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Medical Advice Disclaimer

Frequently Asked Questions

Is there anything I can do to prevent macular degeneration?
There are no studies that show that taking vitamin supplements will prevent macular degeneration. There are well designed studies that do show once a person develops early signs of macular degeneration (we look for those signs in a routine eye exam), taking specific supplements greatly reduces the risk of developing a more serious and vision threatening form of macular degeneration (a second phase of the AREDS study looking at luetin, zeaxanthin and Omega 3 as well as reducing the Vitamin A (which smokers cannot take) and the amount of zinc recommended from the first study, will be completed in the next couple of years.)
So the question is what to do if you have a family history of macular degeneration?
If you smoke, stop. Smoking increases the risk of macular degeneration three times and smokers develop macular degeneration 6 – 10 years earlier than non-smokers. They also don’t respond to treatment as well as non-smokers. Exercise regularly, and eat a diet rich in vegetables and fruits of many colors, and with regular servings of ‘oily’ fish like tuna, salmon, herring and sardines. The take home lesson is that macular degeneration is a symptom of a systemic inflammatory disease. The processes that are causing the leaky blood vessels in the eyes are most likely happening in other parts of the body, so prevention has to be a whole body approach.
What are the most common problems that children have with their eyes?
As a parent, I tend to divide the ‘care of child’ world into what is really scary, what is worrisome and what is normal.
Retinoblastoma is a primary cancer of the eye that can occur in children. It is uncommon and is usually noticed by an unusual appearance to the pupil in which you see a white or amber glint instead of the usual black.
Infantile glaucoma is also unusual and may cause a child to be extremely sensitive to light. Their eyes also often have an unusual bulging appearance as the internal pressure of the eye causes it to protrude. The reality is that the above conditions, though serious, are very unusual.
Eye injuries are a much more common reason why children lose vision. This can occur while playing sports or trauma. A take home lesson I learned in a recent course of eye trauma, was that children will often not tell their parents the whole story if there is an accident, because they don’t want to get in trouble. For example, a young child said a tree branch hit his eye rather than admit he was playing a BB gun (true story!) and only when he was being wheeled in to have a CAT scan admitted that he was shot in the eye. As a parent, have a degree of suspicion if you did not witness the accident and
observe if the extent of the injury jives with the story you are told.
More commonly, children eyes are injured while playing sports. If a ball hits an eye directly, the force of the impact has to go somewhere. The bones below the eyeball and on the nasal (nose) side are quite thin and make break as they absorb the impact. A less treatable problem is if the eyeball and the nerve that connects it to the brain absorbs the blow. The take home lesson is to have children playing sports particularly with smaller balls (lacrosse, racquetball, baseball, softball) wear eye protection (see Liberty Sport under featured eyewear).
Amblyopia (lazy eye) is a condition that occurs if a child isn’t using one of her eyes to see. This can occur if one eye’s vision is much better than the other, for example if one eye has perfect vision and the other eye is nearsighted, or if the eyes don’t align (happens about 3% of the time) so the child can’t use them together. A good way a parent can screen for this at an early age is to play ‘pirate’ and patch one eye and then the other. If your child’s behavior is quite different depending on which eye is covered it raises suspicion that she can’t see well in one eye. I’ve touched on scary and worrisome. Normal problems include allergies, eye infections and vision changes that can be corrected with glasses.
Itchy eyes are the hallmark of eye allergies; so if your child is rubbing his eyes a lot, suspect an allergy. Cold compresses and eye drops (artificial tears that have been kept in the refrigerator) are good home cures. There are several effective prescription drops, like Pantanol, that can be used.
‘Pink eye’ is quite common in children and are spread just like colds or flu so encouraging frequent hand washing helps limit the spread of infections. Generally, the ‘bug’ is viral and will go away in a few days (cold also helps the symptoms of ‘pink eye’, but if the lids are swollen or really stuck together, the infection may be bacterial and need a dual antibiotic like Polytrim. In the United States, fifteen percent of children by eighth grade are myopic (nearsighted) and will have trouble seeing the board at school. A large study in Orinda that has spanned many years showed no evidence that environmental factors like excessive reading or computer work caused children to become nearsighted. The only significant risk factors were having nearsighted parents and having a physically long eyeball. An Austrailian study though suggests that children who play outside an hour a day are less at risk for developing myopia. Why people become myopic is an active area of research with at this point, lots of contradictory findings.
What are the most common problems that ‘aging’ eyes experience?
The fastest growing segment of the US population is people over 80 and more than 80% of them are living independently. Dr. Haegerstrom-Portnoy has been conducting a longterm study (15 years and still going) with a group of elders in Marin to evaluate what happens to vision as we age and has described several functions that are significantly impacted. Below are some of her research results:
One important function that doesn’t decrease is the ability to read an eye chart (and pass that driving test). The problem is, the ‘real world’ doesn’t exist in high contrast like our eye charts; that is; bold black letters against a bright white background.
Contrast sensitivity (the ability to distinguish one shade of grey from a slight lighter or darker shade of grey) drops very rapidly after the age of 65 and by 80 years old is about 18 times worse than a 20 year old. To get a feel for how the world may appear with reduced contrast sensitivity, hold a clear sandwich bag (so two layers of plastic) over a camera lens and then shoot a picture of a sidewalk or a stairway. What you’ll see is that it is much more challenging to read the contours of the sidewalk or stairs.
The ability to recover from bright lights and glare takes significantly longer for this group. A 20 year old may take 10 seconds to see going from outdoors into a dim room while 80 year old eyes may take 2 minutes. Think of the adaptation you go through when you enter a movie theater during the day and imagine it taking 20 times longer.
Our ability to see in the presence of glare (think driving at night with oncoming headlights, or the glare at sunrise or sunset) is greatly affected by age. Half the people over 80 see only 20/400 (the giant E on our eye chart) in the presence of glare so the glare is truly blinding.
She has also reported on more difficulty reading fluently (even though the vision on an eye chart is fine). Recognition of expressions on faces at a distance becomes more challenging and someone over 80 may miss a social cue that a person is angry or sad. There’s also a marked reduction in ‘attention fields’; that is when driving, the ability to pay attention to the object in front of you while at the same time, attending to, for example, a person crossing the street off to the side.
How can we improve vision function in the elderly be it parents, our grandparents or ourselves?
1) Make sure their glasses are up to date by checking the prescription every two years and changing glasses periodically to replace scratched up lenses. It becomes critical to wear the correct lenses to maximize contrast, which may mean drug store reading glasses may no longer be adequate.
2) Increase the lightening in an elder’s home a lot using incandescent rather than fluorescent lighting. (The bluish light of fluorescent light has a harder time reaching the back of an older eye.)
3) Make lighting even throughout the house to minimize glare recovery; that is, going from a brightly lit room to a dim hallway with throw rugs is a recipe for a fall, so even out the lighting.
4) Improve the contrast of objects against the background in places like stairs by putting bright tape on the edge of a stair. (Use your camera with the sandwich bag to see the difference in being able to judge the drop in a stairway with and without high contrast tape.)
5) Wear dark sunglasses and a dark brimmed hat outside to avoid the high intensity light that is hard to recover from.
6) Avoid driving at night, sunrise and sunset, the high glare times; and for those of us not in the 80+ year old range, be more willing to transport elders during those times.
7) Know it is more challenging to attend to driving for an older person so if you are a passenger, you may not want to chit chat but actually help scan for pedestrians, etc. (And if you are crossing the street, don’t assume that driver sees you!)
8) Be patient with yourselves and elders.
The results of this study are based on averages and there is a tremendous variability from individual to individual, so asking anyone over 80 to restrict their driving would be unreasonable (the inability to drive in most communities is very isolating), but some introspection for those people in that age range about how well their vision functions would be useful, as well as feedback and willingness to help out from the younger generations.