July/August 2018 Newsletter
ARE YOUR ARMS BECOMING TOO SHORT?
Have you noticed that you need to hold reading material further away? Can't read messages on your phone easily? Struggle to read the menu in a dimly lit restaurant? Colours do not appear as sharp or bright as they used to? No, it is not that print is getting smaller or of poorer quality, or that manufacture of light bulbs and cell phones has deteriorated, or that you are using the wrong washing powder! It is more likely presbyopia, a common vision disorder that is part of the natural aging process. Just as our bodies show signs of aging as we get older, our eyes decline in performance, too.
The lens inside the eye is elastic and changes its shape so that we can focus at various distances, depending on whether we are looking at something close up or further away. In the young eye the lens and tiny muscles surrounding it are flexible and the lens is able to change shape quickly in order to change focus. As we age, the lens becomes more rigid and is unable to change its shape as easily, making it more difficult to focus close up and to change focus rapidly. As well as this, the muscles lose their ability to control the size of the pupil effectively so that the eyes are less responsive to differences in lighting. Older people need more light for reading and tend to adapt less quickly to changes in light, for example when moving indoors from bright sunlight. Added to this, cells in the retina that are responsible for colour vision decline in sensitivity as we age, causing colours to appear less bright and the contrast between colours to be less noticeable.
Being part of the aging process, presbyopia is not regarded as a disease of the eyes, but it may be coupled with other age-related conditions of the eyes which could be more serious, particularly if they are not treated early. These include cataracts (clouding of the lens), age-related macular degeneration (gradual decrease in central vision), and glaucoma (build up of eye pressure and damage to the optic nerve). At times, floaters or flashes of light may be experienced. These are caused by changes to the gel-like liquid inside the eyes as we age, as it pulls away from the retina at the back of the eye. They are usually harmless but can sometimes indicate a retinal detachment which needs to be treated immediately. Chronic medications and certain medical conditions such as diabetes and cardiovascular disease may impact on eye health and should be controlled to prevent permanent damage and possible loss of vision.
The progress of presbyopia is gradual, and one usually becomes aware of it over time in certain situations. The signs may include blurred vision at normal reading distance, having to hold reading material at arms' length, eye strain or headaches after close work, difficulty reading in dim lighting, decreased colour sensitivity, increased sensitivity to glare, and needing time to adjust to changes in light between bright and darker areas. If you are short-sighted, you will find that you can read more easily by taking your distance glasses off, although you may have to hold things very close to see them clearly. Because presbyopia affects close up vision first, problems with seeing further away, for example on the computer, are generally noticed later. If any of these symptoms are affecting day to day activities, see your optometrist for a comprehensive eye examination. Seek immediate medical intervention if sudden changes occur, for example sudden loss of vision with or without pain, double vision, persistent floaters or flashes of light. These may indicate a more serious problem.
After a comprehensive eye examination, your optometrist will discuss treatment, the goal of which is to compensate for the inability of your eyes to focus on nearby objects. Treatment options include wearing corrective glasses or contact lenses, undergoing refractive surgery, or having lens implants.
Glasses are the simplest solution to correct presbyopia. Over the counter reading glasses are available and may be helpful for you if you had uncorrected vision before developing presbyopia, and if both eyes require the same correction. Check with your optometrist if these would be suitable. When selecting them, try different powers and test them on reading material held at a comfortable distance. If you have no other vision problems, your optometrist may suggest glasses with lenses for reading only. If you need prescription lenses for other vision problems, the alternatives are bifocals, trifocals or progressive multifocals. Bifocals have a visible horizontal line which separates the distance and reading prescriptions. Trifocals have corrections for close, middle and distance vision, which are separated by two horizontal lines. Progressive lenses have different focusing strengths for distance, middle distance and close-up work, but no obvious dividing line between them. Some people choose to have separate pairs of glasses for distance and reading and maybe also for middle distance.
People who prefer not to wear glasses often opt for contact lenses to improve the vision problems caused by presbyopia. Several options are available. Bifocal contact lenses provide both distance and close-up corrections. With monovision contact lenses, a lens for distance vision is worn in one eye, and one for close work in the other. Modified monovision involves wearing a bifocal or multifocal contact lens in one eye and one for distance vision in the other, so that both eyes are used for distance vision and one eye for reading. Because conditions like dry eye syndrome are common in older people, contact lenses may not be recommended for everyone. Your optometrist will guide you.
Surgery is an option to correct presbyopia. Your optometrist will refer you to an ophthalmologist who will discuss the different surgical options, pros and cons, and whether it is advisable for you. Refractive surgery is a non-reversible procedure which changes the shape of the cornea. Some ophthalmologists use a procedure in which they remove the lens in each eye and replace it with a synthetic intraocular lens. Several types of lens implants are available for correcting presbyopia.
Presbyopia can't be prevented but certain lifestyle factors can help to protect and care for your eyes:
- Have your eyes checked regularly, even if you feel you have no vision problems. If you use ready-made reading glasses it is still important to see your optometrist for regular eye examinations as people over 40 years of age are more at risk for eye diseases such as glaucoma and age-related macular degeneration.
- Control chronic health conditions some of which can affect vision and eye health.
- Protect your eyes from the sun by wearing sunglasses that block ultraviolet (UV) radiation. This is especially important if you spend long hours in the sun or are taking a prescription medication that increases your sensitivity to UV radiation.
- Prevent eye injuries by wearing protective eyewear when performing certain tasks, such as playing sports, mowing the lawn, or using products with toxic fumes.
- Eat healthy foods which contain high levels of antioxidants as well as vitamin A and beta carotene, which are vital to maintaining eye health.
- The right glasses optimise vision. As vision changes over time, having regular eye examinations will ensure that your prescription is always correct.
- Use good lighting.
- See your optometrist immediately if you experience sudden loss of vision in one eye with or without pain, sudden hazy or blurred vision, double vision, or persistently see flashes of light, black spots or halos around lights. Any of these symptoms may signal a serious medical or eye condition.
ICONIC WOMEN IN EYEWEAR
A perfect way to kick off Women' Month in August is to celebrate some iconic women and their signature eyewear. It is also an opportunity to raise awareness around women and eye disease. According to research, more women than men have eye diseases such as age-related macular degeneration, cataracts and glaucoma. Due to changes in the balance of hormones, women may also have vision-related issues during pregnancy, while women in the menopausal and postmenopausal age group are at higher risk for dry eye syndrome.
Renowned interior designer, Iris Apfel, believes that "if you are going to wear glasses wear glasses!" This attitude is clearly evident as the 96-year old makes a statement in the choice of all her accessories. Her love of unusual frames dates back to her childhood when she began collecting them from flea markets even before she needed to wear glasses.
BILLIE JEAN KINGWhile many professional sports men and women prefer to wear contact lenses when playing, Billie Jean King never shied away from wearing her glasses on the tennis court. A force to be reckoned with on and off the court, the 39 Grand Slam title winner could often be seen with lightweight gold titanium frames, which were presumably comfortable to wear while playing.
JACKIE KENNEDY ONASSISHer sunglasses may have initially been a way to hide from the cameras of the paparazzi, but they quickly became a recognisable element of Jackie O's sophisticated look and an inspiration to women all over the world.
AUDREY HEPBURNBoth cinematic and fashion history were made in the 1961 movie "Breakfast at Tiffany's" when Audrey Hepburn accentuated her timeless elegance with the black dress, pearl necklace and of course the famous tortoiseshell sunglasses.
RIHANNARihanna has been known to shape opinion in fashion. At the Cannes Film Festival in 2017, her all-white ensemble topped off with white sunglasses created a stir, and since then the style has been copied and worn by people from fashionistas to the man in the street.
MEGHAN MARKLEThe wife of Prince Harry and accomplished actress Meghan Markle has made a splash with her eyewear choices, which reflect her outgoing personality. The sunglasses she wore while attending the Invictus Games in Toronto with Harry became an instant fashion item and sold out in no time.
SOPHIA LORENLegendary film star Sophia Loren was the first celebrity to have an eyewear brand, and since 1980, her collection has been one of the top-selling brands to women over 40. Initially she drew attention with her sunglasses, but as she got older she wore more and more glasses with both tinted and clear lenses. Now in her 80s she continues to be a woman of unique style and elegance.
DIANE KEATONBeginning early in her career, actress Diane Keaton has always known how to use her eyewear as the perfect accessory to her singular look. Playing with glasses shapes and her layered wardrobe, Diane makes a statement that informs and inspires fashion today.
WHOOPI GOLDBERGAmong the trendsetters for round glasses is larger than life actress and comedienne Whoopi Goldberg. With her dreadlocks and habit of wearing her glasses on the end of her nose (an ‘optical crime' according to some optometrists!!), she is a powerful role model to "be yourself".
HAPPY BIRTHDAY NELSON MANDELA
July 18th would have been Nelson Mandela's 100th birthday. A visionary and man of integrity, Mandela wanted to leave a living legacy of volunteerism and service rather than one cast in concrete or marble. Mandela Day on 18th July is a global call for people to "recognise their individual power.......and help change the world for the better".
Mandela Day also celebrates a campaign known as "46664", in reference to Nelson Mandela's Robben Island prison number. The campaign was originally launched to raise awareness of HIV/AIDS. However, its focus expanded to broader humanitarian work. The efforts from Mandela Day support the campaign's ongoing work and other Nelson Mandela charitable organisations.
As much as Mandela had "vision" and a broad view of the world, his eyesight had been affected by years of smashing limestone rocks without eye protection in the quarry on Robben Island. According to his ophthalmologist, he and other prisoners on Robben Island had cataracts and tear duct damage as a result of the light and lime dust, leaving their eyes dry and prone to irritation.
Cataracts, the gradual clouding of the lens of the eye, are the leading cause of blindness worldwide. Despite this, the disease is one of the less serious eye disorders. Surgery for cataracts is one of the most common surgeries performed. It is generally painless, safe and successful, with lost vision being restored in most cases.
Mandela underwent cataract surgery in 1994, aged 75. The operation was longer and more difficult than normal due to the tear duct damage, but ultimately successful. His eyes were extremely sensitive to light, so press photographers were asked not to use a camera flash when taking pictures of him.
GIVING BACK THE GIFT OF SIGHT
Researchers at University of Newcastle, UK have been quoted as saying "a corneal transplant can give someone back the gift of sight." The cornea is the outermost layer of the human eye and has an important role to play in focusing vision. If it is not smooth or regular due to damage or scarring, vision will be impaired. To enable people to see more clearly, help reduce chronic pain or save the eye if the cornea has been perforated, a corneal graft or transplant may be recommended. For many individuals, a corneal transplant may be the only hope of restoring vision and in some cases providing vision for the first time.
A corneal transplant or graft is medicine's most successful transplant operation, with the success rate being as high as 95%. It is a surgical procedure in which part, or all, of the cornea is removed and replaced with healthy corneal tissue which comes from an individual who has donated their corneas for transplantation. Prior to transplanting the donor's cornea, it will have undergone a number of tests to make sure it is suitable and healthy, and to ensure that the recipient will not catch any form of infection from the new cornea.
With millions of people worldwide needing a corneal transplant, there is a significant shortage of corneas available to transplant. Recent research has revealed that human corneas have been 3D printed for the first time by scientists at Newcastle University, UK. The proof-of-concept research, published in Experimental Eye Research, reports how stem cells (human corneal stromal cells) from a healthy donor cornea were mixed together with alginate and collagen to create a solution that could be printed: a 'bio-ink'. Using a simple, low-cost 3D bio-printer, the bio-ink was successfully extruded in concentric circles to form the shape of a human cornea. It took less than 10 minutes to print. The stem cells were then shown to culture – or grow. The unique gel keeps the stem cells alive whilst producing a material that is stiff enough to hold its shape, but soft enough to be squeezed out of the nozzle of a 3D printer.
The scientists, including PhD student Ms Abigail Isaacson from the Institute of Genetic Medicine, Newcastle University, also demonstrated that they could build a cornea to match a patient's unique specifications. The dimensions of the printed tissue were originally taken from an actual cornea. By scanning a patient's eye, they could use the data to rapidly print a cornea that matched its size and shape.
While this exciting research highlights the significant progress that has been made, it needs to continue, and further testing is necessary. It will probably be several years before it is available to patients. However, it demonstrates the potential to combat the worldwide shortage of donor corneas and the positive impact it will have on people living with sight loss.
IT RUNS IN THE FAMILY
She has her grandmother's musical talent. He has his father's red hair and temper. She bites her nails like her mother did as a child. While some physical characteristics, personality traits and even health issues do run in families, there is ongoing debate regarding how much of who we are is due to heredity and how much is determined by our environments. It is thought that good or bad role models are just as influential as good or bad genes. Eye colour is obviously inherited, but so are certain eye conditions, although the line between genetic and environmental factors is not always clear cut. Some inherited eye conditions are present at birth, while others may manifest only later in childhood or even adulthood. Congenital eye defects are present at birth but may not necessarily be inherited.
Genes and Eye Colour
The coloured part of the eye, the iris, like fingerprints, is unique to each individual; in fact, iris scans are frequently used for biometric identification and security on certain situations. It was originally thought that eye colour was determined by a single gene, but research has indicated that the colour and intricate pattern of the iris is based on multiple genes. The colour of the human eye ranges from very light blue to the darkest brown. Blue, green/hazel and brown are the main three categories, with brown being the most common eye colour worldwide. It is always likely a child will inherit one of their parents' eye colours, or some combination of the two.
Genes and Eye Conditions
The more common eye conditions, like Myopia (shortsightedness) or medical conditions that impact on eye health can be partially attributed to genetics with environmental factors playing a role as well. Some eye conditions which have a genetic predisposition are affected and can be exacerbated by life style and the environmental elements to which one is exposed.
Cataracts, the clouding of the lens in the eye, develop over time. Largely due to aging, they may also be caused by exposure to ultraviolet light, injury or past surgery. Heredity can increase a person's risk for developing cataracts. Congenital cataracts which are present at birth occur for a variety of reasons, including inherited tendencies or factors during pregnancy.
Colour blindness, or more accurately colour vision deficiency is the inability to distinguish between certain colours, most commonly red and green. It is more prevalent in males than in females and is primarily inherited.
Dry eye syndrome is frequently one of the symptoms of diseases such as diabetes and some autoimmune conditions. It may be caused by environmental factors such as air conditioning and heaters and is sometimes a side effect of certain medications, but it has been found that genes have an impact on whether a person would be affected or not. Due to hormonal changes, it is more prevalent in women than in men.
Glaucoma is a group of diseases in which there is gradual optic nerve damage and vision loss usually due to increased eye pressure. There is a greater risk of developing open-angle glaucoma, the most common type, if there is a family history. Congenital glaucoma, which is present at birth, is thought to be inherited, but there are forms of pediatric glaucoma that are not inherited but instead caused by injury, surgery or other conditions.
As the leading cause of vision loss among older people, age-related macular degeneration appears to be inherited in a large percentage of cases, and researchers are beginning to identify the genes involved.
The most common visual disorder is refractive error, in which the shape of the eye prevents light from being focused correctly on the retina. Refractive errors include shortsightedness, farsightedness and astigmatism, and these have been found to have a strong genetic component. However, there are some significant environmental influences, such spending a lot of time reading, that are associated with shortsightedness, especially when it develops in the teens and 20s.
This malignant tumor of the retina generally affects children under the age of 6 years and is usually hereditary. If treated early, the cure rate is over 90%.
Visual conditions in children
More than 60 percent of cases of blindness among infants are caused by inherited eye diseases such as congenital cataracts, congenital glaucoma, retinal degeneration, optic atrophy and eye malformations. Certain visual conditions occur in healthy eyes. Examples of these conditions with a genetic component include strabismus (the eyes are not aligned due to the muscles not working together effectively) and amblyopia (lazy eye). Some of these are immediately apparent at birth, while others may only manifest later.
Some of the less common eye disorders and conditions that are inherited include albinism (a condition characterised by a variable lack of pigment in the eyes, skin or hair and usually associated with impaired vision), keratoconus (thinning and bulging of the cornea over time causing blurred or distorted vision), and retinitis pigmentosa (a rare progressive deterioration of the retina leading to gradual loss of vision).
Regular visits to your optometrist and controlling health conditions such as diabetes and cardiovascular disease are the key to maintaining eye health. Inform your optometrist about family history of visual or general health problems which may affect your eyes. Awareness and early detection of problems make for more effective and successful long-term management.
STUFF GETS IN YOUR EYES
When was the last time you heard someone say they're gonna write a fun and interesting article about allergies? Probably... never. So I guess in my own weird way I'm making history. And why? Because August is regarded as our windy month. And we know how wind lifts all kinds of things and blows them straight into our eyes. I probably shouldn't have raised the bar too high by promising fun and interesting things. But it's too late to go back on it now. So here goes...
Did you know that allergies are caused by the immune system making a mistake? It thinks a harmless substance like dust is dangerous, so it sends the body's defences into overdrive. Cue violent sneezing, runny nose and... yup, watery eyes. So next time you can't see because your eyes are red and twitchy, just remember it's your immune system looking out for you because it cares (even though it has a funny way of showing it...)
But things could always be worse. For example, you could be living in Knoxville, Tennessee which, according to Discovery Magazine is the Allergy Capital of the United States. Scientists have awarded this auspicious accolade to the city based on pollen count and the number of people on allergy medication. In fairness, Knoxville is also home to the majestic Appalachians and a thriving country music scene. But I wonder how they get any singing or mountain-climbing done with all that sneezing going on.
And hey, if you think you're suffering alone, dogs and cats get allergies too. In fact, the allergies they get from you can sometimes be worse than the ones you get from them. It's true – human dander is a thing. And it can affect animals, and fellow humans too.
So what to do about all this watering, swelling and itching? There are loads of home remedies, superstitions and what we like to call old wives' tales (however politically incorrect the term might be). And as part of my service, I'm not going to tell you about a single one of them. Instead, pay a visit to your eyecare professional. That's where you'll find out about prevention and treatment and all the other stuff you really need to know.
Me? I'll just keep writing articles. And I'll bet you'll never look at your cat in the same way again. For all we know, she won't look at you in the same way either.