, consider LASIK.  Wearing contact lenses in the water decreases your chance of fighting off possible infections. Should you have a severe corneal ulcer, the scarring may make contact lens wear in the future impossible and also make you a poor candidate for LASIK vision correction.

What's new in Contact Lenses?

Contact lenses improve all the time so if you have had problems with them in the past you may want to try them again every few years. The trend now is to disposable contacts that are worn daily for 2 weeks to a month and then discarded. The advantage of this type of contact is that there is less of a chance for protein build-up so the comfort and vision is improved.

There are contact lenses for those with astigmatism called “Toric” contacts.