The aging eye

Image courtesy of Sohrab Gollogly website at

Image courtesy of Sohrab
Gollogly website at

Age is never a diagnosis. Although certain eye conditions may become more common with increasing age, you should not assume that they cannot be corrected. It can be confusing for a patient to know what part of the normal aging process is correctable and what is not. In this article we hope to clear up some of the most common symptoms of the aging eye. Continue reading

Common eye emergencies and how to react

Courtesy of Brandon Koger on Flickr

Courtesy of Brandon Koger on Flickr

Many people don’t give their eyes much thought until an eye emergency happens. Chances are, it happens on a holiday weekend at midnight when all doctors’ offices are already closed. What should you do and can it wait until Monday morning?

Below are the most common emergent symptoms that you need to pay attention to.

Eye Pain: If you have extreme pain that burns, stings and causes your eyes to water, it’s usually from a foreign object or a corneal abrasion. If rinsing the eyes out with artificial tears or contact lens solutions doesn’t help and the pain is just as intense after 20 minutes, you need to be seen by an eye doctor. Try to keep your eye closed until then.

Boring eye pain with headache, nausea, blurry vision: If you are experiencing a boring pain in one eye with a severe headache, haloes around lights, foggy or steamy vision, and/or nausea, you need to be seen immediately. You may be experiencing a spike in the intraocular pressure of your eye caused by a disease called narrow angle glaucoma.

Change in vision: If you notice a drastic change in your vision such as a shower of floaters or flashes of lights followed by a curtain or veil over one area of your vision, you may be experiencing a retinal tear or detachment and need to be seen. If your vision change is a gradual dimming of vision that doesn’t improve, you may be experiencing a central retinal artery occlusion where a large clot blocks the flow of blood to the eye resulting in gradual vision loss. This may be reversible within a narrow window of a few hours, so it is important to find adequate treatment immediately.

Chemical injury to the eye: If you are splashed in the eyes with a chemical, immediately rinse them out with saline solution (contact lens solutions are okay), artificial tears, or tap or bottled water. If possible, rinse them for 15 minutes with a steady stream of water. Do not use high speeds of water to avoid further injury. If your vision is reduced or you still experience extreme pain after 15 minutes of rinsing, you should be seen by an eyecare physician. Depending on the chemical you are exposed to, the eye may be at risk for further damage.

Physical injury to the eye: If you have been hit in the eye or head, always check your vision and compare the vision in each eye. If one eye is uncharacteristically more blurry than the other, you should be checked to make sure the structures in the eye are intact. If you experience unbearable pain that does not improve within five minutes, you should see your eye doctor immediately.

If you are a contact lens wearer and are experiencing pain with and without contact lenses plus a reduction in vision, you also need to check in with your eye doctor. This is especially important if you have been exposed to water such as oceans, lakes, and water parks which can cause a severe eye infection resulting in vision loss.

The more important question is, “Do you have someone you can call in emergencies?” Emergency rooms see a good deal of patients for ocular emergencies. However, some of the above scenarios require a retinal or corneal specialist, which may be more difficult to find in a timely manner. In emergencies, call your optometrist first. They may have an on-call line or emergency services available. If they are not available to see you or believe you need the services of a specialist, they may be able to find one more quickly for you than the emergency room can.

~ Cindy P. Wang, OD, FAAO
California Optometric Association

How much time should your child spend on the computer?

138284-425x282-child-on-computerIn our society today, children increasingly use computers, smart phones and tablets on a daily basis. Children as well as adults may experience symptoms related to computer use called computer vision syndrome. Symptoms after extensive viewing of technology can lead to eye discomfort, fatigue, blurred vision and headaches, dry eye and eyestrain. These symptoms may be exacerbated by poor lighting, glare, an improper work station arrangement, uncorrected refractive error (vision problems), or a combination of these factors.

In addition, children may be more susceptible than adults to computer vision syndrome.


1. Children use an adult computer.
Since a child is smaller than an adult, the computer workstation may not fit them well. Children may have difficulty reaching the keyboard or placing their feet on the floor, causing arm, neck or back discomfort. For example, a child using a computer on a typical office desk often must look up further than an adult. The optimal viewing angle is slightly down at 15 to 20 degrees. If a different viewing angle is used, problems with binocular vision (both eyes working together) can occur.

2. Children are not as self-aware as adults.
A child may use a computer or keep playing video games without taking breaks for many hours. Prolonged activity without breaks can cause accommodative problems. The eyes focus at a particular target, which may cause accommodation spasm. In some cases, the eyes may be unable to smoothly and easily focus on a particular object, even long after the original work is completed. Also, eye irritation may occur due to reduced blinking. When concentrating and viewing a screen, blinking is reduced.

3. Children may ignore problems.
For example, a child may ignore significant glare or poor lighting when viewing a computer screen, which may lead to excessive eyestrain. Intensified light can contribute to excessive glare and problems associated with eye adjustments to different levels of light. Also, children often accept blurred vision caused by nearsightedness (myopia), farsightedness (hyperopia), or astigmatism because they think everyone sees the way they do. Uncorrected refractive error can cause eye strain.

Important tips for children using a computer:

1. A comprehensive eye examination.
Eye examinations are important for all children and adults, starting at 6 months of age. An eye examination will ensure that the child can see clearly and comfortably at all distances and detect conditions that may contribute to eyestrain. If needed, glasses, contact lenses or vision therapy (eye exercises) can provide clear and comfortable vision for computer use.

2. Check the height and arrangement of the computer.
A computer screen should be 15 to 20 degrees below eye level (about 4 or 5 inches) as measured from the center of the screen and held 20 to 28 inches away from the eyes. The child’s size should determine where the monitor and keyboard are placed. If the computer monitor is too high in the child’s field of view, an adjustable chair may be used that can be adjusted for the child’s comfort. A footstool may be helpful in supporting the child’s feet.

3. Check for glare on the computer screen.
Windows or other light sources should not be directly visible when sitting in front of the monitor. If needed, adjust the desk or computer to prevent glare on the screen. A lower-wattage light can be substituted for a bright overhead light or a dimmer switch may be installed to give flexible control of room lighting.

4. Take a break.
A 20 second break every 20 minutes will reduce the development of eye focusing problems and eye irritation.

5. Keep blinking.
Remind your child the importance of blinking. In order to minimize the chances of developing dry eye when using a computer or digital device, make an effort to blink frequently. Blinking keeps the front surface of the eye moist. Non-preserved lubricant artificial tears may be helpful for children as well as adults.

~ Melissa Barnett, OD, FAAO
California Optometric Association

Vitamin D and the eye

Photo courtesy of

Photo courtesy of

Many of my patients take an assortment of supplements such as Calcium, Omega-3, Multi-Vitamins with Minerals, and Vitamin D on a daily basis. Are you one of those individuals taking vitamins regularly? And if so, are you taking Vitamin D?

It is a known fact that those that reside high up in the northern hemisphere require taking supplemental Vitamin D because they are not exposed to enough sunlight. You see, just being under the sun for about 15 minutes a day will help your skin convert sunlight into usable Vitamin D for your body to use. You can also get Vitamin D through a diet of fish (herring, mackerel, sardines, tuna) and fortified dairy products.

Nowadays, people are unfortunately becoming more deficient in Vitamin D levels for two reasons: diligent use of sunscreen, which on one hand aids in the prevention of skin cancer, but on the other hand it blocks the skin from producing enough Vitamin D for your body; and a diet lacking in foods rich in Vitamin D.

Vitamin D was originally believed to strengthen our bones. Through the Fall Risk studies, Vitamin D has proven that it goes beyond prevention of osteoporosis. It is involved in the prevention or reduction of symptoms in Alzheimer disease, asthma, breast cancer, colorectal cancer, dental caries, depression, diabetes and Diabetic Retinopathy, eczema, hypertension, inflammatory bowel disease, influenza, Lupus, Multiple Sclerosis and Optic Neuritis, pneumonia/respiratory infections, and tuberculosis.

With the eye in particular, research has revealed that individuals with diabetes had little to no presentation of diabetic retinopathy while taking supplemental Vitamin D. Furthermore, clinical research has shown that individuals recently diagnosed with Multiple Sclerosis and subsequently placed on high dose Vitamin D had both their neurologic signs and symptoms improve. Continued studies are proving that sufficient levels of Vitamin D may ward off episodes of inflammation of the optic nerve in the eye (Optic Neuritis).

From all the known benefits of taking Vitamin D, wouldn’t it be a good idea to check the status of Vitamin D level in your blood? Taking supplemental vitamins can be a controversial subject. If you do decide to jump on the band wagon, it is always a good idea to talk to your primary care physician before you start taking Vitamin D or any other supplements. Let’s bone up (no pun intended) on Vitamin D!

~ Judy Tong, O.D., F.A.A.O.
California Optometric Association

Top five vision myths

Courtesy of riekhavoc (caughtup?) on Flickr

Courtesy of riekhavoc (caughtup?) on Flickr

As a doctor of optometry, I hear it all. And with Dr. Google serving as an impromptu family physician these days, myths regarding eye health are bound to circulate. Here are the top vision myths debunked:

  1. Wearing eyeglasses that are too strong or have the wrong prescription will damage the eyes.
    Prescription lenses in eyeglasses alter light rays into the eye. The prescription lenses do not change any part of the eye. In an adult, wearing glasses that are too strong or an incorrect prescription cannot harm the eye, although it may result in eyestrain or a temporary headache. With an incorrect prescription, vision will be blurry, but not harmful to the eye.
  2. Wearing eyeglasses will cause you to become dependent on them.
    Eyeglasses are used to correct blurry vision. Since clear vision with eyeglasses is preferable to blurry vision, one may want to wear eyeglasses more often. With glasses, it may feel that you are becoming dependent on them. However, you are actually just getting used to seeing clearly.
  3. Wearing eyeglasses will weaken the eyes
    Eyeglasses worn to correct nearsightedness, farsightedness, astigmatism, or presbyopia will not weaken the eyes. In addition, glasses will not permanently “cure” these types of vision problems. Wearing glasses will enable clear vision caused by these refractive errors. (There are exceptions – glasses for children with crossed eyes (strabismus) or lazy eye (amblyopia). These glasses are used to help straighten the eyes or improve vision. Not wearing glasses may permanently impair vision).
  4. Using the eyes too much will “wear them out.”
    Eyes are made for seeing and cannot be used too much. We would not lose our sense of hearing by using our ears excessively.
  5. Holding a book too close or sitting too close is harmful to the eyes.
    Many children like to hold books very close to their eyes. Children have excellent focusing ability, so sitting close is normal and safe. Also, both children and adults who are nearsighted may get close to a book to see it clearly. This does not cause or worsen any type of eye problem.

~ Melissa Barnett, OD, FAAO
California Optometric Association

A contact lens exam, what’s different?

Photo courtesy of Valley Eyecare Center

Photo courtesy of Valley Eyecare Center

I often get this question from patients: “I can see fine. My contacts are fine. Why do I have to have a contact lens exam?” This is not an unusual conversation in my office. Now is a great opportunity to explain the different tests done in a Contact lens exam.

One important thing we need to understand is that contact lenses are FDA approved medical devices.  They are actually small, very thin, pieces of plastic that sit directly on the cornea. The cornea of the eye is a very small, yet complicated structure that needs to be examined regularly when a patient wears contacts. Misuse of contacts and/or poor fitting contacts can cause serious harm to the health of the cornea and ultimately your vision.

My vision is fine. Why do I need another exam?

There are several tests your optometrist will do to determine that contacts are safe, healthy on your eyes and that the prescription is correct. We measure the curvature of the surface of the cornea – using a Keratometer or a Topographer – to determine the right size of contact to put on. Taking this measurement every year will help ensure that the contacts are not causing any subtle damage to the surface of the cornea. There is also a highly specialized microscope that some doctors are beginning to use that is able to count the number of corneal cells to make sure that they are staying stable while using contact lenses. These tests are early detectors of corneal changes due to the use of contacts that may not initially affect the vision or comfort of your lenses.

The contact lens exam also includes a detailed tear analysis to determine if you have dry eyes or allergy eyes. These common conditions can affect the comfort of your lenses and your vision. There are many different types of materials that contacts are made of and some are not compatible with certain eye surface conditions. For example, someone might need a contact with more water in it, others might need one that transmits more oxygen to the cornea. All of these factor are determined in the contact lens exam.

Next, the contact lens prescription needs to be determined. Due to the fact that that contact lens sits on the eye, not in front of the eye like glasses do, there is actually a different determination of the contact lens prescription that needs to be done in some cases. So, no … the contact lens prescription is not the same as the glasses prescription.

Once all of the parameters of the contact lens is chosen – size, material and optical prescription – the lens needs to be evaluated on the eye. We look at how the lens moves on the eye and how it sits to determine if it is going to be a healthy lens for you. Sometimes, differences in eyelids, blinking and tears can affect how a lens sits on the eye and adjustments might need to be made.

Finally, when your optometrist is happy with the fit and the vision through the contacts, then your contact lens examination is complete. Depending on the difficulty of your prescription, any eye surface disease, such as dry eyes or allergies, and if you are an experienced wearer or not, this process can take from one visit to several. Work with your optometrist during the process so that your can safely wear contact lenses for many years to come.

~ Lisa M. Weiss, O.D.
California Optometric Association


The internet isn’t just for kids

As elderly adults become more computer savvy, some vision risks may arise.

Photo courtesy of

Photo courtesy of

Do you remember the excitement of receiving mail from your grandma with a crisp $5 dollar bill stuffed inside? With the recent explosion of computer use in the age 65 and up crowd, I wonder if my children will get to experience that or if they might receive an email with an e-gift card for Amazon instead.

Currently 74.8 percent of households in the United States have internet access and a remarkable 53 percent of persons 65 years old and up make use of the technology. Even social media is changing with seniors comprising 25 percent of all users. As a result, more seniors than ever before will be using their vision to perform tasks like emailing and making online purchases. While this is clearly a benefit, as seniors can do business in the comfort of their own homes and even order groceries online, there are some inherent pitfalls when it comes to their vision. As we know, patients over 40 tend to have greater difficulty with all near tasks and as the years go by, this only gets worse. Also, conditions such as cataracts and macular degeneration are much more prevalent in this population making most visual tasks more difficult. Finally, dry eyes are more common as we age and since we blink less when using a computer, this to can lead to discomfort and fatigue.

So, what can we do to make computer use more comfortable for seniors?

  • Make sure the computer font is at an appropriate size
  • See an optometrist for an up to date glasses prescription and to check for eye disease
  • Consider glasses that are specifically made for computer use with protection from glare
  • Use lubricating drops (artificial tears) and take frequent breaks
  • Do not forget to stand up occasionally and stretch your legs

Additionally, more of the 65 and older crowd is starting to use smart phones (14.5 percent!).   While many smart phones and tablet computers have zoom text, I encourage them to make a purchase with their vision in mind. So, for phones, a phablet like the new iphone plus or the galaxy note makes sense and will be less frustrating to use.

So, while my kids may be fruitlessly waiting by the mailbox, they do get to talk to grandma via skype and facetime which is amazing. What a great time to be a senior!

~ David C. Ardaya, O.D.
California Optometric Association

Age-related macular degeneration: what you need to know

US population – 318.8 million
US population over 60 – 60.5 million
US population with age-related macular degeneration – 15 million

Age-related macular degeneration (AMD) is the number one cause of blindness over the age of 60. As the population continues to age, AMD will continue to cause millions of people to lose their vision.

Image courtesy of Sohrab  Gollogly website at

Image courtesy of Sohrab
Gollogly website at

So what is AMD and how can it be treated?

Age-related macular degeneration is the breakdown of the light sensing tissue in the back of the eye – the retina. In the normal process of seeing, as light hits the nerves in the retina, the nerves go through a chemical change in order to send a signal to the brain saying, “light, hit me.” As the nerves go through this change, they slough off a lipo-protein material called drusen that is cleaned up by the layers below the retina. In the normal process of aging, these garbage collectors in the retina don’t do their job as well and with time, drusen begins to deposit. These cells are important, not only for cleaning up the debris of seeing, but also for bringing nutrients to the retinal. In AMD, there is a faster than normal aging in the retina, resulting in a greater buildup of drusen and eventually the loss of the light sensing nerves and loss of vision.

Most people who develop AMD develop a slow loss of vision over many years. This is the definition of “Dry” AMD. In about 15 percent of patients, the body’s response is to grow new blood vessels into the damaged area of the retina in order to try to fix the problem. These new blood vessels are poorly constructed and leak badly. This “Wet” form of AMD causes bleeding in the retina and a rapid loss of vision within weeks to months.

Unfortunately, there is no treatment for macular degeneration. In some cases, the use of lasers or injections of medications into the eye can “dry up” wet-AMD, but cannot stop the slow steady loss of vision. Fortunately, AMD does not cause complete blindness, only the loss of central vision. However, dealing with the loss of vision from AMD can be difficult. Fortunately, the use of magnifiers and other low vision devices prescribed by low vision specialists can help significantly with the activities of daily living.

The goal of treatment is early detection and mitigation of vision loss. Detection can only happen by the examination of the eye by a doctor of optometry or ophthalmology using special instruments to examine the inside of the eye.

Researchers at the National Eye Institute tested the use of nutritional supplements to protect against AMD. This Age-Related Eye Disease Study 2, AREDS2, found that daily supplements of certain vitamins and minerals can slow progression of vision loss in people who have intermediate AMD, and those who have severe AMD in one eye. The AREDS2 study recommends the following nutritional supplements for patients who have AMD:

  • 500 milligrams (mg) of vitamin C
  • 400 international units of vitamin E
  • 80 mg zinc as zinc oxide (25 mg in AREDS2)
  • 2 mg copper as cupric oxide
  • 15 mg beta-carotene, OR 10 mg lutein and 2 mg zeaxanthin

In addition, other factors increase the risk of developing AMD – smoking, obesity, UV light absorption, systemic vascular diseases, and poor nutrition. So it is important to quit smoking, wear glasses that inhibit UV light, eat a diet high in fruits and vegetables and have yearly eye exams to detect AMD in its early stages. Remember, there are no symptoms until the later stages of the disease, so eye examinations by doctors of optometry and ophthalmology are the only way to determine if you are at risk of developing vision loss from age-related macular degeneration.


~ Dr. Steven Sage Hider, OD
California Optometric Association


Coping with vision loss

Photo courtesy of

Photo courtesy of

Sometimes, it’s easy to take our vision for granted. Vision is our most dominant sense. We rely on it for just about everything and rarely need to think about what would happen if we lost this precious gift of sight. In the last few months, this topic has hit home with me in a very personal way. My close friend, who is a graduate student, suicide crisis counselor, avid reader, husband and father to two boys has recently lost his sight. I asked him to share his experiences first hand:

“Since the complete legally blind diagnosis only came to me less than a month ago, the coping is still coming. For me, it might have helped that I was already blind in my left eye from a previous retinal detachment. In the meantime, it has been key for me to keep busy and not dwell on the negative.  Contacting the Department for the Blind and Visually Impaired (DBVI) was one of the first things we did. The DBVI have been amazing with a turn around time of two to three days, at the most. They have given me access to technology such as a portable CCTV/video magnifier and a regular CCTV/video magnifier – both have made my life easier. They will be providing me with my white cane and mobility training, as well. I have signed up for bookshare and started using an on screen magnifier, which have also helped. 

I think for me, the biggest things that have helped me cope will be returning back to school, work and my internship. It will be good to keep busy so I don’t  dwell on the topic of my blindness all the time. It has been suggested I also see a counselor, which I may do in the future.

One thing most people don’t realize is that this is a loss. I have been going through the different stages of grief, mostly anger and sadness. I think of all the things I am never going to see. I am not going to get to teach the boys how to drive or “see” them graduate high school. Then, I remind myself that it could be a lot worse. There are always worse scenarios and I just keep reminding myself of that. Of course, my wife and the boys have been very supportive and encouraging.  

No matter what, life goes on, and sometimes you get hit with a curve ball, but that doesn’t mean life has to stop.

If something is bothering your eyesight, don’t delay.  I assumed the black patch and flashing light in my eye was due to being tired and stressed. Instead, it was a retinal detachment.

Go to your eye doctor immediately. Had I done that, then I might still have vision in my left eye.

I have found the following resources helpful: | |


If you are facing this challenge either for yourself or a loved one, contact your COA Optometrist for available resources in your area.  And remember to have your eye exam every year, so that your doctor can detect any potential vision threatening conditions early.

~ Lisa M. Weiss, O.D.
California Optometric Association

Workplace eye protection – What advice can an eye doc give?

Wear your safety glasses

If you are a carpenter, chemist, dentist, gardener, machinist, manicurist, painter, or plumber just to name a few occupations, these four little words should be ingrained in your mind and practiced 100 percent of the time. Protective eyewear does not consist of your standard frame or ordinary lens material that you may wear on a daily basis for vision correction or as a fashion accessory.

The standards for “protective eyewear” is set forth by one of the branches of the federal agency called Occupational Safety and Health Administration (OSHA). Mandates to wear protective eyewear is to safeguard you, the workforce, from unnecessary injury and harm. Such protective eyewear for the workplace is very specific and is typically made of a chemical and impact resistant material such as Trivex®. The lens may incorporate your prescription or it may simply have no prescription at all. The frame is manufactured with materials that is flexibly strong and is has a Z87 labeling. Additionally, the frame may have side shields for added protection if needed.


Photo courtesy of John Carleton on Flickr

The story of Mr. Plumber

A patient of mine named Mr. Plumber (real patient, fictitious name). He is a hard working plumber in our town. Mr. Plumber frequents our office way too often. You see, Mr. Plumber refuses to wear “safety goggles” because he feels uncomfortable and restricted with them on. In only ten years, he has suffered 25 pieces of metal lodged into both corneas. It wasn’t until one of the metal pieces pierced the center of his right eye, causing loss of vision, that he finally decided to comply with our ongoing recommendation of those four little, but impactful words… wear you safety glasses!

~Judy Tong, OD, FAAO
California Optometric Association