Protecting Your Vision and Overall Eye Health
by Taylor Arnold
It can be easy to overlook routine eye care, especially if you are already seeing clearly. But regardless of the current state of your vision, it is important to be aware of common vision problems as we age. From difficulty reading fine print to more serious disorders like macular degeneration and glaucoma, knowing what's normal (and what's not) can help you maintain strong eye health.
How Your Eyes Change Over Time
"Eyes develop fastest in the first decade of life," explains Dr. Takeia Locke of Family Eye Care Center. "This is when it is most important to begin good habits for prevention of vision problems later on." During these years, she suggests proper UV protection, good reading posture, a diet rich in zinc, vitamin A and lutein, and avoiding prolonged time in front of a computer.
"Slower changes occur up through age 40, so maintenance is key during these decades," she says. "During the 50s and 60s, the lens begins to lose its focusing ability for reading, therefore, most people by age 50 will be diagnosed with presbyopia." Hormonal changes and systemic diseases may impact your eye health as well, causing dry eye, early cataracts, macular degeneration and many other vascular changes.
"In the 50s and 60s, the lens becomes hazy, or cataract," says Dr. Niraj Desai, a cataract, cornea and refractive surgeon at Milan Eye Center. "With the eye itself, properties change, so even if you don't have cataracts, it can still be more difficult to drive at night. The retina can also change over time and degenerate." During the golden years, most vision-threatening conditions do not have early symptoms, so by this point annual eye exams are crucial.
A Glimpse Into Your Family History
Many vision diseases are genetically linked, so knowing your family history will guide your care. Personal health history such as smoking and high cholesterol impact the eyes as well.
"Vascular disorders like diabetes, high blood pressure and high cholesterol really affect the eyes," Dr. Desai says. "In the back of eye, you can have swelling of the retina, which steals your vision very quickly. That's why it's important to have routine exams of the retina, because diabetic eye disease can happen even if diabetes is well controlled."
A family history of diseases like keratoconus can predispose you as well, even though there may be varying degrees of severity among affected family members. "Diseases of the retina, such as macular dystrophies and retinitis pigmentosa, are most often hereditary in nature," explains Dr. Richard Pare of North Fulton Eye Center. "Even some forms of retinal detachment and optic nerve disorders such as glaucoma have a strong hereditary propensity."
In cases where these genetic defects are already known, a patient's risk for disease can be determined with genetic testing. "In any case, an individual with a family history of known eye disease or unexplained blindness would be well advised to have regular, complete eye examinations including a dilated exam of the back of the eye," Dr. Pare says. "Healthy adults should obtain a comprehensive baseline eye examination by age 40. Those with family history of eye disease should begin comprehensive screening exams in their twenties. With early detection, many hereditary eye diseases can be prevented or successfully treated."
Looking Out For Your Eyes Today
"The main environmental factor that affects our ocular health is sun exposure," Dr. Pare says. "Heavy or sustained exposure to ultraviolet light can accelerate formation of cataracts and possibly macular degeneration."
Wearing sunglasses is one of the easiest ways to protect your eyes. "You wear sunscreen for skin, and it's the same principle for the eyes," Dr. Desai says. "Exposure to UV radiation can cause pterygium or pinguecula, which is sunlight-related damage to the white part of the eye."
A colorful diet can do wonders for maintaining your eye health too. "Eat a diet heavy in greens, and go for more pigmented fruits and vegetables, as these can slow down premature aging of eyes," Dr. Desai says.
The Latest Treatment Options
Beyond Lasik, a new surgical option for restoring vision is a clear lens exchange. "The natural lens of the eye is removed before it forms a cataract, and an implant is placed into the eye that allows the patient to see both near and far," Dr. Desai explains. "Lasik only corrects distance – the near vision isn't corrected, so people still have to wear glasses to see up close. With a lens exchange, the artificial lens gives people the ability to see far and near."
Traditionally cataract surgery has been done manually, but today more practices are turning to the laser. "," Dr. Desai says. "With laser, there is more precision, so it is safer. Implants are becoming extremely sophisticated and complex, and they work best when done in an exact fashion." Laser is also cutting down the recovery time from cataract surgery to one week. "The cost difference is patient-specific depending on implants they pick, but not very much," he says.
And today patients have more options than ever when it comes to selecting their implants. "There are numerous lens implants on the market that allow people to have more freedom from glasses and contacts," says Dr. Susanne Hewitt of North Fulton Eye Center. "There are multifocal implants such as Alcon's Restor and Abbott's Tecnis, and accommodating implants such as Bausch & Lomb's Crystalens, that allow people to be significantly less dependent on their distance and reading glasses after lens replacement/cataract surgery. There are several toric implants that correct astigmatism at the time of lens replacement as well. Also, people who have been successful with monovision with contact lenses can achieve this effect after lens replacement surgery to become less dependent on readers."
Common Eye Conditions
Presbyopia - This is the lack of ability to focus up close and affects such tasks as reading, computer use, cell phone use or any task within arm's length. It is caused by the thickening and hardening of the crystalline lens and can be corrected with reading glasses, multifocal glasses, contact lenses or clear lens exchange.
Droopy eyelids - These are usually caused by ptosis or dermatochalasis. Ptosis can be caused by the age-related weakening or stretching of the major muscle that lifts the eyelid called the lavation muscle. Dermatochalasis is an age-related decrease of skin elasticity, allowing the skin of the eyelid to loosen and sag. When there is a loss of vision associated with droopy eyelids, insurance usually covers the blepharoplasty surgery, which involves the removal of excess skin and fat causing the drooping of the eyelids.
Dry Eye Syndrome - This occurs when the eye does not produce a sufficient amount of tears, or when the tears are not of the proper consistency to wet the eye normally. Treatments include prescription eye drops, over-the-counter drops, surgical cautery or silicone plugging of the tear drainage canals to slow down the drainage of tears into the nasal canal.
Flashes and floaters - These are caused by the liquefaction of the vitreous gel located deep within the eye. They can also occur when the vitreous capsule detaches from the retina. Floaters can be annoying but are usually not a cause for alarm and are a natural consequence of age. Flashes of light can be a more serious symptom caused by retinal detachment, migraine headaches or a by product of the vitreous merely pulling on the retina.
Cataracts - A cataract is a clouding of the lens of the eye, which causes decreased visual acuity. The lens of the eye is made of proteins arranged in a precise manner, but as we age, the proteins can clump in a random manner, rendering the lens opaque instead of transparent.
Macular Degeneration - The macula is the center of the retina, and this tissue can break down with age, causing a loss of central visual acuity. The two main types are classified as dry and wet macular degeneration. There is no real curative treatment for dry macular degeneration, but a healthy diet and nutritional supplements can slow its progression. Wet macular degeneration is characterized by hemorrhages in the macula area that can cause permanent vision loss. This is treated by injecting therapeutic agents into the back of the eye that reduce abnormal blood vessel growth and subsequent bleeding. New genetic tests can predict the likelihood of developing macular degeneration.
Glaucoma - This disease is characterized by progressive damage to the optic nerve inside the eye and is usually associated with an elevated intraocular pressure. It often has no symptoms during the initial stages, and only a qualified eye doctor using advanced diagnostic equipment can diagnose it during the early phases. The first sign is often the loss of peripheral vision, but as the disease progresses it can lead to blindness.
— Information courtesy of optometrist Dr. Alan Hymowitz
Over 40 Eyes
It's an exciting time for patients over 40, particularly now that presbyopia can be managed with clear lens exchange surgery and with increasingly accurate digital lenses. "Lens materials are getting thinner and more lightweight, so comfort should not be an issue," Dr. Locke says. "Now we even have contacts targeted for early or emerging presbyopes (age 40-50)."
According to Dr. Pare the use of oral antioxidants or "eye vitamins," is gaining popularity as well. "Their effects have demonstrated a slowing of the progression of macular degeneration, but their ability to actually prevent eye disease is less understood and less demonstrated with controlled clinical trials."
Most experts still agree, however, that glasses are the gold standard for improving vision non-surgically. "Decreasing near vision after age 40 is caused by physiologic changes to the lens inside the eye and the muscle that works to change the focus power of the lens," Dr. Pare says. "While it is problematic for most people, it is rarely due to any pathologic condition. Some oral medications can exacerbate this condition, but it is most often addressed with the use of reading glasses or bifocals."
Dr. Niraj Desai – Milan Eye Center, www.milaneyecenter.com
Dr. Susanne Hewitt and Dr. Richard Pare – North Fulton Eye Center, www.northfultoneyecenter.com
Dr. Alan Hymowitz – Eye Haven of Atlanta, www.eyehaven.com
Dr. Takeia Locke – Family Eye Care Center of Atlanta, www.familyeyecareatlanta.com