You may have cataracts?

Courtesy of entirelysubjective on Flickr

Courtesy of entirelysubjective on Flickr

Cataracts are common

Not a day goes by in the office when I don’t tell a patient that he or she has a cataract, which is any kind of clouding in the crystalline lens of our eye. Some patients have heard of the term and understand that it’s a common occurrence as one ages. Other patients are terrified of the term and think it’s a disease that will make them blind. But the patients I relate to are the ones who hear the word cataract, and think “I’m old.”

Cataracts can affect your vision

If it helps, most cataracts develop over decades, from young adulthood onward. As early as 40 years old, we can start to notice the effects of this change over time. The crystalline lens in our eye, which is responsible for focusing light onto our retinas, begins to change shape and chemical structure over time. These changes result in more light scatter and dimming of vision. Usually, a patient will begin noticing glare from car headlights, double or ghost images around letters and lights or that night vision is not as clear or bright.

These are often initial symptoms and do not require treatment. As the cataracts continue to develop, patients’ eyeglass prescriptions may begin to change and they will also experience blurry or cloudy vision with worsening of the above symptoms. When they reach this point, which is about half of patients over the age of 65, cataract surgery may be indicated.

Cataract surgery – not as bad as you’d think

Cataract surgery is the most common surgery performed in the world. Nowadays, it can be a 15 minute out-patient procedure. The cataract is removed from the eye and replaced with an artificial lens implant, called an intraocular lens. With many advancements in this field, the lens implant can also have specialty optics which can correct for astigmatism or for both distance and reading.

What many don’t know is that cataract surgery is an optional procedure. A cataract is not malignant and does not always have to be removed. However, a patient’s vision will improve significantly with a successful cataract surgery. They will notice a much brighter and clearer environment. Some patients who have glaucoma or have a crowding of the internal structures of the eye would benefit from having cataract surgery.

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Photo courtesy of Community Eye Health on Flickr

Types of cataracts

There are many different forms of cataracts. In fact, I found a cataract in a 9-month old baby when his mom brought him in for a well-visit eye examination. In such a case where the eye is still developing, clouding of the lens can interfere with visual development and needs to be removed. Other congenital form of cataracts may simply be a cloudy spot on the lens which doesn’t interfere with vision. In this case, there is no need for cataract surgery.

Cataracts can also develop from trauma, use of certain medications and diabetes. Depending on the type, a cataract can slowly worsen over years, or change rapidly requiring surgical intervention within months. For patients whose vision is changing rapidly, I often like to follow them every few months to monitor for vision and cataract changes.

People often ask what can be done to prevent cataracts. Unfortunately, genetics plays a factor so if your parents required cataract surgery, you will most likely need one also. If you’re outdoors, wear a good quality pair of sunglasses that block UVA/UVB rays. This goes for kids as well since exposure to ultraviolet radiation is cumulative. If you’re outdoors for long periods of time, throw on a hat for added protection. Smoking has been shown to cause cataracts also, so limit your exposure to cigarette smoke. If you are currently being treated for diabetes or using steroid medications, be sure to see your internist regularly.

Why wait for your vision to blur? See your optometrist every year!

Most importantly, see your optometrist annually for an eye examination. They can check for cataracts but also determine if there are other factors that may be contributing to a reduction in your vision. It’s not just the lens that helps you to see but a whole network of related structures that work as a team to provide you with optimal vision.  If you require a new pair of glasses, always opt for an anti-glare coat on the lenses, which would further reduce disabling glare symptoms.

~Cindy P. Wang, OD, FAAO
http://eyehelp.org
http://www.coavision.org

 

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Winter eye care – How can I protect my eyes during winter?

Photo credit: adwriter from Flickr

Photo credit: adwriter from Flickr

Got dry eyes?

We are now in the heart of winter, which means I have seen a number of patients come in with complaints associated with the season.  A common complaint? Dry eyes.  With cold weather comes increased use of heating systems both in our houses and cars. While the  warm air certainly feels great, the heat and decreased humidity dry your skin and eyes.  This is particularly true for my contact lens patients. An easy way to stay comfortable is to keep artificial tears handy and to point vents away from your face.  Also, a humidifier can come in very handy for both your eyes and other sensitive tissues like the inside of your nose.

Playing in the snow?

Photo credit: LaRimdaME from Flickr

Photo credit: LaRimdaME from Flickr

I also had a couple patients tell me they were going on a winter sports trip in the mountains. While playing in the snow is definitely fun, it can be unhealthy for your eyes.  Ultraviolet light is even more powerful when reflected off of snow and with increased altitude.  Too much exposure to ultraviolet light can cause a condition called photokeratitis.  Unfortunately, I had a mild case of this after building a snow fort as a child.  While the fort turned out great, my eyes did not.  My eyes stung and my vision was blurry for about a day.  Some people suffer much worse, so it is very important to use UV-protecting sun glasses when hitting the slopes.

Interestingly, a new coating for your glasses has been invented that eliminates fogging.  So, if you find yourself going from hot to cold environments quickly for work or play, or eating a hot bowl of soup on a cold day, you may want to ask your doctor about this new technology. As you can see with a few simple steps, your eyes can be healthier and better protected in winter. So get out there, stay protected and have a great time!

~David C. Ardaya, OD
California Optometric Association
http://www.coavision.oeg

The ABCs of cataracts

CataractCataracts are a fact of life. Anyone who lives long enough will get them and almost everyone knows someone who has had them.  The good news is, with the latest technology available, improving your vision is very safe and will often times leave you with better vision without glasses than you had before the cataract.

Let’s look at the ABCs of cataracts:

A – Age. Remember that cataracts are changes to the lens of our eye as we get older. Different factors can influence when the cataracts start to form. Cataracts tend to develop sooner in folks who spend a lot of time outdoors in the sun without sun protection or sunglasses. They also tend to form earlier if you have diabetes or if you are a smoker. So keeping your eyes out of the sun and staying healthy will help delay the onset.

B – Blurry Vision. The lens of the eye starts changing with cataract formation, making vision blurry. It is like looking out of a blurry window. Usually night driving will be much harder and cataracts can cause difficulty with headlights a night. Cataracts can also cause glasses prescriptions to change as well. It is common to need one or two changes in glasses prescription before the cataract is affecting vision enough to have it removed.

Courtesy of laulau555 on Flickr

Courtesy of laulau555 on Flickr

C – Cure! The good news about this eye disease is that there is a very good treatment option. Cataract surgery involves removing the blurry lens from the eye and inserting a prosthetic lens in its place. This is an outpatient procedure and can take as little as 20 minutes.  The new lens often has a prescription in it that will be very close to your current glasses or contact lens prescription and will allow you to see better without the use of glasses or contacts.  There are even lenses available that can help with near vision as well as far vision. Usually after cataract surgery, vision improvement can be noticed as early as the next day.

Remember, make sure to have routine eye health and vision exams to determine if cataracts are forming or changing.  Your eye care provider can assist you in determining the appropriate time to have them removed.  Until then, stay healthy and wear sunglasses!

~Lisa M. Weiss, OD, FCOVD
California Optometric Association
http://www.coavision.org

Vision and the aging eye

Courtesy of ORBIS US on Flickr

Courtesy of ORBIS US on Flickr

Many patients reach a certain life stage and realize they need to start thinking more about their vision and preventing eye problems.  This usually happens in their early to mid-forties when people notice reading is a lot easier when there’s plenty of light and the print is held further away.  Those who have seen an eye care provider for this problem should have already discovered that this is a normal aging process.  But how does one know when vision changes are normal or should be concerning?

Eye conditions that impact vision:

  • Presbyopia is the medical term for when the focusing muscles in the eye are not as flexible, causing poor focusing ability for objects nearby.  This typically occurs in the late thirties/early forties and is easily corrected with reading glasses or bifocal or progressive lenses.
  • Cataracts begin to develop in our forties and progress over time.  There is a natural clear crystalline lens in our eye which focuses light onto our retina.  With ultraviolet ray exposure, this lens can become more opaque and yellow over time, causing a dimming of vision and glare and haloes around lights.  The best way to prevent cataracts from progressing quickly is to protect the eyes with UV-blocking sunglasses anytime you are outdoors.  The good news about cataracts is that they can be easily removed and replaced with an artificial lens implant.  With the latest technology of intraocular lens implants such as muiltifocal lenses, patients are now able to see clearly at all distances without the use of glasses or reading glasses.
  • Glaucoma is a symptomless eye disease of the optic nerve head where the nerve slowly deteriorates over time.  Most patients who develop glaucoma will not have any symptoms until the late stages of the disease, when peripheral vision deteriorates and patients are left with tunnel vision.  There is no cure or preventative measure for glaucoma, however, it is easily treated with eyedrops.  The only way to determine if you have glaucoma is to have annual comprehensive eye examinations.

    Courtesy of Nargopolis on Flickr

    Courtesy of Nargopolis on Flickr

  • Macular Degeneration is another common eye disease that can cause debilitating vision loss.  This occurs when the macular region of the retina loses its integrity causing poor central vision with distortion or gray spots.  It is often detected upon routine examination, especially when photos of the retina are compared over time.  Fortunately, there have been extensive studies on macular degeneration and the field has changed dramatically over the last several years.  An important test in recent years is genetic testing to determine one’s risk factor for vision loss as a result of macular degeneration, as well as antioxidants that may be useful in reducing this risk.  Clear risk factors include a history of smoking, exposure to ultraviolet radiation, increased cholesterol levels and Caucasian women with lighter eyes and fairer complexions.
  • Retinal Detachment tends to occur more often in those who are older than 65.  The retina is a thin and fragile tissue that lines the back wall of the eye and sends visual information to the brain.  This tissue becomes more fragile over time and can easily develop a hole or tear leading to a retinal detachment.  If you experience flashes of light, new floaters, or a change in your vision, you need to be seen right away by your eyecare provider.

There are a myriad of eye conditions that can develop as one ages.  The most important and useful method of preventing vision loss is to stay healthy.  See your primary care physician regularly to evaluate and treat high blood pressure, high cholesterol, diabetes and other health conditions.  If you have uncontrolled health conditions, you can easily lose your vision to diabetic retinopathy, hypertensive retinopathy, or a stroke in the eye.

So, as I tell all my patients, see your physician regularly, eat green leafy vegetables, take your medications, and monitor your own blood pressure or blood sugar.  And of course, wear sunglasses outdoors and see your optometrist annually.

~Cindy P. Wang, OD, FAAO
California Optometric Association
http://www.coavision.org

The SCARY… and fun truth about colored contact lenses

Colored contact lenses are a popular topic this time of year as many people prepare their Halloween costumes. How fun is it to have a cool accessory like tiger eyes, cat eyes or red or white eyes to complement the most creative of costume? Colored contacts are a great fun option.  There are also many people who like to wear colored contact lenses daily to make their eyes more blue, more green, more brown or a different color all together!

Courtesy of therefromhere on Flickr

Courtesy of therefromhere on Flickr

However, most people do not realize that even contacts worn for cosmetic purposes still pose a potential health risk for the eye if not properly fitted. This is true even if there is no prescription on the lens.  Contact lenses are classified as “medical devices” with the FDA.  Regardless of a corrective prescription, contacts are plastic on the surface of the eye and need to be fit properly and be taken care of properly to lessen the chance of vision threatening infections such as corneal ulcers.

Doctors of optometry perform additional tests above and beyond the glasses and eye health examinations when fitting contacts. We evaluate the size and shape of the cornea, the health of the tear layer and the fitting relationship between the cornea (the outer surface of the eye where the lens sits) and the contacts lens to insure the safest most appropriate lens for each individual patient.  We also educate patients on the best cleaning and wearing regimen for the them.  This greatly reduces any complications associated with contact lens use.

Buying contact lenses without a doctor’s prescription is something that happens with colored contacts often.  This practice leads to rise in vision threatening conditions that could be prevented with a proper contact lens examination. So, buy a different kind Halloween contact lens for each Halloween party this season, but get a prescription first!

~Lisa Weiss, OD, MEd, FCOVDCalifornia Optometric Association
http://www.coavision.org

The vision problem affecting 1 in 5 school children

Chronic underfunding, overcrowded classrooms, run down schools, and shortage of textbooks and resources are some of the school issues that grab the headlines.

Yet, there’s a problem in our schools that affects an estimated 15-20% of our children and receives virtually no publicity. It’s a problem that is as acute in affluent communities as in the inner city.

The problem is our children’s vision. I’m saddened to report that there are millions of school-aged children in the U.S. who have vision problems that are interfering with their ability to learn. Unfortunately, the vast majority of them, their parents, and their teachers are unaware of the problem.

In too many cases, I have seen these undiagnosed vision problems create a cycle of despair. A child is labeled as a “slow learner,” receives special attention, yet shows little progress if the underlying vision problems are not treated.

Courtesy of MDGovpics on Flickr

Courtesy of MDGovpics on Flickr

In other less severe cases, I have seen problems linger as life-long “nuisances”- hindering the productivity and job satisfaction of successful executives, attorneys, actors, and other professionals.

How is it that so many of these problems can go undetected? There are three main reasons:

  1. Inadequate vision testing – The typical vision test given at schools (usually administered by the school nurse), and general eye doctors’ offices (that do not specialize in developmental vision) primarily only evaluate distance vision and eye health. Near vision tests, which determine if a child can read a book up-close, are often overlooked. More complex vision skills that are necessary to read effectively, such as eye tracking and teaming, are very rarely tested.
  2. Poor vision skills are “silent” ailments – A child cannot tell if he is seeing clearly because he cannot objectively compare his vision skills with others. By the same token, a parent or teacher cannot assess how a child is seeing because they cannot see through the child’s eyes.

No matter how poor a student’s vision skills, it is all that he or she has known. I have seen extreme cases where a child with double vision has never reported this to her parents because she thought everyone saw like this. Consequently, it is especially important that parents and teachers are aware of the behavioral signs that indicate a possible vision problem.

Signs of vision problems include:

  • School or sports performance below potential
  • Resistance to school work and homework
  • Slow reader or test taker
  • Clumsy catching a ball
  • Words go in and out of focus
  • Rubs eyes while reading
  • Covers an eye while reading
  • Uses finger to keep place reading after the 2nd grade
  • Moves reading material closer or further away to see it better
  • Short attention span on visual activities
  • Poor penmanship, doesn’t stay on the line
  1. Lack of public awareness-
    • The fact that proper vision is the learned mastery of variety of skills is not widely understood. Most people assume that visual skills naturally develop, when in fact, for approximately 20% of people these skills do not develop fully by themselves.
    • Fortunately, most people with these vision problems can be helped through a program of Vision training. A Vision training (VT) program builds and enhances deficient visual motor and perceptual skills step by step.

I am hoping that we will reach a time when poor vision skills are eliminated as a reason why many of our children are not performing to their potential in school and sports. This begins with one child at a time, and one developmental vision exam  at a time.

~Elise Brisco, OD

California Optometric Association

http://www.coavision.org

Night blindness 101

The term night blindness sounds alarming, as though some people are actually blind at night.  There is a small percentage of the population that does in fact experience true night blindness, but it is rare and often the result of late stage eye disease.  In optometry, it is not common to use the term night blindness although we do encounter a significant number of patients who complain of poor night vision.  The symptoms are usually blur and dimming of vision at night, glare and haloes around lights and poor adaptation from light to dark environments.  How do you know if what you are experiencing is normal or a result of something more serious?

There are a handful of eye conditions that can create symptoms of poor night vision.

Photo Courtesy of kenleewrites on Flickr

Photo Courtesy of kenleewrites on Flickr

  1.  Patients who have had surgery to the corneas such as LASIK or corneal transplants may notice glare and haloes around light.  They may also experience diminished contrast sensitivity which can cause images in the evening to appear more dim.  Unfortunately, surgical results usually cannot be reversed.
  2. Cataracts are the number one cause of decreased night vision.  Patients over the age of 40 will begin developing mild cataracts.  This is when the natural lens inside the eye becomes more yellow and opaque as a result of age and ultraviolet exposure.  Cataracts can cause haloes and dimming of vision in the dark and decreased contrast sensitivity.  Fortunately, cataracts are easily removed thereby restoring problems with night vision.
  3. Corneal diseases such as keratoconus and severe dry eyes may also affect one’s vision in the evenings causing double vision or haloes.  For some of these patients, specialty contact lenses or eyedrops will alleviate these symptoms.
  4. Newer technology has also allowed optometrists to detect higher order aberrations in some patients.  For these patients, standard spectacle lenses may not improve night vision problems.  An instrument to detect higher order aberrations will determine whether a patient requires a specialty custom-made spectacle lens to improve night vision.

Some patients do in fact have true night blindness caused by an eye disease in its late stage.  Usually, symptoms begin slowly over time and progress to an inability to see in the dark.  These patients usually suffer from one of two eye conditions.

  1.  Retinitis pigmentosa is an inherited eye disease of the retina, the tissue that lines the back wall of the eye and captures visual images.  Retinitis pigmentosa affects the rods of the retina and causes slow deterioration of these structures.  The rods (unlike the cones) are responsible for night vision and for peripheral vision.  As the disease progresses, patients will notice a decrease in their ability to see in the dark and in the periphery.  Unfortunately, there is no current cure for retinitis pigmentosa.
  2. Glaucoma is an eye disease where the optic nerve slowly degenerates.  Patients with glaucoma usually have no symptoms in the early stages of the disease.  As the disease progresses, nerve fibers in the retina begin to deteriorate resulting in a decrease in peripheral vision as well as night vision.  Usually, patients do not experience symptoms of poor night vision and poor peripheral vision until the late stages of the disease.

Now that you know the causes, what are some ways to alleviate or improve poor night vision?  The simplest solution is to wear an updated pair of prescription glasses (if you have a prescription) with higher index lenses and an anti-glare coat.  Your optometrist can also inform you if you require customized lenses to correct for higher-order aberrations.  If your night vision problems are not a result of surgery or any eye diseases that you are aware of, then it is important that you visit your optometrist for a comprehensive eye examination.

– Cindy P. Wang, O.D., F.A.A.O.
California Optometric Association
www.coavision.org