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Eye Health and Diet

Healthy vision is important in ensuring quality of life. Two common threats to aging eyes are cataracts and age-related macular degeneration (AMD) which can, however, be prevented to some extend by a good diet.

Some important nutrients are found in common foods, and including them in the daily diet will help to preserve good vision throughout life. Antioxidants protect tissues from the toxic effects of free radicals which lead to a breakdown of cell membranes and nucleic acids.

Free radicals are formed when tissue is exposed to ultraviolet radiation as from direct sunlight, in cigarette smoke, and other air pollutants. The retina is exposed to a lot of light and is therefore a prime spot for free radical damage. This makes it all the more important to provide antioxidants that reduce the high level of oxidative stress.

Specific Nutrients

Lutein and zeaxanthin: Found in spinach and kale, as well as other green leafy vegetables, and also in eggs. These powerful antioxidants, which are typically found together in food, are known to reduce the risk of AMD as well as cataracts. They enter the retina and lens and prevent degenerative changes, absorbing light frequencies (such as blue and ultraviolet) which can promote free radical formation, especially the vulnerable macular area. Other sources include kiwis, grapes, collard greens, and broccoli.

Vitamin C or ascorbic acid is found in fruits and vegetables, and may reduce the risk of cataracts. AMD may also be slowed if vitamin C and other nutritional factors are taken in combinations. Vitamin C is found in grapefruit, strawberries, Brussels sprouts, ripe papayas, oranges, and green peppers.

Vitamin E or alpha-tocopherol is another powerful antioxidant found in nuts, sweet potatoes, and fortified cereals. It is also found in sunflower seeds, wheat germ oil, and vegetable oils.

Essential fatty acids: These fats are not synthesized in the human body but are required for the proper health and functioning of the nervous system, for energy metabolism and immunity. Among these, omega-3 fatty acids like DHA (docosahexaenoic acid) are vital for retinal function and for the development of vision, being concentrated on the outer parts of the photoreceptor cells. These are anti-inflammatory agents, which helps to prevent AMD. These fatty acids are found in salmon, herring and sardines, as well as tuna, halibut and flounder. Two servings or more a week are advised.

Zinc: This trace mineral is a cofactor in the transport of vitamin A from its storage site in the liver to the retina, where it is converted to melanin. This black pigment is essential in protecting retinal tissues against photodamage. High concentrations of zinc are present in the retina and the choroidal vascular tissue under the retina. Zinc is found in white meats from turkey, oysters, and crab meat, as well as eggs, peanuts, whole grains, and red meats.

Beta carotene which is found in all vegetables and fruits that are deep yellow or orange is part of the essential visual pigments, and its deficiency cases night blindness. Pumpkins, red peppers, carrots, sweet potatoes and winter squash are all prime sources.

Supplements – Do they play a role?

AMD may be prevented or slowed using supplements made to AREDS standards. AREDS stands for the pivotal Age-Related Eye Disease Studies which tested the formula of this mix of antioxidants clinically. The current AREDS 2 version contains more lutein and zeaxanthin than before, which covers any dietary deficiency. Unlike many other supplements, it doesn’t have beta-carotene and is therefore safe for smokers or those who have just quit. In this subgroup, this nutrient could cause a higher risk of lung cancer, though only at very high doses.

While no research suggests exactly how much of each of these nutrients is necessary to keep vision in good working order, the good old rule of five or more servings of colourful fruits and vegetable every day, with fish at least twice a week, seems to be most helpful in preventing eye problems with age.

By Dr. Liji Thomas, MD

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Risks Associated with Eye Make-up

Applying make-up is an everyday routine for millions of people worldwide. Even if a person only applies make-up once or twice a week, maintaining good make-up hygiene is essential in preventing skin irritations and serious eye infections.

How to practice good make-up hygiene

There are a number of simple but important steps that can help to prevent eye irritation and eye infections.

  • Renew your make-up every three months to reduce the risk of developing infections. This is particularly true in the case of eye make-up like mascaras or eyeliners. In some rare cases, women who have developed an eye infection from cosmetics have been temporarily or permanently blinded, according to the FDA. Some of these infections may stem from the make-up wands or brushes themselves.
  • Once a mascara wand or eyeliner brush comes into contact with the eyelashes, contamination of the applicator occurs as eyelashes naturally have bacteria on them. Over time, this contamination of both the brush and the container builds up and can lead to an increased risk of infection or allergic reactions.
  • For this reason, sharing cosmetics is not advised at any time, as bacteria can harm another person even if the original user does not experience any reactions or infections themselves.
  • Avoid applying make-up at the meeting of the eye and the eyelid to avoid blocking the important Meibomian oil glands, and causing dry eye.
  • Fortunately most people won’t experience any problems using make-up for longer than three months. If irritation does occur after using make-up products, it is essential to stop using the product immediately. If the irritation persists, medical attention should be sought.
  • Storing make-up products properly is also important. If cosmetics are stored in particularly hot conditions the preservatives in the products are at higher risk of deteriorating.

Risks associated with eye make-up

It is important to remove make-up before sleeping.

Ophthalmologist Dana Robaei published a case study in 2018 about a woman suffering from chronic foreign body sensation in both her eyes. The article detailed the harmful effects that can occur after leaving mascara on overnight.

After examining the eyes, Robaei found subconjunctival mascara deposition beneath both eyelids. This was due to over 25 years of heavy mascara use without taking care to remove it properly. Small pieces of mascara had built up inside the eyelid and formed into solid concretions that were scratching the cornea, resulting in irritation and discomfort.

The patient was left with permanent scarring on the cornea and on the eyelid after a surgical procedure to remove the built up concretions. Although Robaei clarifies it was a rare and extreme case, it nevertheless highlights the importance of removing eye make-up properly every night.

Other reports have been made about the risk of mascara-induced damage to the lacrimal drainage system, with one patient developing a dacryolith (a concretion usually comprising of lipids, epithelial cells and other debris) loaded with mascara.

Other reports in literature reviews on problems caused y mascara include eyelid dermatitis, infection keratitis, and mascaroma, among others.

Additionally, not all make-up applied to the eyes remains within the area of application. For instance, mascara can flake off and small particles travel in the eye, causing redness or irritation. In other cases, the eye can be scratched by make-up brushes or pencils that can then lead to serious eye infections.

Ensuring that any applicator used near the eyes is clean can help to reduce the risk of scratch-induced infections. However, the trauma caused by scratches may still trigger problems or reactions.

Summary

As most make-up and cosmetic products undergo rigorous testing before being sold, the daily use of make-up is thought to pose minimal initial risk.

It is when make-up is not removed properly, contaminated, or used when individual allergies are already apparent, that risks of infection, irritation and permanent damage to the application area increase.

A microbial study asked forty women to use one of two brands of non-waterproof mascara every day for three months. It was found that out of the 33 samples collected from the 40 women, microbial growth was present in over 36% of mascara containers.

As such, the need to practice good make-up hygiene is clear. Careful application of make-up around the eyes can reduce the risk of eye injury and subsequent irritation, infection, and loss of vision, in rare cases.

By Lois Zoppi, BA

Reviewed by Dr. Liji Thomas, MD

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FAQ: Cataracts and Cataract Surgery

What is a cataract?

A cataract is a cloudiness of the eye’s natural lens, which lies directly behind the pupil.

What causes cataracts?

The lens is mostly made of water and protein. The protein is arranged in a precise way that keeps the lens clear and lets light pass through it. But as we age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract, and over time, it may grow larger and cloud more of the lens, making it harder to see.

No one knows for sure why the eye’s lens changes as we age, forming cataracts. Besides advancing age, cataracts can also be caused by injury, chronic diseases and prolonged use of corticosteroid medication and smoking.

Can cataracts cause blindness?

Yes – if left untreated, cataracts cause continual loss of vision, eventually leading to legal blindness or even total blindness. Visual outcomes of modern cataract surgery are so good that a person who was legally blind prior to surgery often is able to see well enough to drive without eyeglasses after surgery.

When should cataract surgery be considered?

For best results from cataract surgery, it’s generally recommended to have the surgery performed before the cataract causes low vision or legal blindness. Advanced cataracts that cause severe vision loss are more difficult to remove and increase the risk of cataract surgery complications.

Are cataracts found only in older people?

Most cataracts develop slowly over time and affect people over age 50. About half of the U.S. population has a cataract by age 65. Nearly everyone over age 75 has at least a mild cataract in one or both eyes. In rare cases, infants can have congenital cataracts. These usually are related to the mother having German measles, chickenpox, or another infectious disease during pregnancy; but sometimes they are inherited.

My doctor says I have a cataract, but he wants to wait before removing it. Why?

Mild cataracts often cause little or no vision problems. Your doctor is probably monitoring your cataract to see if it worsens and more significantly affects your vision or lifestyle before recommending surgery. Some cataracts never reach the stage where they need to be removed. But if your cataract worsens and you begin to have trouble seeing clearly for driving and other everyday tasks, it’s probably time to consider cataract surgery.

Is cataract surgery serious?

All surgery involves some risk.

However, cataract surgery carries a very low risk and is one of the most rewarding and commonly performed surgical procedures.

How is a cataract removed?

A small incision is made in the front surface of the eye with a scalpel or diamond blade. A circular hole is then cut in the front of the thin membrane (anterior capsule) that encloses the eye’s natural lens. Typically the lens is then broken into smaller pieces with an ultrasonic device. Then it can be removed easily from the eye. Once the entire lens is removed, it is replaced with a clear implant called an intraocular lens (IOL) to restore vision. In most cases, the eye heals quickly after surgery without stitches.

What is a “secondary cataract”?

In a minority of cases (perhaps 20-30%), months or years after cataract surgery, the posterior portion of the lens capsule that is left inside the eye during surgery for safety reasons becomes hazy. This causes the vision to become blurred again. This “secondary cataract” (also called posterior capsular opacification) usually can be easily treated with a less invasive follow-up procedure called a YAG laser capsulotomy. In most cases, this 15-minute procedure effectively restores clear vision.

My grandfather had cataract surgery years ago, he had to wear thick glasses afterwards. Is this still necessary?

Rarely does anyone have to wear thick, heavy spectacles after cataract surgery these days. Most modern cataract procedures replace your eye’s natural lens with an IOL that often can correct your distance vision to 20/20. In many cases, your cataract surgeon can choose an IOL that will provide functional vision without any spectacles at all except perhaps for reading glasses.

What are the possible side effects of cataract surgery?

As with any surgery, pain, infection, swelling and bleeding are possible, but very few people experience serious cataract surgery complications. In most cases, complications or side effects from the procedure can be successfully managed with medication or a follow-up procedure.

To reduce your risk for problems after cataract surgery, be sure to follow the instructions your surgeon gives you and report any unusual symptoms immediately.

Are you awake during cataract surgery?

Most cases are done under local anaesthesia so, typically you are awake during cataract surgery.

This eliminates risks associated with general anaesthesia (being “put to sleep”) and enables your surgeon to communicate with you during your procedure. If this idea of being awake during surgery concerns your, fear not – you will be given oral medication before the procedure so you are fully relaxed and feel no discomfort.

The medication typically makes it difficult for most patients to remember their experience in the surgical suite after the brief 15 to 20-minute procedure has been completed and they are in the recovery area.

Some cases need to be done under full general anaesthesia and with modern anaesthetics this is very safe too.

Within a short period of time after your procedure, you will be able to leave the surgery center, but you should not drive after surgery. You should have someone with you to drive you home.

Can cataract surgery be performed on both eyes at the same time?

If you have cataracts in both eyes, surgery typically is performed on one eye. Then a few days or a few weeks later, it’s performed on the other eye. This approach allows the first eye to recover and your vision in that eye to stabilise before surgery is performed on the fellow eye. That said, modern cataract surgery is very safe and effective, and the rate of cataract complications is very low. This has led to some surgeons to begin offering simultaneous bilateral cataract surgery (SBCS) – in other words, cataract surgery performed on both eyes on the same day.

Cataract surgeons who support the idea of SBCS point out that a significant percentage of cataract surgeries in some European countries are performed in this fashion with no increased rate of complications. Also, advantages of same-day surgery on both eyes include lower costs, fewer office visits, faster recovery of binocular vision for driving and other critical tasks, and a quicker return to normal living.

Dr Clive Novis

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HIDDEN IN PLAIN SIGHT: How the Covid-19 Pandemic is damaging children’s vision

Eye doctors had planned to celebrate 2020 as the year of vision (as in seeing 20/20). Instead, it will be known as the year that worsened the world’s vision for decades to come.

Scientists are attributing this latest health issue – one that is hidden in plain sight – to the pandemic. Rates of myopia, also known as nearsightedness or shortsightedness, have been increasing worldwide for decades. Half of the world’s population is predicted to be myopic by 2050.

The length of time children spend viewing digital screens has been exacerbated by a massive increase in remote schooling, direct contributing to further increases in childhood myopia.

Home-schooled children of the COVID-19 era are at risk of becoming the visually compromised population of tomorrow.

A recent study of more than 120,000 children in China demonstrated that six- to eight-year-olds who were in lockdown for the first six months of 2020 are more myopic than their counterparts from previous years.

MYOPIA RISKS

For a child with myopia, distance vision is blurry while near vision remains clear. In the past, the increase in myopia diagnoses from year to year was given little thought, since it was correctable with glasses or contact lenses. However, eyecare professionals now know that the younger a child becomes myopic, the higher their prescription may eventually become, and high prescriptions are bad news for eyes.

There is an established link between high myopia and increasds lifelong risk of devastating eye diseases. Someone who has a prescription of more than six corrective units, or diopters, (a prescription of -6.00) has a 90 percent likelihood of being visually impaired by the age of 75.

A number of eye conditions are more prevalent in highly myopic adults including cataract, glaucoma, retinal detachment, retinal degeneration and other ocular diseases that can have a lifelong impact on their vision. These complications typically happen in later life, so concern for children may seem irrelevant or premature. However, there are other more immediate effects of high prescriptions.

A child or teenager with a fairly high prescription will be visually debilitated when not wearing their glasses or contacts, making them totally dependent on their vision correction. As an example, someone who has 10 diopters of myopia sees anything beyond half an arm’s length as blurred. And don’t think that laser vision correction will save the day once they’re old enough. That degree of myopia may leave them ineligible or subject to a less successful outcome.

SCREEN TIME

The question then turns to what causes myopia in the first place and what can be done about its onset and progression.

The biggest factor that can’t be changed is parental myopia. A child is extremely likely to become myopic if both parents are myopic.

One factor that is modifiable is the amount of time children spend on “near tasks”, those that involve viewing things closer than 40 centimeters from their eyes.

Extended periods of time spent focused on short distances is contributing to myopia increases. Digital screens have been targeted as the reason, but is it the electronic display itself or that a child holds a tablet or phone very close for extended periods? While there is some debates, the short focusing distance is the more like culprit.

Even with the digital onslaught, all is not lost. Parents and caregivers can help prevent children from becoming nearsighted and slow down the rate at which the condition progresses.

SIMPLY SPENDING MORE TIME OUTSIDE CAN DELAY THE ONSET OF MYOPIA.

Direct sunlight plays a part, as well as the long-range focusing while playing outdoors. Restricting screen time is an option with optometrist-endorsed recommendations relating to screen time for children. For children schooled at home where limits are not practical, ensure that the screen is not being held or positioned too close to a child, encourage regular breaks and use the 20-20-20 rule: look 20 feet (seven meters) away every 20 minutes for 20 seconds.

Some researchers have found that children who go to bed later are more likely to be myopic – an added incentive for parents who are looking for reasons to call it a night.

A child’s myopia usually continues to progress until around the age of 16,but about 10 percent of myopic patients’ vision keeps worsening into their early 20’s.

TREATMENT AND PREVENTION

Many options exist for vision correction, but more importantly, there are an increasing number of options available to slow down the progression of myopia and reduce the risk of developing sight-threatening complications in later life. They range from contact lenses and glasses specifically designed to slow down myopia progression to precisely formulated eye drops.

These can be discusses with your eyecare practitioner, who will recommend the best path based on each child.

More than anything else, do not assume a child can see well. There is no substitution for an examination with an eyecare professional. The pandemic has already caused widespread hardship. By acting now, parents can minimize its impact on the vision and ocular health of generations to come.

Debbie Jones, University of Waterloo

Kate Gifford, Queensland University of Technology

Source: THECONVERSATION.COM