You’ve been diagnosed with diabetes – what does that mean for your eyes?

You’ve just been diagnosed with diabetes.  Your head is still spinning with the news.  Sensory information overload.  Somewhere in between hearing those 3 words “you have diabetes,” you also heard that you should get your eyes checked.  No problem.  There are many optometrists out there in your community just like me.  The first thing I usually do is to take a very detailed history of your overall health including various aspects of your diabetes management.  Be prepared to answer questions regarding when you were first diagnosed with diabetes about what oral or injectable medications you are currently taking and what your blood sugar readings are.  The history portion of the exam will also give me a chance to get to know you better and allow us to work together to set some important health care goals.

Photo courtesy of Community Eye Health on Flickr

I tailor my diabetic eye work-ups for each patient that comes under my care, depending on if he/she is a newly diagnosed diabetic or have had some issues with diabetes in his/her eyes.

A complete diabetic examination may include but not limited to checking for prescription changes, lens clouding, and swelling or bleeding in the back of the eye.

With vigilant and periodic evaluations, you should reduce the chance of ever developing any of the following diabetic changes.  Diabetes may cause your vision to “fluctuate” making your vision clear during parts of your day and blurry at other times.  So, I will definitely check to see how different your prescription has changed from your previous exam.  Diabetes may also cause you to prematurely develop cataracts or clouding of your lens.  Most importantly, I will dilate your eyes to carefully inspect the retina for any bleeding, swelling, or new blood vessel growth.  Again, I assure you that no one should lose their vision to diabetes these days with close monitoring.  And if need be, I will refer you to a retinal specialist that I work in close partnership with for further evaluation.

Further testing or treatment by a retinal specialist may include:

• A dye test to evaluate the back of the eye (fluorescein angiography)
• Laser treatment (focal, grid, or pan retinal photocoagulation)
• Injection with steroid to reduce swelling (triamcinolone acetonide)
• Injection with anti-vegf medication that reduce swelling, stop the bleed, and stunt the growth of unwanted blood vessels (Avastin® or Lucentis®)

Now it’s your turn to do your part to prevent diabetes from developing in your eyes.

I always recommend four things to all my patients: 

1) Eat sensibly – according to the American Diabetes Association, fresh veggies should fill half of your plate, a lean protein for a quarter, and a carb of your choice for the last quarter
2) Exercise for 30 minutes daily
3) Take your medication(s) as recommended by your primary care physician or endocrinologist
4) Know your level of blood sugar control.  Ask your physician about your glycosylated hemoglobin or Hemoglobin A1C.

I look forward to seeing my patients back every year.  Until then, stay happy and healthy.

~Judy Tong, OD, FAAO

Get your fix of eye healthy foods

Get your fix of eye healthy foods and protect yourself from eye disease at the same time with this easy guide to the best eye healthy foods.

We all are aware that eating a variety of healthy foods including tons of fruits and vegetables, whole grains and nuts can help control weight and stave off many diseases, including heart disease and diabetes. The good news is those same healthy eating habits will also help reduce the risk of certain eye diseases such as cataracts and macular degeneration.

Key nutrients for the eye include Lutein and Zeazanthin, Vitamin C, Vitamin E, Selenium, Beta Carotene, Essential Fatty Acids and Zinc. These antioxidants and fatty acids can be easily added to your diet if you know where to find them:

Photo courtesy of Jaime h on Flickr

• Lutein & Zeazanthin are found in your green leafy vegetables such as spinach and kale.

• Vitamin C is found in citrus fruit, including oranges and strawberries.

• Vitamin E is found in a variety of nuts as well as broccoli, mango, and kiwi.

• Selenium is found in eggs, mushrooms, and grains such as brown rice.

• Beta Carotene is found in sweet potatoes, kale, carrots and spinach. That ingredient is why we’ve always known that carrots are good for the eyes.

• Essential Fatty Acids include the Omega 3 and Omega 6 fatty acids found in fatty fish as well as walnuts, soybeans, flax seeds and tofu.

• Zinc can be found in peanuts and cashews as well as dried beans and dairy foods.

Now that you know where to find these eye healthy foods, incorporate 8 servings in your diet per day and you will be on the way to a more healthier you, and at the same time helping to ensure that your vision will last a lifetime.

For more information, visit www.aoa.org and search for “Caring for your Vision” through “Diet and Nutrition.”

~Dr. Lisa Weiss, OD, MEd, FCOVD

Dry Eye Disease

If you ever have stinging, burning, gritty or sandy sensation, excessive tearing or itchy eyes, you may have symptoms of dry eye disease.

Dry eye disease is a condition where you don’t have enough tears or have poor quality tears to lubricate and nourish the eye. Tears maintain the health of the front surface of the eye and provide good vision. Dry eye disease is a common and often chronic problem, particularly in older adults. Advanced dry eyes may damage the front surface of the eye and impair vision.

The front surface of the eye is called the cornea. With each blink of the eyelids, tears are spread across the front surface of the eye. Tears are produced by several glands in and around the eyes. The tear film is composed of nutrients, electrolytes, proteins and lubricants. Tears provide lubrication, reduce the risk of eye infection, clear the eye of foreign matter, and keep the surface of the eyes intact and clear. Tears drain from the eyes into small drainage ducts called puncta in the corners of the eyelids, which drain in the back of the nose.

Courtesy of Clearly Ambiguous on Flickr

If there are any irregularities in the tear film, symptoms of dry eye may manifest. Dry eye disease may limit daily activities including reading, driving, working on the computer or wearing contact lenses.

Many different factors cause dry eye. These are some of the most common:

1) Hormones: Dry eye disease is more common in people 50 years old or older. Hormonal changes that are common in women experiencing menopause can cause dry eye.

2) Systemic diseases: Other systemic diseases including diabetes, glaucoma, Sjogren’s syndrome, lupus and rheumatoid arthritis can exacerbate the symptoms of dry eye.

3) Medications: Medications including antihistamines, hormonal replacement therapy and androgen therapy may contribute to dry eyes.

4) The environment: Environmental factors such as pollen or allergies, working on the computer or contact lens wear can make dry eyes worse.

Dry eye disease is diagnosed by patient history. In diagnosing dry eye disease, your doctor of optometry will evaluate the symptoms, general health problems, medications or environmental factors that contribute to dry eye disease. Your doctor will perform an external examination of the eyes including the eyelid structure and blink dynamics. Your doctor will evaluate the eyelids, cornea and conjunctiva is performed using bright light and magnification. Measurement of the quantity and quality of tears is assessed for any abnormalities. From this information, your doctor of optometry can determine if you have dry eyes and advise you on treatment options.

Treatments for dry eyes include:

• over the counter artificial tears,
• punctal plugs (small plastic pieces that close the ducts that drain tears out of the eyes),
• eyelid hygiene,
• dietary supplementation,
• or a prescription eyedrop called Restasis (cyclosporine 0.05%).

If you experience any of theses symptoms, contact your doctor of optometry and ask for a dry eye evaluation.

~ Melissa Barnett, OD, FAAO

Makeup & Glasses

Glasses are becoming a popular trend, many wearing cat-style eye glasses or hipster rims. However, since it’s a fashion statement that covers up your eyes, many women think they can’t wear makeup when they wear their glasses, but it’s just the opposite, according to fashion website Refinery29.com. They suggest you wear warm and bright colors on your lids, because if you use cool colors you run the risk of just looking like you have a black eye.

Check out this video where Refinery29 eyeglass wearer, Taylor, shows you how she puts her makeup on to make her eye pop behind her stylish Warby Parkers.

Eyecare Myths Debunked, Getting the Facts Straight

As an optometrist, there are several questions I hear pretty often. Questions that some may consider myths, while others deem them as fact. Today, I’m going to set the record straight. I’ve narrowed down the questions to the top five based on how often the question is asked or because some people are too embarrassed to ask.

1. Wearing glasses will make your eyes weaker. I’m asked this question almost daily, mostly by patients over 40, wondering whether their reading glasses are making their vision worse. The simple answer to this question is no, glasses do not ruin your vision. People often forget that every day you get a little older, and as your eyes get older it becomes harder to get by without a proper prescription.
2. Smoking marijuana is good for glaucoma. Yes, marijuana can lower the intraocular pressures of the eyes, which is helpful in decreasing the progression of an eye disease called glaucoma. However, the amount needed would essentially make you non-functional since you would have to smoke constantly throughout the day. Your optometrist can prescribe once daily eye drops that are more effective at lowering the pressures in the eye without the added risk of smoking at all.
3. Contact lenses can roll behind the eye into the brain and get stuck. This question will inevitably come up while I’m bending at odd angles trying to find a “lost” contact lens in a patient’s eye. No, the contact lens has nowhere to go and will not roll into the brain. There’s a thin tissue covering the front of the eyeball and the inner eyelid that keeps the lens in front of the eye. Sometimes, contacts can slide off to the side of the eye but this tissue prevents it from going any further back.
   

   Picture courtesy of I.gence on Flickr

4. Eating certain foods will improve my vision. Contrary to popular belief, carrots are not the best food for your eyes (spinach is more like it). Eating a variety of antioxidant-rich foods can protect your eyes from various eye diseases, thereby preserving one’s vision at its current state. I could write a full article on this topic but to put it simply, just add some fish, nuts, whole grains and colorful fruits and vegetables to your diet for the health of your eyes and your body.
5. Reading in the dark and watching TV or video games too long can make your vision worse. None of these have been proven to cause poor vision, however they can all cause eyestrain and/or dryness of the eyes. Eyestrain can occur if you aren’t reading or watching television under ideal circumstances or for very long periods of time, but that should not cause your vision to decrease. Proper ergonomics such as bright illumination, a working distance of approximately 16 inches, proper head and neck positioning and taking breaks to allow your eyes relax can help keep eyestrain to a minimum.

I’ve only addressed five common eyecare myths today, although there are plenty more. If you would like the answers to more in a future article, please comment below.

~Cindy P. Wang, O.D., F.A.A.O.

California Optometric Association, Communications Chair

South Pasadena Optometric Group