September/October 2018 Newsletter
HOW OFTEN SHOULD I CHANGE MY GLASSES?
Unless our glasses break or we notice changes in our vision, we wear the same pair of glasses for years without giving a thought to whether we need new ones. Although we think we can still see clearly, vision changes over time, typically becoming worse. There may be small and subtle changes so gradual that we are barely aware of them. So, how often should we have our eyes examined? How often is it necessary to consider new glasses? There is no simple answer to this question. Some people may have to change their prescription frequently, while others may not need to for many years. As a general rule, it is recommended that adults over 16 years of age have their eyes tested every two years and those over 70 once a year. Your optometrist is the best person to advise you and make a judgement as to whether your glasses need changing or not.
If you feel that you see perfectly with your current glasses and are not experiencing any problems, why is it necessary to visit your optometrist regularly? Prescriptions change over time. If you are wearing an outdated prescription you may be causing unnecessary eyestrain that could easily be prevented. Factors such as minor damage to the lens and misalignment of your glasses have a role to play in compromising your vision. Lens technology is constantly improving, offering better options for effective vision. Certain eye conditions develop gradually, with symptoms being noticed when the condition is quite advanced. With regular eye examinations your optometrist will assess your general eye health and detect problems before you are aware of them. The earlier certain conditions are diagnosed, the sooner they are managed, and the better the prognosis.
At times there are signs that may alert you to the fact that you need to see your optometrist and possibly purchase new glasses. Recurring headaches are one of the earliest signs that there may be vision changes. While you may not notice the slightest change in your vision, the brain may recognise it and try to correct the problem, often resulting in headaches. People who are shortsighted typically experience headaches in the front of the head or over the eyebrow, and people who are farsighted tend to experience headaches after looking at things closely for an extended period of time.
Squinting is a natural way to attempt to improve focus and clarity, and you may not even realise you're doing it until you experience eye strain or a headache. Increased squinting, whether while reading, working on the computer or looking into the distance, is probably an indication that your prescription needs updating. If your eyes are constantly feeling fatigued or strained, you may be experiencing one of the clearest signs that your vision has changed. Eye fatigue can be caused by a number of factors, including lack of sleep, seasonal allergies and extended periods of time reading or working on the computer. These should be relieved fairly easily, but ongoing eye strain or fatigue usually means a new prescription may be necessary.
Blurred vision may or may not necessitate new glasses, but a visit to your optometrist is advised to determine whether it is due to an old prescription or a symptom of an eye condition that requires further assessment.
Children, just like adults, need regular eye examinations. As children grow, so do their eyes, and subtle changes in vision may occur. Vision is subjective, so a child is unaware that he sees differently from others and may not be seeing as clearly as others do. Parents and teachers may be the ones who pick up tell-tale signs such as squinting, holding a book close to the face, or complaints of eye strain or headaches after doing close work. As the child progresses through school visual demands increase with more reading, computer work or longer hours spent doing homework. If the child's vision is not as clear as it should be other problems may arise, including negative attitudes to school and school work.
If the child wears glasses, parents need to be alert to issues such as scratched lenses, bent frames or poorly fitting glasses, all of which can contribute to compromised vision. Children are often less careful with their glasses than they should be, so they might need to visit their optometrist based on their visual needs rather than on the calendar!
AN APPLE OR AN ORANGE A DAY?
The well-known adage that "an apple a day keeps the doctor away" may have to share its place in the sun as new research indicates that oranges may have a role to play in reducing the risk of macular degeneration. Macular degeneration is a group of retinal eye diseases characterised by progressive loss of central vision eventually leading to blindness if not detected and treated early. It is a leading cause of blindness worldwide. Researchers at the Westmead Institute for Medical Research in Australia analysed the relationship between diet and age-related vision impairment and found that regular consumption of oranges stood out as significantly helping to reduce the risk of macular degeneration. People who ate one to two servings of oranges a day had a 60% reduced risk of macular degeneration. While the research is still in its preliminary stages and needs to continue, these early findings are exciting.
Surprisingly, the researchers believe that it was not the vitamin C in the oranges that produced these results, but rather the flavonoids. Flavonoids are a diverse group of plant chemicals found in almost all fruits and vegetables as well as in other foods and beverages. They are powerful antioxidants which have been linked to anti-inflammatory boosts for the immune system and work to protect the eyes in the same way as they protect other areas of the body. Flavonoids are thought to fight the harmful free radicals which can damage a cell's DNA and may trigger a variety of diseases. Another interesting finding was that there did not appear to be a relationship between other food sources protecting the eyes against macular degeneration, although the research team examined common foods containing flavonoids, such as green tea, apples and red wine.
According to Bamini Gopinath, this study doesn't prove that oranges can ward off macular degeneration, but the link is a strong one, indicating the possibility that one day oranges could form the basis of a preventative treatment. She advocates a healthy diet in general with oranges as part of it. Eating a varied diet that includes lots of fruits, vegetables, and lean proteins is enough to ensure that most people get the essential nutrients for eye health. A healthy diet protects the eyes and can reduce the risk of age-related eye conditions. People who cannot get these nutrients from their diet or who are on restrictive diets should seek advice about eye health supplements.
Fish, particularly oily fish such as salmon, tuna and sardines, provides omega-3 fatty acids, which some studies have found to aid in dry eye syndrome. Nuts, legumes and seeds, also rich in omega-3, contain a high level of vitamin E which can protect the eyes from age-related damage. Vitamin C-rich citrus fruits are excellent sources of antioxidants. As well as being a good source of vitamin C, leafy green vegetables are rich in lutein and zeaxanthin which protect the eyes against the damaging effects of sunlight and air pollution and help to filter out harmful blue light. Carrots contain beta carotene and vitamin A which plays an essential role in the effective functioning of the eyes. The eyes contain high levels of zinc which has been linked to long-term eye health and is found in beef. Eggs are an excellent source of lutein and zeaxanthin, as well as vitamins C and E and zinc. Water is as vital for eye health as it is for the general hydration of the body.
NATIONAL NUTRITION WEEK (9th to 15th October)
is a good opportunity to become aware of the
important foods for overall health and eye health.
EVERYTHING LOOKS FUZZY!
Do you often find yourself squinting, blinking or rubbing your eyes to clear your vision because everything looks blurred or fuzzy? Blurred, unclear vision is a very common problem, with the causes ranging from the need for new glasses to a more serious health condition. It may be temporary or permanent and may worsen over time. Blurred vision is usually not of major concern and, depending on the cause, can be treated relatively easily. However, sudden changes in vision especially if they are accompanied by other symptoms may signal something more serious and should be dealt with immediately. It is always advisable to investigate blurred vision so that the cause, whether serious or not, can be addressed and dealt with.
Refractive errors are the result of the eyes being unable to focus effectively and are the most common causes of blurred vision. Shortsightedness (myopia) is a condition in which one is able to see close objects clearly but objects further away appear unclear. With farsightedness (hyperopia) close objects are blurred while objects further away are seen clearly. Astigmatism is usually caused by an irregularly shaped cornea which does not allow light coming into the eye to focus in a single point on the retina, leading to blurred vision at various distances. Refractive errors are easily corrected by corrective lenses in glasses or contact lenses. As a more permanent solution refractive eye surgery is an option. Discuss the most suitable option with your optometrist.
Presbyopia is a naturally occurring condition which affects most people as they age and begin to have difficulty focusing close up. Reading glasses generally resolve this issue effectively. However, if you have presbyopia as well as another refractive error, your optometrist will guide you with regard to solutions including bifocals, multifocals, progressive lenses or contact lenses.
Blurred vision can be one of the symptoms of eye infections such as conjunctivitis ("pink eye") or herpes. Wearing contact lenses for longer than prescribed or sleeping with contact lenses in can lead to tiny scratches on the cornea and a build-up of microorganisms which increase the risk of developing eye infections and may lead to blurred vision. Treatment such as eye drops or ointments are usually helpful. Conjunctivitis spreads extremely quickly so strict hygiene is vital.
Cataracts are a common condition of the eyes which are typically associated with aging, although can occur in infants. The lens of the eye becomes cloudy over time, gradually blocking light from reaching the retina and resulting in blurred vision, sensitivity to glare and halos around lights. Surgery to remove cataracts is one of the most successful operations in medical practice. Your optometrist will monitor the growth of the cataracts, referring you to an ophthalmic surgeon when it becomes necessary.
Glaucoma, another age-related vision condition, is usually caused by increased pressure in the eye, eventually leading to damage of the optic nerve and loss of vision. Like cataracts, glaucoma is usually slow to develop and the symptoms are not apparent until the condition is quite advanced. The best way to prevent glaucoma is to have regular eye examinations. Glaucoma cannot be cured and vision loss cannot be reversed but once it is detected medication, laser treatment or surgery are the management options.
DRY EYE SYNDROME
Dry eye syndrome can affect the eyes in numerous ways, including causing blurred and fluctuating vision. One way to relieve the symptoms of dry eye syndrome is by using artificial tears like lubricating eye drops. More advanced cases might need a prescription medication or punctal plugs to keep the eyes lubricated and healthy.
Not simply a "bad headache", a migraine is typically accompanied by a variety of symptoms including blurred vision, sensitivity to light and flashes of light, which sometimes precede the pain and may last until it is over. This condition needs to be medically managed.
Pregnancy is usually associated with symptoms such as morning sickness, backache and fatigue. Blurred vision may occur due to hormonal changes and changes in sleep patterns in which case it should disappear after the baby is born. However, it may be due to something more serious and should be reported to your doctor.
Optometrists are often the first professionals to detect diabetes because its effects on the eyes occur without one being aware of them until late in the disease process. Diabetes increases the risk of diabetic retinopathy, a condition in which the tiny blood vessels in the eye are damaged leading to leakage of blood, swelling on the retina and the growth of new unwanted blood vessels. Along with blurred vision, there may be floating spots in the field of vision, and diabetes has been linked to development of cataracts earlier than normal. Early diagnosis, control of blood sugar levels and regular eye examinations are the best way to ward off permanent damage.
Extremely high levels of blood sugar can lead to swelling of the lens and intermittent blurring of vision. Accompanied by other symptoms such as excessive thirst and frequent urination these levels may signal the onset of diabetes. Check your blood sugar levels and make an appointment for a consultation with your optometrist.
HIGH BLOOD PRESSURE
High blood pressure can be one of the causes of stroke which, among other characteristic symptoms often leads to changes in vision. It may also cause a mini stroke in the eye, which results in blurred vision but is painless and usually affects only one eye.
Whether blurred vision is an early symptom or develops later, it is generally one of the symptoms of progressive neurological conditions such as multiple sclerosis and Parkinson's disease, among others. It is always one of many other characteristic features which need to be managed by medical specialists.
WHEN TO SEE A DOCTOR
Fortunately, most of the reasons for blurry vision don't threaten eyesight and can be effectively dealt with. But there are times when medical intervention should be sought immediately. These times include sudden changes in vision, vision loss in one area of the visual field and pain in the eye.
MISTER SANDMAN BRING ME A DREAM
The magical character who sprinkles fine grains of sand into our eyes to induce sleep first appeared in a story by Danish writer Hans Christian Andersen. The Sandman occurs repeatedly in folklore across the world, interpreted differently from stories to word of mouth, literature to film, and even to popular songs. While Andersen's Sandman was kind and told beautiful stories to children as they slept, some other versions of him are more sinister. In 1993 Paul Berry's short film "The Sandman" was nominated for an Oscar for Best Animated Short Film. In USA, the Sandman was used in a TV advert to "hypnotise" people into buying mattresses. Legend has it that the sand prevents the eyes from opening until morning so that children will have a good night's sleep. Upon waking, many people need to wipe away the grit that is often left in the corners of the eyes, "proof" of the Sandman's night-time visit.
What is the substance that remains in the corners of the eyes and why is it there? It is called rheum, a thin mucous naturally discharged from the eyes, nose or mouth during sleep, and gathering as a crust in the corners of the eyes and mouth, and along the eyelids. Just like the mouth and inner nose, the outer layer of the eyes functions best when wet. The eyes are kept moist by a thin layer of tear film made up of water, mucous and oil produced by the meibomian glands in the eyelids. The oily meibum has numerous functions: as well as preventing the tear film from evaporating and the tears from streaming downwards, the moistness helps to focus incoming light by keeping the cornea smooth.
When we are awake, blinking of the eyelids causes rheum to be flushed away with tears via the nasolacrimal duct. When we close our eyes for a long night's sleep, the tears continue to wash over the eyes as they move around during different sleep phases. The tears pick up dust, dead cells, mucous and other small foreign objects in the eyes, and the closed eyelids guide this excess matter to the corners of the eyes and along the eyelashes where it accumulates.
Most people wake up with sleep crust, although it occurs in different amounts in different people. The amount may vary depending on the season or the general condition of the eyes and how dry they are. Sometimes eye discharge may be a sign of a problem with the eyes or eyelids, such as allergic conjunctivitis, infection or an inflammation of the eyelids. Be aware of the signs that may indicate a problem. These include changes in the quantity, colour or consistency of the discharge, increased light sensitivity, blurry vision, pain or redness of the eye.
Practicing good eye hygiene is important in keeping the eyes healthy and avoiding irritation and infection. The best way to wipe sleep out of the eyes is with a cloth or cotton wool and warm water. Always remove makeup before going to sleep. It is tempting, but try to avoid rubbing the eyes, particularly on waking in the morning. If abnormal eye discharge is a symptom of conjunctivitis, which is very contagious, prevent it spreading by washing the hands frequently, not touching the eyes and not sharing towels with other family members.
DON'T BE BLINDSIDED BY GLAUCOMA
There is a reason that glaucoma is known as "the silent thief of vision". According to the South African Glaucoma Society, 4 in 50 South Africans over the age of 40 suffer from glaucoma but approximately 50% of these don't know they have it! Glaucoma usually develops slowly with no obvious warning signs or symptoms at first and when these are noticed the disease may be fairly advanced. While glaucoma cannot be cured or the lost vision restored, the good news is that if it is detected and treated early, its progression can be delayed or even prevented. By means of a simple test your optometrist can pick up the signs of glaucoma and refer if necessary.
The healthy eye constantly produces a clear fluid called aqueous humor which circulates in the front part of the eye. As new aqueous flows into the eye, the same amount should drain out, maintaining a constant stable eye pressure, the intraocular pressure (IOC). The fluid drains out through an area called the drainage angle.
If the drainage angle is not functioning properly, fluid builds up and pressure inside the eye rises, gradually damaging the optic nerve. The optic nerve is a bundle of tiny nerve fibres which supplies visual information from the retina at the back of the eye to the brain where it is processed and interpreted. Over time, damage to the optic nerve results in irreversible vision loss.
TYPES OF GLAUCOMA
There are five major types of glaucoma. The most common type is open angle glaucoma, a chronic condition which progresses slowly and has no symptoms initially. As the optic nerve becomes more damaged changes in peripheral vision are noticed, by which stage the damage is quite extensive and irreversible vision loss has occurred.
Closed angle or angle-closure glaucoma is an acute sudden blockage of the drainage angle resulting in a rapid increase in intraocular pressure. It is usually accompanied by severe pain, headache, eye redness, nausea and blurred vision. Closed angle glaucoma is an emergency situation which should be treated immediately. In some cases it can develop slowly with no symptoms until the damage is severe or a sudden attack occurs.
Although glaucoma generally occurs in people over 40 years of age, congenital glaucoma can occur in infants and children, presenting with symptoms including excessive tearing, cloudy eyes and sensitivity to light.
Secondary glaucoma may be a side effect of injury or another eye condition, such as cataracts. Medications such as corticosteroids may also cause this type of glaucoma. Rarely, eye surgery can cause secondary glaucoma.
In some cases people with normal eye pressure develop damage to the optic nerve, with blind spots in the peripheral vision. The cause of normal tension glaucoma is often unknown. On the other hand, certain people with increased eye pressure do not show signs of glaucoma and may never develop it, although their risk is higher than for people with average eye pressure. This ocular hypertension needs to be closely monitored with regular eye examinations.
WHO IS AT RISK FOR GLAUCOMA?
Some people have a higher than normal risk of getting glaucoma. This includes people who are over age 40, have a family history of glaucoma, are of African, Hispanic, or Asian heritage, have high eye pressure, have had trauma to the eye, have used corticosteroids for an extended period of time, or suffer from a medical condition such as diabetes or cardiovascular disease.
While a glaucoma screening tests eye pressure, a comprehensive eye examination is the only sure way to detect signs of glaucoma. The first step is a detailed medical history, during which your optometrist will ask questions regarding your general health, family history of eye conditions and symptoms you are currently experiencing. A number of tests may be administered. Tonometry measures the internal pressure of the eye. Pachymetry reveals if the corneas are thinner than average as this is one of the risk factors for glaucoma. In order to assess peripheral and central vision a perimetry or visual field test may be conducted. The optic nerve is examined for damage and pictures of the optic nerve may be taken so that the optometrist can monitor any changes over time.
Glaucoma damage is permanent and lost vision cannot be restored but treatment can help in delaying or preventing the progression of the disease. The main objective in treatment is to lower intraocular pressure so that the risk of further damage to the optic nerve is reduced. The most common, and generally effective treatment is eye drops. Different eye drops perform different functions, including the reduced production of fluid in the eyes or increasing fluid drainage, and you may be prescribed either one or a combination of eye drops. Sometimes these medications are given as tablets.
If surgery is indicated your optometrist will refer you to an ophthalmic surgeon who will discuss the most appropriate procedure for your particular condition. Because closed angle glaucoma is a medical emergency which requires reduction of eye pressure as quickly as possible, treatment differs. Medication is usually attempted first but if this is unsuccessful a laser procedure may need to be performed to increase fluid drainage.
Treating glaucoma successfully is a team effort with you as the patient assuming the main role. It is essential to strictly follow the instructions for the use of the eye drops and tablets. As the saying goes: "Every dose every day can save your sight!" See your optometrist regularly for eye examinations and monitoring the effectiveness of the treatment and progression of the disease.
It's World Blindness Awareness Month. And it got me thinking about all the things I see that really annoy me.
For instance, someone cuts in front of you in traffic. You know, one of those people driving an off-roader 4x4 even though you know he won't be going anywhere more adventurous than to work and back home to his gated community. He doesn't even thank you but just pushes in front of you. And all the way to work you have to sit behind him and stare at his arrogantly personalised number plate.
But imagine a world where you couldn't see that number plate… or anything at all. Then again, you wouldn't be driving in the first place. You'd probably be calling an Uber – except you'd need your sight to do that too.
What about those annoying ads that come up before a YouTube video? The ones where you have to wait five seconds before you can skip them? What if the alternative to waiting five whole seconds is not seeing those videos at all? You wouldn't feel impatient to watch the video you want to see, because you wouldn't be able to see that either.
In fact, it's likely you wouldn't be sitting in front of a computer, unless it was specially enabled.
If you couldn't see anything at all, you'd be spared the sight of those gym bunnies who work out in front of the mirror. But you possibly wouldn't be in the gym to begin with. You wouldn't have to watch people pretending they have less than ten items in the express queue. But that's because you wouldn't be able to see anything inside the supermarket. And you'd have to make sure you didn't have more than ten items in your basket yourself – because you wouldn't be able to tell just by looking.
You wouldn't be annoyed at the sight of people running to your car to clean your windscreen. You wouldn't be annoyed to see people parked in the Moms and Tots parking bay (when they clearly don't have a baby seat in their car). You wouldn't get angry to see rubbish thrown into a river. But that's because you wouldn't even see the river.
Hey, I'm not one to get sentimental. And I'm not one to preach about how it's a wonderful life and we must be grateful for each blessing. But as the ultimate Mister Grumpy, even I feel that World Blindness Awareness Month gets me to stop being annoyed about the stuff I see. Even if it's just for a month.