June = Cataract Awareness Month

pexels-photo-902194.jpegContrary to popular belief, a cataract is not an eye disease, rather it is a natural age related change to the lens of the eye which causes it to become opaque and difficult to see through. Generally cataracts are very slow growing and most commonly develop in people over the age of 55. Signs and symptoms can be subtle at first, ranging from blurry vision, glare from headlights, difficulty driving at night and frequent eyeglass prescription changes. Most people come into the office complaining that their glasses are not working when in reality they are experiencing blurred vision from cataracts.

So what exactly is a cataract? There is a part of the eye called the lens which is located behind the iris, the colored part of the eye and it functions to focus light on the retina. When we are young the lens is clear and flexible but as we age the lens becomes opaque or cloudy and consequently images on the retina become blurred. Cataracts can also form in patients with diabetes, smokers, and those on certain medications like steroids. There is no proven way to prevent cataracts but UV protection, smoking cessation and a healthy diet that includes antioxidants can help prevent their premature development.

pexels-photo-690887.jpegHow do we treat cataracts? When cataracts start to interfere with quality of life and ability to function, surgical removal of the cataract is indicated. The lens of the eye is removed and replaced with an artificial lens which greatly improves vision. The most common comment I get on the first day after the operation is how bright and beautiful colors look. As with any surgery there are risks, but we co-manage surgery with the best cataract surgeons in order to ensure the best possible outcomes.

February Is Age Related Macular Degeneration Month

pexels-photo-902194.jpegAge Related Macular Degeneration (AMD) is one of the leading causes of vision loss in patients over the age of 60 in the United States.  Since February is AMD awareness month let’s talk a little about the detection, diagnosis, and treatment of this potentially visually devastating condition. The macula is the central part of the retina and if it is damaged central vision becomes impaired. There are two types of AMD, one is “dry” and one is “wet”. Dry AMD comprises roughly 90% of AMD patients and is characterized by thinning of the central retina and deposition of yellow spots (called drusen) in the macula. Although dry AMD is slow to progress and vision loss may be minimal, it can progress to a more intermediate or advanced form of dry AMD which can then progress to wet AMD. Wet AMD happens when abnormal and fragile blood vessels grow underneath the retina and then bleed (this is why it is called ‘wet’) causing destruction of the central vision. Dry AMD has no treatment per se, however there are lifestyle changes that can be taken in order to deter the progression from dry to wet. These lifestyle changes include smoking cessation, UV protection such as sunglasses, and ingestion of nutrients such as lutein and zeaxanthin in foods such as spinach or kale or in a vitamin supplement. Wet AMD is treated with drugs that are delivered into the vitreous (inner jelly like portion of eye) and go under the the broad umbrella term of “anti-VEGF” agents. Laser treatments and PDT (photodynamic therapy) are other treatments utilized in wet AMD.

blur-close-up-focus-906055Symptoms of macular degeneration include blurry vision, darkening of vision, loss of color vision and visual distortion. Once the central vision is lost, there is no way to restore it and low vision devices such as telescopes and magnifiers can be helpful to maximize the remaining vision. Early detection of AMD is crucial in order to preserve central functional vision which is why yearly eye exams are so important.

Is Diet Soda Bad For Diabetics?

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We know that excess sugar is bad for diabetics so patients with diabetes turn to foods with artificial sweeteners to get that burst of sweetness without the dangers of sugar. A recent study in the journal Clinical and Experimental Ophthalmology has reported a linkage between diabetics who drink more than four cans of diet soda and the development of the blinding complications of diabetic retinopathy (severe leakage of blood vessels in the eye). It was not associated with the development of the less severe eye complications of diabetes or macular edema which is swelling in the central part of the eye.

This study is pretty scary. Diabetics rely on these artificial sweeteners on a daily basis to keep them safe from sugar and here is a study that says that these sweeteners can cause severe eye complications. Now what? This research is very new and the results have to be repeated in order to make definitive decisions about cutting sweeteners out of a diabetics diet. A confounding factor in the research also notes that people who consume a lot of artificial sweeteners also have a higher body mass index (they weigh more) as well as a worse cardiovascular profile. In other words, more studies are needed.

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So if I am diabetic and drink a lot of diet soda what do I do now? Admittedly this is a tough call. It would probably be wise to cut down the consumption of diet soda and try to switch over to water and stay tuned for further studies to be done.

What Do You Mean My Kid Needs Glasses??!!

pexels-photo-914931.jpegThe other day the cutest little girl came in for her first eye exam. She was starting third grade and was an excellent student reading above grade level. Her parents were sure she didn’t need glasses but thought it was time for her to start having routine eye exams. She was articulate and outspoken and wanted to be done with her visit so she could get on with her day. She read the eye chart in her right eye all the way down to the tiniest letter and was eager to do the same on the left eye. To everyone’s surprise she struggled, barely getting down to the second to last line, guessing and growing frustrated as she realized something wasn’t right. She also had some trouble seeing in 3D which indicated that her two eyes were not working together. At the end of the exam I told her parents that although her right eye was perfect she was hyperopic, or farsighted in her left eye and the large discrepancy between the two eyes had created amblyopia (lazy eye) in that left eye. She left with a new pair of glasses and a follow-up appointment in three months.

80% of learning is visual – if your child does not see well he or she will not do well in school. Sometimes kids are unable to realize or articulate that something is wrong – either they will think that whatever they are experiencing is normal or they just won’t complain. Vision screenings at the pediatrician are not a substitute for a full and comprehensive eye exam. Eye exams are recommended at the age of six months (by specialized infantsee providers) and subsequently yearly after the age of three. Early use of iPads and other digital devices creates a new challenge for children’s developing visual systems and seeing well involves more than just seeing 20/20 on an eye chart. Evaluation of tracking, eye teaming and convergence are crucial to ensuring optimal ocular performance and subsequent academic success.

kids-girl-pencil-drawing-159823.jpegThis little girl and her family were lucky that she was doing so well in school despite her amblyopia and suboptimal visual system. Don’t wait until your child complains or you get a note sent home from the school nurse or your child’s teacher – book your childs yearly exam now before the school year gets underway.

Are video games bad for your eyes?

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The president of China, Xi Jinping, seems to think so. The Xinhua News Agency came out with an article this past week that stated that since the “vision health of our country’s young people has always been a great concern” to Xi Jinping, the country is going to start limiting the number of new online video games available for sale. A recent study found that there was a 12% prevalence of myopia (or nearsightedness) in first grade children, a number that jumped to 67.4% by seventh grade. Excessive reading and/or prolonged near point work has long been a contender in the lineup of reasons for why nearsightedness develops, and the Chinese have glommed onto the specific near point activity of gaming as an activity to limit in order to curtail the myopic epidemic.

There are many theories as to why myopia develops, and there is no one culprit to blame. Genetics play a role as does lack of spending time outdoors and near point stress from prolonged reading as well as the digital world that we now inhabit. Doctors are reluctant to blame any one thing for the development of myopia and many do not agree with China’s video game restriction. Instead of totally banning video games, parents should rather limit screen time and encourage their children to play outside. Kids (and adults) should also be encouraged to follow the 20/20/20 rule – every twenty minutes, look twenty feet away for twenty seconds. As you can imagine gaming industry stock dropped in response to China’s announcement….

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