During March we take time to remind Americans of the importance of eye health and comprehensive eye examinations. Eye health and vision care must be viewed as a national priority according to the National Academies of Sciences, Engineering and Medicine (NASEM). In their report NASEM stated that vision is tied to the health of this nation. The report estimated 142 million Americans over age 40 experience vision problems. Between 8.2 and 15.9 million people have a correctable visual disability attributable to uncorrected refractive error. Research bears out the importance of healthy vision to children, so they can learn and develop to their full potential in life, and to adults, who are more productive at work and more socially engaged with the world around them. Spread the word and remind people to get their eyes examined!
Light emitted by the sun and personal electric devices contain significant amounts of high-energy, short-wavelength blue light. Ultraviolet (UV) light contains more energy than blue light but is it absorbed by the cornea and lens thus limiting retinal exposure. Visible blue light may potentially be harmful to the retina after extended exposure. Children may be at a higher risk for blue light retinal damage than adults because the juvenile lens absorbs less short-wavelength light than the adult lens allowing more blue light to reach a child's retina. After a life time of exposure the risk of cataracts and macular degeneration is increased. At this time, the long term consequences of blue light exposure in children is not well understood. All children should have sun protection in the form of dark sunglasses that filter UV light to reduce any risk of retinal and eye damage.
Although the light emitted by personal electronic devices is not bright enough to damage the retina it is able to alter the circadian rhythms that affect sleep and degrade sleep quality and impair alertness the following day. Therefore, it is recommended to limit the use of personal electronic devices before bedtime especially in children.
(excerpted from Winter 2017 Eye on New Jersey)
These are the top ten sports for eye injuries:
1. Water & Pool Activities
3. Guns, Darts, Arrows, Slingshots
7. Health Club - Exercise/Weight-Lifting
8. Other Sports and Recreational Activities
10. Racquet Sports
The average child between the ages of 0 and 8 spend about 58 minutes daily watching television and 48 minutes daily engaging with a mobile device in the US. Since electronic devices are not going away the key is to use them in moderation. While the TV watching time is down by 11 minutes a day compared to 6 years ago in that age group the average screen time for mobile devices is up by 43 minutes daily.
In a survey, "The Common Sense Census: Media Use by Kids Age Zero to Eight 2017" other noteworthy findings include:
- 49% of parents report their kids watch TV, videos or play video games in the hour prior to bedtime and have these devices in their rooms despite a recommendation from the American Academy of Pediatrics that advise against it.
- 67% of parents believe their children learn from screen media though they are concerned about the violence, sexual content and advertising their children see.
- 43% of children under two are not read to on a daily basis despite a contrary recommendation from the AAP that they should be read to from infancy.
"The results are grounds for concern", says Dr. Glen Steele, a professor of pediatric optometry at Southern College of Optometry in Memphis, Tennessee. "It is a significant concern that device use is increasing so rapidly. The use of mobile devices requires more sophisticated visual function to participate.
The young visual system is not prepared for this type of sustained activity but it is socially compulsive; all their friends are doing it. When they force themselves on through the discomfort, secondary vision problems are created particularly in focusing. We do know that visually, the child must defocus in gaming. This potentially reduces the child's ability to sustain near-focus activities, such as reading when they are younger."
Prolonged smartphone use also has been linked to dry eye underscoring the need for routine comprehensive eye examinations on a yearly basis. Doctors of Optometry and parents have a role in monitoring use and supporting children's visual development. Doctors can inform parents about the "20/20/20 rule"; take a 20-second break every 20 minutes and look at something 20 feet away. Looking at screens for long periods of time, causing near-point stress can lead to headaches, blurriness, and eyestrain and can distract children from the typical visual development needed for traditional classroom activities.
An estimated 1 in 5 preschool children have vision problems and 1 in 4 school-age children wear corrective eye wear in this country. Because eye and vision problems in children have become a significant public health concern the American Optometric Association has released new guidelines for pediatric eye care. The new guideline is designed to increase awareness of the importance of checking children's eye health at all ages. It is important to educate patients and their caregivers about eye health and the importance of frequent exams. Early detection and prevention are key because the visual system is developing in early childhood. There is no substitute for an in-person comprehensive eye exam that can lead to prevention or a timely diagnosis and treatment. If you can catch certain eye conditions and diseases early in the course of their lives, you can really change children's lives. If a child isn't functioning well visually, it can impact his or her performance in school and impact his or her behavior, future goals and even the kind of work he or she will do as an adult.
Managing age-related macular degeneration (AMD) is a significant focus for primary care optometrists. With an early diagnosis, OD's can take potentially life-altering steps long before patients hit the intermediate stage and are forced to struggle with vision loss. The longer clinicians can keep patients from advancing to wet AMD and needing injections, the better off they will be.
In a recent study, subjects with impaired dark adaptation were twice as likely to develop clinically evident AMD and eight times as likely to advance beyond the earliest stage of AMD. Usually expressed as "night vision difficulties" impaired dark adaptation is often among the first detectable consequences of AMD and a method of identifying patients with potential sub clinical disease.
Many changes to an AMD patient's lifestyle can help avoid further central vision loss and retinal damage. Once diagnosed with early AMD, optometrists can encourage patients to take the following steps:
- More frequent examinations. Moving from a 12 to a six-month follow-up interval is useful for monitoring disease progression.
- Stay healthy. Following a healthy diet, exercising regularly and maintaining overall health are sound goals for all patients. One study found that women who followed a healthy diet, engaged in physical exercise, and avoided smoking had a substantially lower risk of early AMD compared with women who did not follow these healthy lifestyles. A Mediterranean diet is another consideration, as studies suggest those who consume a Mediterranean-style diet carry an overall lower risk of developing advanced AMD compared with those who regularly consume a traditional Western diet.
- Advocate for an active lifestyle.
- Recommend supplements and blue light-blocking lenses.
- Timely referral to a retinal specialist.
With an earlier diagnosis, optometrists can do more than let AMD run its course and eventually rob patients of their sight.
Excerpted from Dr. Jeffry Gerson, OD Review of Optometry September 2017
There's no substitute for the quality of life good vision offers. Adding certain nutrients to your daily diet—either through foods or supplements—can help preserve your vision. Researchers have linked eye-friendly nutrients, such as lutein and zeaxanthin, vitamin C, vitamin E and zinc, to reducing the risk of certain eye diseases.
Lutein and zeaxanthin are important nutrients found in green leafy vegetables, as well as other foods, such as eggs. Many studies show that lutein and zeaxanthin reduce the risk of chronic eye diseases, including age-related macular degeneration and cataracts.
Vitamin C (ascorbic acid) is an antioxidant found in fruits and vegetables. Scientific evidence suggests vitamin C lowers the risk of developing cataracts. Also, when taken in combination with other essential nutrients, it can slow the progression of age-related macular degeneration and visual acuity loss.
Vitamin E is a powerful antioxidant found in nuts, fortified cereals and sweet potatoes. Research indicates it protects cells in the eyes from unstable molecules called free radicals, which break down healthy tissue.
Fats are a necessary part of the human diet. They maintain the integrity of the nervous system, fuel cells and boost the immune system. Research shows omega-3 fatty acids are important for proper visual development and retinal function.
Zinc is an essential trace mineral or "helper molecule." It plays a vital role in bringing vitamin A from the liver to the retina in order to produce melanin, a protective pigment in the eyes. Zinc is highly concentrated in the eye, mostly in the retina and choroid, the vascular tissue layer lying under the retina.
Today's cataract patients are on the go. Many are still working and having good vision is essential to helping them stay active and involved. Patient satisfaction with cataract surgery hinges on gathering accurate lifestyle information and matching it with clinically appropriate surgical options. Truly successful outcomes, as measured from the patient's perspective, simply cannot be achieved without knowing the patient's lifestyle and individual visual demands.
Most patients have very little knowledge of the types of IOLs (intraocular lenses) available to them. Patients often understand they have astigmatism but they don't know what their choices are to compensate for it with IOL selection. Addressing astigmatism is a key aspect in providing a true refractive correction as part of the cataract procedure. Toric (astigmatic) IOLs correct two eye conditions; cataracts and astigmatism. Toric IOLs deliver crisp, clearer distance vision and may reduce dependence on glasses to see at a distance. Toric IOL's are proven to deliver the highest quality visual outcome versus a basic lens option.
Without complete and successful treatment of astigmatism, the goal of achieving excellent uncorrected distance vision and reducing spectacle dependence for distance vision cannot be met.
Alcon's new consumer campaign at mycataracts.com helps to explain the concept that correcting astigmatism at the time of cataract surgery is like getting two birds with one stone. Alcon's "My Cataracts" YouTube channel also helps to deliver the demand for online learning. The "Two Birds" educational video has already surpassed 1.6 million views. The new My Cataract call center (1-844-MYCATARACT) allows patients to communicate on their own terms. This patient call center is staffed with dedicated, trained cataract counselors and offers a best-in-class patient experience.
We need to engage patients early and often to ensure that we make a positive impact on the patient's final choice and enable them to feel prepared to make what is for the majority of people a once in a lifetime decision.
Article excerpted from Review of Optometry May 2017 David Geffen, OD
Last month we talked about the impending solar eclipse on August 21, 2017. This month we will talk about ways to safely view the eclipse without hurting the eye or retina.
Only a small sliver of the US will experience a total solar eclipse-the sun's complete occlusion by the moon-so the vast majority of viewers will need special solar filters or eclipse glasses to view the partial eclipse. Solar filters or eclipse glasses are a must as along as the sun's face is visible. An indirect way to view the eclipse is with a pinhole projector.
To make a pinhole "camera":
- *2 pieces of white card stock
- *aluminum foil
- *pin or paper clip
- Cut a square hole into the middle of one of the pieces of card stock
- Tape aluminum foil over the hole.
- Poke a hole in the foil.
- Place the second piece of card stock on the ground in a shadowed area. Stand with the sun BEHIND you and hold the card stock with the aluminum foil (foil facing up) above it. View the projected image on the card stock below. The farther away you hold the pinhole card the bigger the projected image will be (jpl.nasa.gov/edu/learn).
An eclipse is a cosmic solar billiard shot- the Sun, Moon, and Earth line up to reveal the Sun's atmosphere; it's Corona. Eclipses on Earth occur only because of an amazing celestial coincidence. For more information visit greatamericaneclipse.com.
On August 21, 2017 a solar eclipse will envelope the nation for 2-3 hours, while a small, 70 mile sliver from Salem, Oregon to Charleston, SC will experience a total solar eclipse for the first time since 1979. Dubbed "The Great American Eclipse" this eclipse is noteworthy for its cross-country path of totality that will be visible from most Americans' backyards. However, watching a solar eclipse isn't as simple as looking skyward. Looking directly at the sun is unsafe except during the brief totality. And that only happens in a small area. Consequently, while millions can -and will- watch the eclipse, not all are aware of how to safely do so.
Solar retinopathy, or photic retinopathy, can occur when a person stares at the sun, causing retinal tissues to be damaged at the fovea, and resulting in a mild-to-moderate visual acuity deficit and central or paracentral scotoma. Captain Tyson Brunstetter, OD, PhD, a U.S. Navy doctor working with NASA says the single greatest risk to viewing a solar eclipse comes from nonionizing (low energy) radiation, the visible and infrared light that easily passes through the eye and is focused on the retina. The ramifications of improperly viewing a solar eclipse can be immense and permanent and because there are no pain receptors in the retina, this damage can occur without any sensation of pain.
The only safe way to look directly at the uneclipsed or partially eclipsed sun is through eclipse glasses or filters.
Stay tuned next month on DIY indirect viewing devices.
--Information for this article from Myron Wasiuta, OD, AOA Focus magazine, May 2017