Eye care is important at any age – after all, you only get two. But in your 40’s, 50’s and 60’s, it’s even more significant. Here we have more information on eye care and another perspective on controversial LASIK surgery.
SHOULD YOU GO SEE AN OPHTHAMOLOGIST EVEN IF YOU DON’T CURRENTLY WEAR GLASSES?
Absolutely! Part of taking care of your overall health is taking care of your eyes and a yearly eye exam should be a part of everyone’s health routine. For example, did you know some of the first signs of diseases such as thyroid disease, high blood pressure, auto-immune conditions and diabetes show up in an eye exam? Reason enough to make sure you call to make that appointment.
AS WE GO FROM OUR 30S TO OUR 40S AND EACH DECADE THEREAFTER, WHAT ARE SOME THINGS WE SHOULD BE MINDFUL OF WHEN IT COMES TO TAKING CARE OF OUR VISION?
As part of your annual eye exam, your eye doctor screens for many conditions including:
Glaucoma:While there are several factors associated with it, glaucoma damages the optic nerve which can lead to loss of vision and even blindness. Early detection – during an annual eye exam – is essential as treatment can help manage the disease and prevent significant vision loss. However, there is no cure and any vision loss due to glaucoma cannot be restored.
Cataract:The clouding of the lens of the eye is part of the natural aging process. Several factors can contribute to cataracts forming, in addition to age, including: smoking, diabetes, long-term exposure to UV (sun) light and medications such as corticosteroids. Cataracts are generally thought to be a sign of old age, but in fact people can develop cataracts in their 40s and 50s. Cataract development is often monitored over time and treated with surgery once the visual impairment can no longer tolerated.
Other age-related eye conditions: As part of your annual eye exam, your eye doctor takes your refractive measurements to check on your need for vision correction. Everyone after the age of 45 begins to lose sharp focus in their near vision – called presbyopia – and reading glasses may be prescribed. Also, during your eye exam, your eye doctor screens for macular degeneration, the deterioration of the center of the retina causing loss of vision in the center of your vision that spreads over time.
Routinely done after dilating your eyes, your eye doctor checks the overall health of the retina and may also choose to use more advanced imaging technology to scan the retina for a more detailed evaluation. The risk for macular degeneration increases with time – typically after the age of 55 – and early detection is essential for preserving vision as long as possible.
WE HAD ANOTHER OPTHAMOLGIST ON RECENTLY WHO WAS 100% OPPOSED TO LASIK. DO YOU RECOMMEND LASIK SURGERY?
I wholeheartedly recommend LASIK to those who are good candidates for the procedure. The claims made on the previous show were wild and unsubstantiated – which is why I am here today to set the record, the science, straight for your listeners. There is more than 20 years of clinical data supporting LASIK as both safe and effective and any notion that it isn’t is simply untrue.
LASIK is one of the most researched and best understood surgical procedures of all time. We have 20 years of clinical experience, millions of happy patients whose lives have been improved by LASIK and over 7,000 clinical studies to draw on.
These tell us that LASIK is extremely safe and effective, with a satisfaction rate of 96 percent, the highest of any elective procedure. As a point of fact, ophthalmologists who perform LASIK and know the risks and benefits of the procedure better than anyone are the most likely to have undergone LASIK themselves.
WHO IS A GOOD CANDIDATE FOR LASIK?
It is an important question, because LASIK is an elective procedure, not a medical necessity. Patients have the option of glasses or contact lenses, which have their own associated risks. The individual patient must weigh the inherent risks and benefits to decide how to handle their vision correction needs and if a laser vision correction procedure is right for them.
An important deciding factor in choosing laser vision correction is the surgeon’s recommendation, which is based on whether or not a patient is a good candidate, because not everyone who wants a procedure should have it. In fact, on average between 15 and 20 percent of patients are considered ineligible for a procedure like LASIK.
Knowing if you are a candidate for laser vision correction is necessary for even considering a procedure. The best way to determine if you are a candidate for LASIK is to work with a highly qualified surgeon and have a complete evaluation of your eyes and vision. Then both you and your surgeon will have the information needed to make the best recommendation for you which may be LASIK or one of the many other laser or lens-based vision correction treatment options available today. You can learn more about LASIK candidacy here.
AFTER HAVING LASIK SURGERY, WHY DO SOME PATIENTS EXPERIENCE DRY EYES?
Dry eye is extremely common and is, in fact, the most common reason patients visit an eye doctor’s office. You may have heard that some patients may also have dry eye symptoms after LASIK. It is true that during the healing process, some LASIK patients may experience dry eye symptoms. But only some patients, and usually for a short while. Some patients don’t. A few may have dry eyes for up to a year as the surface of the eye heals. To help with the healing process and to keep patients comfortable, eye drops are prescribed to all LASIK patients.
Because dry eye can be caused by many different conditions, it is important to understand dry eye symptoms in the context of having LASIK. The fact is, many people who want LASIK already have dry eyes. Recent research reports that up to 30 percent of laser vision correction patients report dry eye symptoms prior to surgery. This isn’t surprising because many contact lens wearers complain about uncomfortable dry eyes as a result of using contacts. Those patients often look into having LASIK so they can continue to see well without having to resort to wearing glasses when their contacts are no longer tolerated.
There have been a lot of advances in the field of dry eye, both in diagnosing the condition, as well as treating it. An important part of the evaluation for LASIK candidacy is assessing any dry eye symptoms and their potential impacts to the surface of the eye, because about 50 percent of LASIK candidates have some clinical signs of dry eye prior to surgery.
If dry eye is diagnosed before LASIK, the patient can have their pre-existing dry eye problem treated. Pre-existing dry eye is the leading risk factor for significant dry eye after LASIK, so it is important to discuss any dry eye symptoms during the LASIK evaluation. Once the dry eye is resolved and the surface of the eye is in good condition, patients can often move forward successfully with LASIK.
All surgeries involve cutting tissue. In the case of LASIK, some nerves in the cornea are cut which can temporarily reduce the sensation – the awareness or feeling – you have of the surface of the eye. During the healing process, the eye may not sense the need for moisture, so it produces fewer tears which can lead to dry eye symptoms.
Because LASIK changes the shape of the cornea, it is also possible that, while the eye heals, the tear film is unevenly distributed across the surface of the eye. When the surface of the eye is dry it doesn’t do as good of a job in focusing light, causing blurry vision.
This is why it is important to keep up the eye drop routine prescribed by the eye surgeon, which includes both lubricating eye drops and other medication to help with healing. The good news is that for the vast majority of LASIK patients, dry eye symptoms are mild and temporary and, with today’s advanced dry eye therapies, can be well-managed.
Recently, the FDA led a study designed to develop and validate a survey for patients to scientifically report their overall experience with LASIK. This included how and how often patients reported experiencing dry eye symptoms before and after LASIK. The findings of the FDA patient-reported outcomes with LASIK study were particularly interesting when it came to dry eye symptoms:
- For those who reported having dry eye symptoms before LASIK, nearly 60 percent reported their symptoms resolved after having LASIK.
- Less than 30 percent of patients with no symptoms before LASIK reported having dry eye symptoms after LASIK. The majority – 85 percent – reported the symptoms were mild.
- Regardless of whether or not they had dry eye symptoms before LASIK, patients reporting dry eye symptoms after LASIK continued to see improvement in their symptoms over time.
Importantly, having dry eyes does not automatically eliminate you as a candidate for LASIK or other laser vision correction procedure. Your eye doctor will need to thoroughly evaluate your condition and discuss treatment with you before recommending a procedure. You should feel comfortable asking your eye doctor about the potential of dry eye symptoms after LASIK, so you have an informed understanding of what to expect. This should include talking about what therapies might be recommended to keep you comfortable during the healing process.
WHAT CAUSES EYE STRAIN? AND IS THERE SUCH A THING AS DIGITAL EYE STRAIN?
Recent research shows that up to 60 percent of American report symptoms of digital eye strain – not surprising when you think about our reliance on computers, tablets and cellphones today. Staring at a fixed distance, in challenging lighting conditions, for long periods of time without blinking and taking breaks is the root cause of the blurred vision, headaches, dry eye associated with digital eye strain.
DOES DIET AFFECT YOUR VISION?
The research shows you can protect, but not improve, the health of your vision with a good diet – eat your fruits and vegetables!
HOW WELL DO SUNGLASSES PROTECT OUR EYES?
UV rays can increase the risk of eye disease, including cataracts and cancer and wearing good quality sunglasses offers important protection. Avoid sunglasses that just reduce the glare of bright sunlight and don’t offer UV protection. Instead, wear UVA and UVB-blocking sunglasses that are labeled “100 percent UV Protection” or UV 400.
Go for wrap-around sunglasses so your eyes are completely protected. If you wear contacts, you’ll still need to wear UV-blocking sunglasses when you’re outdoors. And don’t be fooled into taking them off during cloudy weather because the sun’s rays can pass through the clouds and haze to inflict damage to your eyes.
SHOULD WE GET YEARLY EYE X-RAYS?
An annual eye exam, which encompasses many diagnostic tests, is important to keeping your eyes and vision healthy. If you haven’t had an eye exam recently, take a moment for some self-care and make an appointment with your eye doctor today.
Eric Donnenfeld, M.D. was a resident and Chief Resident at Manhattan Eye, Ear and Throat Hospital, completing a Cornea Fellowship at Wills Eye Hospital in 1985. He is a trustee of Dartmouth Medical School and a clinical professor of ophthalmology at NYU. He has written over 200 peer review papers on cornea, external disease, cataract and refractive surgery, and 40 book chapters and books.
He is on the editorial board of nine journals and has participated in over 60 FDA studies. He was a primary investigator of the excimer laser and was one of the first surgeons in the world to perform laser vision correction. He is a Fellow of the American Academy of Ophthalmology and has received its Honor Award, Senior Honor Award, Life Time Achievement Award, and Secretariat Award.
Dr. Donnenfield answers your Text Tom questions on the next page.
What causes you to keep getting sties?
Styes are infections of the oil glands in the eyelids. They are due to clogging of the oil glands because the secretions do not melt at body temperature. Consuming more omega-3 fatty acids can change these secretions and reduce the incidence of styes. In addition using a hot compress to melt the oils in the eyelids once a day is also helpful.
Is there a non-surgical correction for eye floaters?
Floaters are condensations of the jelly in the back of the eye called vitreous. They are usually annoying but not serious. They can be removed with surgery but we reserve this for only very significant floaters. Recently, a laser has been approved to break up these floaters but most eye doctors are conservative about using this device.
I recently had an ALT procedure and my eye stayed red for much longer than usual (over a week). Should I be concerned when the doctor wants to do the same eye again a few weeks later?
ALT is a procedure to treat glaucoma. Occasionally the eye may have inflammation following the treatment and be red for a few days. I would discuss this with your doctor and ask him is there are eye drops that can be used to reduce the inflammation following the ALT.
What if you are both nearsighted and farsighted?
Nearsighted means you cannot see far away. Farsighted means you cannot see up close. You cannot be both in the same eye. Most patients over the age of 45 lose the ability to focus up close. This is called presbyopia. We can treat both nearsightedness and farsightedness with laser vision correction very effectively. However, there is no good treatment at the present time for presbyopia
Can sun gazing restore sight?
Sun gazing is very dangerous and can permanently damage the eye.
Dr., Do eye vitamins really benefit our eyes (both drops or pills)?
There is good scientific evidence that vitamins can be effective at reducing the incidence of dry eye disease and macular degeneration.
Please ask the doctor why at 51 years old, I still have 20/20 vision? I am someone who was looking forward to wearing eyeglasses!
Many patients at the age of 51 continue to have 20/20 vision at distance but lose the ability to read up close and need glasses for near activities. To have good vision at distance and near at the age of 51 is unusual but not unheard of. I would consider you a very fortunate individual.
Is its dangerous to sleep with contacts in your eyes every day?
Sleeping in contact lenses increases the risk of serious eye infections greatly. It has been shown in studies that having LASIK is significantly safer for the eye than wearing contact lenses over night.
Dr., I’m a Candidate for “Corneal Transplant” in December, what am I to expect? I am 70 years of age.
A corneal transplant is a surgical procedure used to replace a damaged cornea (the front of the eye). This procedure is very successful and has been used for decades to restore vision. A skilled surgeon will perform the operation and it will take weeks to months for full vision recovery. It is very important to follow the advice of your doctor, avoid trauma to the eye and take medications to prevent rejection.
Doc, I had cataract surgery about a year ago. Ever since, it seems they are itchy or something in my eye all the time.
There are multiple reasons for an eye to be itchy. This may be due to the incision created during the cataract surgery or it may be unrelated and due to allergy. I would recommend seeing a good eye doctor to have the cause of your symptoms evaluated and there are many good treatments to help resolve them.
Dr. Eric, I have a whitish ring around my eyebal.l My doc says it from cholesterol but mine is good on all levels. How do I get rid of it?
The whitish ring around an eye is called arcus and is rarely due to high cholesterol, but most commonly is an aging change that cannot be removed. Patients who are under the age of 40 who have arcus have an increased risk of high cholesterol and are one of the examples of how a good eye exam can help diagnosis systemic diseases.
Can you have cataract surgery later on in life if you had LASIK surgery?
A: Yes. We very routinely perform cataract surgery on patients who have undergone LASIK. LASIK does not cause cataracts but cataracts are very common in patients over the age of 50. Seeing an ophthalmologist who has performed cataract surgery commonly in patients who have undergone LASIK is important to obtain the best visual results as there is special testing that can be done to provide the best vision possible. Conversely, for patients who have undergone cataract surgery and wish to see better with out glasses we can also perform LASIK to correct vision following cataract surgery.
