July/August 2019 Newsletter
WOMEN SEE THINGS DIFFERENTLY
With August being Women’s Month it is perfect timing to examine the factors that affect women’s vision. As we get older, age-related health conditions occur, and the eyes are no exception. This is especially true of women, who tend to live longer than men and are more likely than men to develop vision problems. Cataracts are more common in women who are also at higher risk to develop age-related macular degeneration. While open angle glaucoma affects males and females equally, the less common and more serious closed angle glaucoma is two to four times more likely to affect women.
Vision problems occur for a variety of reasons, but an imbalance in hormone levels is often the underlying cause. Hormones are chemicals in the body that regulate important body functions. Often called the messengers of the body, they travel through the bloodstream and other fluids to organs and tissues coordinating and controlling major functions. From childhood to old age everyone experiences hormone fluctuations which can affect all parts of the body including the eyes. Changes in hormone levels generally occur more frequently in women during the specific life-changing milestones of their lives.
As children go through the hormone fluctuations of puberty, their bodies change and grow rapidly, and so do their eyes. If their eyes lengthen too much, this can cause or worsen short-sightedness, leading to blurred distance vision. For girls the onset of menstruation brings huge changes in hormone production and estrogen levels which is thought to be largely responsible for changes in vision and eye health. Once hormones stabilise so should vision, but it is important to have annual eye examinations to assess and monitor vision changes.
After puberty women may continue to experience vision changes due to fluctuations in hormone levels. Women of child-bearing age commonly have changes in vision due to birth control pills or pregnancy. Hormonal shifts during pregnancy affect the surface of the eyes and can cause temporary eye conditions such as dry irritated or watery eyes as well as discomfort wearing contact lenses. Sometimes water retention has an effect on the shape and thickness of the cornea resulting in a slight change of vision. It is recommended that pregnant women wait until after the baby is born and hormones have stabilised to get a new prescription. In addition to birth control pills, other medications such as antidepressants, anti-anxiety medications, and antihistamines, can cause changes in vision.
Fortunately, blurry vision due to hormonal changes during pregnancy resolves when hormones level out. However, if your vision doesn’t return to normal a couple of months after pregnancy, or if there are sudden vision changes it is important to see your optometrist to rule out more serious eye conditions.
The hormonal shifts associated with perimenopause and menopause often trigger vision changes in older women. Declining estrogen levels may lead to dry eye syndrome which is characterised by itching, watering, light sensitivity and a feeling of grittiness as the watery layer of the tears evaporates more easily. Trouble focusing close up may be due to increased water retention and inflammation of the cornea. The dryness and the change in refraction can cause blurry vision and can also make wearing contact lenses difficult.
While most of the vision changes which take place during menopause are irreversible, certain healthy lifestyle behaviours can help to maintain vision and reduce the negative effects of hormonal fluctuations. Eat plenty of fruit and vegetables and follow a diet rich in omega 3, zinc and vitamin C, or take recommended supplements. Ask your optometrist to suggest eye drops or artificial tears to relieve the symptoms of dry eye syndrome. Use a humidifier and avoid overly dry rooms indoors, and wear sunglasses outdoors to eliminate the drying effects of wind and smoke. Visit your optometrist regularly to monitor your eye health as well as be aware of health conditions such as diabetes and thyroid problems that may be evident in the eyes.
HELLO SPRING, HELLO ALLERGIES
Spring is in the air! For some people it is a time to look forward to enjoying warmer weather, longer days and the beauty of blossoms, while for others it is a time to dread the discomfort of allergies with red itchy eyes and runny noses. While some people are packing away winter woollies, others are unpacking allergy remedies. Spring is typically the season for allergies to emerge, due to an increase in allergens in the air both indoors and outdoors. These allergens include pollens from grass, trees and other plants, dust, pet dander and mold. Allergic reactions to perfume, cosmetics or drugs can also cause the eyes to have an allergic response. Allergy to contact lenses, particularly hard contact lenses, can occur in some cases.
Eye allergies, also called allergic conjunctivitis, are quite common. Although they tend to run in families, anyone can experience allergic reactions, which are essentially an over-reaction of the body’s immune system in response to an irritant. A substance called histamine is produced to fight off the allergen. As a result, the eyelids and conjunctiva become red, swollen and itchy, and the eyes tear and burn. The eyes are an easy target for allergies because they are directly exposed to the environment without the help of a filtering system such as the hairs found in the nose. Sometimes the eyes can react to allergens that do not necessarily come into direct contact with them, such as insect bites or certain foods.
The most common eye allergy symptoms include red, swollen or itchy eyes, burning, tearing and sensitivity to light. These allergy symptoms can range from very mild redness to severe swelling associated with discharge. If accompanied by nasal allergies, there may be a stuffy itchy nose, sneezing, and sometimes an itchy or sore throat, headache and coughing.
A contact eye allergy is an allergic inflammation of the eyelids from direct contact with certain allergens, such as eye makeup or cosmetic products, over the counter ointments and sometimes contact lens solutions. Symptoms and signs include itching, blisters and redness which appear 24 to 48 hours after exposure to the offending agent. The conjunctiva may also become red and watery.
The symptoms of certain eye conditions can be confused with eye allergy. Dry eye, which usually occurs in people over 65 years of age, is characterised by burning, watering and a sensation of grittiness. Watery eyes usually without itching could be a sign of tear duct obstruction, also typically seen in the elderly. Conjunctivitis due to infection can be caused by either bacteria or viruses. In bacterial infections, the eyes are often "bright red" and the eyelids stick together, especially in the morning. Viral conjunctivitis causes slight redness of the eyes and a glassy appearance from tearing.
The key to treating eye allergies is to avoid or limit contact with the allergen. This is often easier said than done! If you are allergic to pollen, avoid going outdoors as much as possible when pollen counts are highest, usually in the mid-morning and early evening. Keeping windows closed both in the car and home will help lower exposure to pollen and other irritants while you are inside.
Rubbing itchy eyes is a natural response. However, rubbing usually worsens the allergic reaction by triggering a further immune response. Eye drops can provide relief. Keeping eye drops refrigerated helps to make their application more soothing. Moistening the eyes with artificial tears helps to dilute and rinse away accumulated allergens while lubricating the eyes and preventing the allergens from sticking to the conjunctiva.
Antihistamines prevent the release of histamines and other compounds that cause itchy eyes. Decongestant drops minimise the appearance of redness by shrinking the blood vessels on the conjunctiva. Different active ingredients treat different aspects of allergies and sometimes long-term use of certain eye drops may actually increase the symptoms. Discuss the most suitable treatment with your optometrist.
Steroid anti-inflammatory eyedrops are very effective in treating eye allergies, but they are reserved for severe symptoms that are unresponsive to other treatments. Side effects of long -term use of steroids can increase the risk of developing cataracts and glaucoma. Their use should be supervised by a medical professional.
Oral antihistamines which target the chemical causing the symptoms of the allergic reaction may be helpful in relieving itchy eyes. However, they can make eyes dry and potentially worsen the uncomfortable symptoms.
For those with severe allergy symptoms which are not controlled by allergen avoidance, eye drops or oral medication, immunotherapy injections may be an option. This involves a series of injections which help the immune system become less sensitized to allergens.
Your optometrist can help determine which treatments are best for you.
AGE-RELATED MACULAR DEGENERATION
Everything we look at directly is identified by the macula, the area on the retina at the back of the eye responsible for sharp central vision. When the macula is damaged in some way there is a gradual loss of central vision. Peripheral vision remains intact, but it becomes difficult to see fine details both close up and further away. This age-related macular degeneration (AMD) is a leading cause of vision loss in people over the age of 50. Because the vision loss is gradual, many people are unaware that they have macular degeneration initially. Your optometrist is usually able to detect the early signs, often before you experience visual problems, so regular visual examinations are important.
TYPES OF AMD
There are two types of AMD, dry and wet. Dry AMD is more common than wet AMD.
In most cases dry AMD is diagnosed when tiny white spots are noticed on the retina due to a thinning of the macula. These are called drusen (pebbles) and they represent tiny deposits of cellular waste products and immune system proteins. Over time the macula may become thinner and the drusen may increase in size or number, increasing the risk for the development of intermediate AMD. Although symptoms are not generally present at first, a blurred spot in central vision may begin to appear.
Wet AMD is less common but more serious than dry AMD. It tends to progress more rapidly and cause more severe vision loss. Wet AMD occurs when new, abnormal blood vessels grow under the retina toward the macula. Because these blood vessels are abnormal, they break and leak blood or other fluids, damaging the macula and causing it to lift away from its base.
WHO IS AT RISK FOR AMD?
Anyone can develop AMD, but lifestyle and diet are major factors in an individual's risk. People most likely to develop AMD eat a diet high in saturated fat, are over 50 years in age and smoke. Conditions such as high blood pressure and heart disease may increase the risk. Family history has a role to play, with genetic factors influencing when AMD starts and how quickly it progresses.
Presently, there is no specific treatment for the dry form of AMD. However, there may be some benefits from taking a certain combination of nutritional supplements. While not a cure, a large study found that the progress of the condition was slowed by the daily intake of vitamin C, vitamin E, lutein, zeaxanthin, zinc and copper. Ask your optometrist for recommendations and advice on the taking of supplements.
To help treat wet AMD, there are medications which help reduce the number of abnormal blood vessels in the retina and slow down any leaking from blood vessels. Laser surgery may also be effective to treat some types of wet AMD. Discuss appropriate treatments with your optometrist who will refer you to an ophthalmologist if necessary.
Modifications to lifestyle and eating eye-healthy foods can reduce the risk of AMD progression. A healthy diet including fatty fish such as salmon and mackerel as well as dark leafy greens and yellow and orange fruits and vegetables can help, too. Giving up smoking is essential. Sunglasses are advisable when out in bright light.
Most importantly, regular eye examinations, particularly if there is a family history of AMD, are critical in detecting and treating AMD as early as possible, as well as monitoring the progress of the condition over time. If a significant amount of central vision has been lost, your optometrist can refer you to a low vision specialist or offer suggestions to help you make optimal use of your remaining vision.
WHAT I WISH PEOPLE UNDERSTOOD ABOUT MY VISION LOSS
A group which offers support to people with AMD has listed a number of personal experiences highlighting issues regarding this condition.
“Just because our vision changes doesn’t necessarily mean our interests do. People may assume that sight-related hobbies are no longer accessible or interesting with vision loss, so we are not invited on shopping trips or to watch a sports match. Things do change, but there are almost always ways to compensate and adapt when it comes to activities we enjoy.”
“It can feel socially isolating. It can make me feel awkward and self-conscious when some-one can see me, but I can’t see them. It helps when people acknowledge me personally and identify themselves, instead of me trying to figure out who greeted me!”
“The things we can and can’t see can sometimes be confusing, even for us. I can identify most colours in a general sense but often can’t distinguish certain colours. It can be difficult to explain to people why I can see certain things and not others when I can’t really understand it myself.”
“I can have bad and good vision days, depending on whether it is sunny or cloudy, the time of day, indoors or outdoors, my eyes are tired, or factors I haven’t even thought of, causing my eyes to play tricks on me.”
“It’s not something I dwell on daily. Gradual vision loss, as the name suggests, does not happen suddenly. It is similar to aging which happens over time without me noticing it. Sometimes I am surprised when my optometrist tells me my vision has worsened because I hadn’t been aware of the change.”
“Some of us use mobility aids like canes and dogs, and some of us don’t. There can be people who have the exact same vision who move about the world completely differently.”
“Most of us lead regular, happy lives. I have dealt with my share of sadness over having AMD, but sadness is definitely not the word that comes up for me when thinking about my life. Challenge? Sure. Adventure? Yes. Joy? Absolutely.”
While travelling on the Gautrain recently, an optometrist overheard a conversation between two other passengers.
“I have just collected my new glasses from my optometrist,” said one of the men. “I can see clearly with them, but I find the glare really bothers me.”
“Didn’t you discuss that with your optometrist? Couldn’t he recommend something to deal with your problem?” asked his companion.
“He made a number of suggestions but none of them are covered by my medical aid, so I decided against them.”
Making a decision based primarily on what is covered by medical aid may be false economy. Glasses are often an expensive item but making a co-payment that will not be too tough on the pocket may be worthwhile in the long run. Lens coatings can improve the performance, longevity, durability and appearance of your glasses as well as providing necessary protection for both your lenses and your eyes.
At the very least one should consider a hard or scratch-resistant coating. Scratched lenses interfere with the clarity of vision, often leading to eye strain or headaches. Sometimes excessive scratching necessitates replacing the lenses fairly frequently. While no lenses are completely scratch-proof, applying a scratch-proof coating makes them more resistant to scratching, reduces smudging and makes them easier to clean, prolonging the life of the lenses.
The man on the train would certainly benefit from an anti-reflex coating on his glasses. This virtually eliminates reflections on the front and back surfaces of the glasses by blocking reflected light, allowing more light through the lenses, reducing glare and optimising visual acuity. It is particularly effective with night driving when reflections and haloes of street lights and the lights of oncoming cars is a problem for some people. As well as the cosmetic benefit of improving the appearance of the glasses, an anti-reflex coating helps reduce eye strain from working at the computer or in low light for lengthy periods.
Polarised lenses eliminate the glare from light reflected off the road, bonnet of the car or surface of water. This glare may be irritating or uncomfortable at times, but it can also be dangerous when the reflection is at a certain angle and can be blinding. Some optometrists are of the opinion that polarised lenses are not an option but a necessity, particularly for people who drive long distances.
Ultraviolet coating cuts down on ambient light and helps protect the eyes from the harmful ultraviolet rays of the sun, which play a role in the development of eye diseases such as cataracts and macular degeneration. The most effective protection blocks out 99 to 100% of the full ultraviolet spectrum.
Thanks to LED lights and the ever-increasing use of digital devices, we are exposed to more blue light radiation than ever before. Recent research suggests that filtering blue light while working on the computer cuts down screen brightness and flickering, reducing the symptoms of eye strain and fatigue. Blue light filter coating on lenses is claimed to minimise the harmful portion of blue light while allowing the less harmful portion to pass through.
Photochromic lenses darken automatically in response to specific types of light, most commonly sunlight, and return to clear (or nearly clear) when indoors or in the absence of the activating light. They are useful for people who have light sensitivity or for those who do not want a separate pair of prescription sunglasses.
Taking into account that medical aids generally cover only the basic essentials, a frank discussion with your optometrist will help you decide if it would be worth adding to the extra cost of your glasses.
RED EYES RED FLAG?
Most people suffer from red or bloodshot eyes at some time or another. They occur when blood vessels near the surface of the eye become irritated, causing them to become enlarged and dilated. While red eyes are a common condition which generally does not “raise a red flag” to signal anything serious, the eyes are red for a reason, and there is a variety of reasons which may be responsible. Depending on the underlying cause, red eyes can be associated with other symptoms including burning, itching, watering, discharge, swelling of the eyelids and sensitivity to light.
CAUSES OF RED EYES
A common cause of bloodshot eyes is dry eye syndrome, which occurs when there are not enough natural tears to keep the front part of the eye lubricated. When the eye becomes dry, it also becomes very red and irritated. Dry eyes may be the result of hormonal changes in the body, chronic medications, lack of sleep, wearing contact lenses for too long or extended periods of staring at computer screens. Lubricating eye drops, either bought over the counter or recommended by your optometrist, may be helpful. Take regular breaks from computer work and follow your optometrist’s instructions on contact lens wear. Don’t forget to blink!
Conjunctivitis, commonly called “pink eye” is an inflammation or infection of the clear, protective layer that coats the front part of the eye. It may be bacterial or viral, causes the eyes to be red and is often associated with a discharge. Although uncomfortable, it is usually not serious, but is contagious so should be treated with the correct eye drops prescribed by a doctor.
Blepharitis is inflammation of the eyelids which occurs when the oil glands at the base of the eyelids become clogged, leading to irritated red eyes, swollen eyelids, a gritty or burning sensation or crusting of the eyelids. While uncomfortable and unsightly, it does not cause damage to the eyesight. The exact cause is unknown, and it is often difficult to treat. If it does not improve despite good eyelid hygiene, medication may be prescribed.
Uveitis, an inflammation of the eye's uvea, can cause redness, pain, blurry vision, floaters, and light sensitivity. Symptoms of this condition can occur suddenly and get worse very quickly. Unless treated promptly, it can lead to complications.
Frequent Use of Eye Drops
Surprisingly, frequent use of eye drops to reduce redness of the eyes can actually make the eyes appear even redder. The chronic use of these eyedrops can cause “rebound dilation” of the blood vessels in the eyes, causing the eyes to appear more bloodshot. Consult your optometrist to determine the underlying cause of the redness and for the recommendation of appropriate eye drops to use.
Contact Lens Wear
Wearing contact lenses can sometimes cause eye redness. If you experience discomfort while wearing contact lenses, discuss this with your optometrist who may suggest suitable eye drops for contact lenses or seek alternative solutions.
Redness sometimes occurs with an eye injury. When you injure your eye, blood vessels inside the eye enlarge and dilate to bring blood and cells to heal and repair the injury. Visit your optometrist to assess the extent of the injury and ensure that the eye is not damaged.
Red eyes associated with burning and itching are often caused by allergies. They generally occur at specific times of the year or in particular situations. The eyes become red because the blood vessels in the front part of the eye dilate and become larger. Fluid accumulates and causes swelling. Standard allergy treatments can help reduce eye redness, but there may be specific treatments based on the situation.
Computer Vision Syndrome
Red, dry eyes result from a lack of moisture to the eyes, which is replenished by blinking. Blinking is one of the fastest reflexes of the body. However, people tend to blink about half as much as normal when they are working on a computer. Try to reduce redness by blinking more often and looking up from the screen at regular intervals. Artificial tears can replenish tears and provide relief.
Smoking a cigarette releases several harmful chemicals including formaldehyde, ammonia, and hydrogen sulfide which are irritating to the sensitive membranes of the eyes, causing inflammation and red eyes. Smoking can also increase the risk of cataracts., a cloudiness in the lens of the eye.
Lack of Sleep
If you don't get enough sleep, your eyes may show it. Losing sleep tends to increase the retention of blood and fluid around the eyes, making them appear puffy and red. Lack of sleep can also lead to dry eyes which exacerbates the redness. Eyes need a constant supply of tears to function properly, which is why blinking is so important. Not allowing the eyes to close for a long night prevents eyes from getting proper fluid circulation. Your eyes need fluid in order to clean and renew. Staying awake too long is not a good idea for overall eye health.
Alcohol can cause vasodilation, causing the vessels on the white part of the eye to become larger and more visible. Also, alcohol is dehydrating and can causes the eyes to appear red and tired.
Corneal Ulcer or Infection
The cornea does not have blood vessels, so if it becomes infected, nearby blood vessels become enlarged and swollen as cells rush in to help fight the infection. These cells can cause visible redness. Corneal ulcer treatment needs to be prompt and aggressive in order to prevent potential vision loss. Treatment usually involves antibiotics as well as antiviral or antifungal medications or steroids.
A subconjunctival hemorrhage causes the white part of the eye to become completely red. It occurs when one of the blood vessels bursts or breaks underneath the conjunctiva, the transparent, clear tissue that covers the white part of the eye. The blood has no place to go, so it spreads out beneath the conjunctiva. A subconjunctival hemorrhage can look unsightly, but it is usually no cause for alarm especially if there is no pain or visual changes. The cause of a subconjunctival hemorrhage is not always known, but some cases have been linked to coughing, straining, or using blood thinners.
Occasionally subconjunctival hemorrhages have been linked to high blood pressure or a bleeding disorder. Because the hemorrhage is not dangerous, no treatment is needed and symptoms usually disappear within a week or two. If the cause is high blood pressure or a bleeding disorder, you may need to consult your doctor for treatment.
Acute Angle-Closure Glaucoma
Sometimes a red eye can signal a serious condition. One very serious eye condition that may cause red eye is acute angle-closure glaucoma, which is a medical emergency that must be treated immediately. It occurs when the fluid pressure inside the eye rises quickly. This type of glaucoma usually occurs in only one eye, causing sudden redness in the eye, severe eye pain, and blurred vision. Visit your optometrist as soon as possible.
Episcleritis is an inflammation of the thin clear layer of tissue that lies between the conjunctiva and sclera. Episcleritis causes mild eye pain and irritation along with eye redness. Sometimes the eyes become tender to the touch. Although it may go away on its own, topical steroids are often needed.
HOME REMEDIES FOR RED EYES
In most cases, red, bloodshot eyes will clear up on their own within a few days.
If you are experiencing bloodshot eyes due to allergies or environmental irritants oral antihistamines or over-the-counter eye drops may help.
Either the gentle heat of a warm cloth or an ice pack helps reduce irritation and redness of the eyes.
Rinsing the eyes with warm or cool water can irrigate and cleanse your eyes without harming them.
Take a break from your smartphone or computer.
Stay hydrated by drinking enough water.
Artificial tears are a simple solution which help flush out irritants as well as alleviating dryness.
Fatty acids found in fish, nuts, and leafy vegetables can be beneficial to dry, red eyes.
If the condition persists or is associated with symptoms such as pain or a sudden change in vision, schedule an appointment with your optometrist.
This month we honour the strength, power and spirit of women. We celebrate the achievements of women throughout history, and their many contributions to the world.
Speaking of history, what if some of the world’s most legendary women had worn glasses? And speaking of legend, what if fairytale heroines had worn glasses too? Would the stories have been any different?
To start with Red Riding Hood, well… Without a full examination it’s difficult to say whether it was a case of short-sightedness or long-sightedness or possibly astigmatism. But seeing a wolf in a nightgown and believing it was her grandma? Getting lost in the forest in the first place is a sign that her eyes needed attention. Or maybe she just needed a better GPS.
Come to think of it, the course of all fairy tales could’ve been changed with just a few pairs of prescription glasses. Maybe Sleeping Beauty would’ve seen that spindle and avoided the finger prick. Maybe Cinderella would’ve left the ball in time, because thanks to a pair of glasses she would’ve read the clock on the wall and seen that it was almost midnight.
With an appropriate pair of glasses, that other princess could’ve found the pea under her mattress and got a decent night’s sleep – instead of doing nothing and complaining about it the next morning. If Jack’s mother had had a pair of glasses to correct her vision, she might’ve noticed that those beans were magic, and capable of producing one remarkable beanstalk.
And it doesn’t end with fairy tales. How would the course of history have been different if Cleopatra had worn glasses? (Considering the Egyptians worshipped their felines, she no doubt would have worn a pair of cat’s eye frames.) Marie Antoinette could’ve bought a pair of readers, opened a recipe book, and figured out how to bake cake for the masses (and then let ‘em eat it). We’ll never know how things might have been different if Helen of Troy had worn glasses. Maybe a stylish pair of sunglasses would only have enhanced her legendary beauty.
Who knows what might have been had the women of legend worn glasses? Who knows how the world might have been a different place? Then again… Joan of Arc led an army. Elizabeth I was on the throne for forty-four years. And they did it without a single pair of designer frames or prescription lenses.
So we celebrate the women with prescription frames and without. With readers, with contact lenses and with fabulous shades. Across the world and in so many ways, you are women of vision. And we salute you all.