Do you recognize yourself in any of these scenarios? Holding the restaurant menu farther and farther away in order to see it. Your eyes become more fatigued during those longer stints at the computer. Reading product ingredients at the market and recipes on the fly are a struggle.
With increased time on computers, iPads and other technologies, we are demanding much more from our eyes, and yet our eye health is often relegated to an afterthought. Grabbing a pair of “readers” off the shelf at a local drugstore may seem like a good enough fix, but is it, really? Truth is, we may be inadvertently shortchanging our vision options and jeopardizing long-term eye health.
Advances in eye care, early disease detection and treatment options are helping create a clearer view in more ways than one. Dr. Suzanne Hauck, an Allentown optometrist, shares, “I will see people as adults that tell me they have never seen an eye doctor before because their vision was good. Well, the doctor can do more than just check vision. We can look inside the eye and detect eye disease as well as systemic issues. Some eye diseases don't have symptoms and early detection can be critical. It is good to have a baseline reading for the patient's future.”
Who do I see?
A common area of confusion in eye health begins with understanding the difference between eye care professionals: the optician, the optometrist and the ophthalmologist. Dr. Lisa Bunin, an ophthalmologist in Allentown, has been practicing for 27 years and applies a simple principle to the three terms. “The longer the name, the more schooling they have had,” Bunin says. An optician is a technician who can ensure prescriptions from the optometrist or ophthalmologist are accurate as well as performing the service of fitting eyeglass lenses, contact lenses and any other corrective eyewear. They DO NOT perform eye exams, diagnose or treat eye disease.
The bigger confusion often comes in distinguishing between an optometrist and ophthalmologist since both are referred to as doctors. An optometrist completes a four-year postgraduate degree, receiving a doctorate in optometry (OD). Optometrists provide vision care including eye exams and can diagnose common eye conditions including glaucoma, cataracts and conjunctivitis (pink eye). They are able to prescribe some medications for certain eye conditions. They also can provide vision therapy services as well as pre- and post-operative care for those who have had eye or LASIK surgery. Not all optometrists may have specialized training in the latter, however.
Ophthalmologists are licensed physicians, having completed medical school, plus one year of internship followed by three or more years of residency in medical and surgical eye care. Ophthalmologists are able to perform surgery as well as diagnose and treat a broader scope of eye conditions with a full range of therapies. Dr. Bunin notes, “There are a host of diseases where early detection is critical. Ocular surface diseases are becoming more common due to our forced air environments, the dramatic rise in allergies, poor nutrition and the increased demand we are placing on our eyes. These diseases are often going undetected.” The result is not only potential damage to the surface of the cornea, which is the clear surface that refracts light producing a majority of the eye's focusing power, but Dr. Bunin adds that, “the damaged surface will impact the choices a patient has when going for cataract surgery down the road.” The bottom line is that proper diagnosis is critical.
It's not your grandmother's cataract surgery
Cataract surgery used to be reserved typically for those in their mid-to late- 70s who had advanced symptoms including clouded and blurred vision, trouble seeing at night, double vision or seeing halos around light sources. Cataracts result in the clouding of the eye's lens, typically when proteins in the lens begin to clump together and diminish vision and clarity. This happens very gradually as we age.
With the advent of custom cataract surgery along with advances in surgery techniques, waiting until the lens in your eye is totally clouded over or “ripe” is a thing of the past. Early cataract intervention is less risky and can actually result in improved vision. Early symptoms are subtle like a glare at night, needing more light to read or some trouble distinguishing colors.
Previously, lenses used in cataract surgery improved only one aspect of vision, usually distance vision, therefore reading glasses were still required. New advances in lenses, including high definition lenses, allow custom cataract surgery to improve distance, as well as your much-needed near and middle-distance vision.
Dr. Bunin sees many patients in their 50s now for cataract surgery, saying “It is like going from being in a room with a 40 watt bulb to being in the room with a 90 watt bulb. The clarity is incredible. I usually hear my patients say, ‘Why did I wait?'”
With cataracts, the changes are very gradual, and our adaptation often causes us to overlook the symptoms. New lens options and enhanced surgical techniques can make for clearer and brighter vision sooner rather than later.
Can my computer make my eyes weaker?
Demands of near vision are markedly increased with our high usage of and dependence on technology. Greater time in front of screens of any size does take a toll on eyes. However, the eye's ability to focus clearly on objects nearby does naturally decrease as we age. Over time, the lens of the eye becomes stiffer, decreasing its flexibility to focus on close objects. Even though the computer may be putting more wear and tear on the eyes, the hardening of the lens in the eye, decreasing its flexibility to focus, is also a part of aging.
“Most people coming in over age 40 want to blame the computer, or cell phone, but in fact it is a normal aging change called presbyopia. We often just don't want to admit we are aging.” The eyes, however, were not designed to be focusing on close objects and screens for such extended periods of time. This increased exposure does put extra strain on eye muscles resulting in drying of the surface of the eyes. Taking periodic breaks and allowing the eyes to focus at a distance is an important step to reduce eyestrain.
What's best for me: bifocals or OTC readers?
According to Dr. Hauck, over-the counter reading glasses are an option, however she does caution that both lenses in the readers are the same prescription and most people do not have the same vision in each eye. Therefore, to properly address each eye may require a different prescription for each lens. She also finds people choose the wrong power, often choosing a stronger magnification than what they actually need.
“It's my job to educate the patient on what is best for them, possibly a progressive (no line) bifocal so they can keep the glasses on and not misplace them, or a prescription reader to suit the differences in the vision correction in the two eyes.”
What about these droopy eyelids I am getting?
What seems to be a purely cosmetic issue can actually be a vision and quality of life issue for many. Symptoms like falling asleep after a meal, not being able to focus after a long period of time, blurry vision by the end of the day and not being able to drive for extended periods of time could all be contributed to droopy eyelids. Dr. Bunin, who is also a plastic surgeon, explains that your body expends a great amount of energy holding up your eyelids.
“In essence, the body is trying to lift a heavy window shade all day long.” As if the increased fatigue you feel from droopy eye lids isn't enough, they could also be interfering with your peripheral vision. The loss of peripheral vision can have a dramatic effect on everyday activities including driving.
What are the latest advances in eye disease prevention and care?
LASIK® surgery has become a very popular option over the last decade or so for patients who are nearsighted, which means having difficulty seeing at a distance. The procedure uses a laser to reshape the cornea, allowing for better focus in distance situations.
However, now there is an enhanced procedure similar to LASIK that can help more people see better without a prescription. According to Bethlehem ophthalmologist Dr. Anthony Grosso, there is a “sweet spot” for vision correction using LASIK surgery. LASIK is typically used to treat patients with a -10 diopter value or less. (A diopter is the unit of measure physicians use to determine the refractive or focusing power of the lens in your eye.) Optimal patients for LASIK have a prescription or diopter value of -2 to -8. Most often, patients with prescriptions or diopter values of -10 or greater, or patients with thin corneas, are disqualified as candidates for LASIK.
Grosso says the newer version of the FDA-approved procedure called Visian ICL® is providing vision improvements to those who don't qualify for traditional LASIK. With this procedure, patients with prescriptions of -6 to -18 can now potentially be contact- or eyeglass-free. To understand these measurements using the 20/20 standard as optimal vision, -2 is roughly 20/400 vision. Someone with a prescription of -8 would be able to see and recognize a person standing in front of him, but it would be blurry. With a prescription of -10 or -18, a patient can't recognize the person in front of him at all.
Dr. Grosso admits it is a smaller population that falls into this category, but adds, “I wanted to be able to address any patient that came into my office and give them a solution.” Currently, he is the only area ophthalmologist performing the Visian ICL® procedure. Unlike LASIK surgery, the cornea is not re-shaped. Instead, a lens is implanted behind the eye's natural lens, complementing the eye's focusing power. As with all surgeries, there are risks, so consult with your doctor to understand any complications that could arise.
Advances are significant in glaucoma diagnosis, making earlier detection easier and treatment more effective. Glaucoma is the second leading cause of blindness, and once damage to vision occurs it is irreversible. Having better methods for early detection along with advances in treatment options means vision loss can be halted and possibly prevented. A family history of glaucoma, age, ethnicity, diabetes, heart disease, high blood pressure, hypothyroidism and long-term use of steroids can increase your risk, so don't bypass a good, thorough exam.
Patients diagnosed with glaucoma and facing cataract surgery may qualify for another option—an implant device that helps reduce pressure in the eyes called iStent®. Dr. Grosso says the device has helped many of his patients reduce their dependency on the prescription drops they previously used to manage the eye pressure associated with their glaucoma.
Wet Macular Degeneration, an eye disease that causes vision loss in the central field of vision, previously had few treatment options. New injectable treatments are now available that help reduce swelling/inflammation in the eye, in some cases recovering partial vision that had been lost. Risk factors that increase your chances of developing WMD include obesity, smoking, poor diet, cardiovascular disease, high blood pressure, a family history of macular degeneration and inflammation in the body.
Changes in eye health are often gradual and eye diseases can be asymptomatic. Eye care is much more than eyeglass prescriptions. Advances in eye disease detection and treatments, as well as advances in vision options, can have a dramatic impact on the way you view your world.
Dr. Suzanne Hauck, OD | Blink Optical Boutique | 524 N. 19th St., Allentown | blinkon19th.comDr. Lisa Bunin, MD | 1611 Pond Rd., Suite 403, Allentown | lisasbuninmd.comDr. Anthony Grosso | Bethlehem Eye Associates | 800 Eaton Ave., Bethlehem | bethlehemeye.com
By Susan Bianchi, MS Health & Wellness Coach
