November 2017


EYES ON DIABETES

A routine eye examination can show many things, from a minor change in a prescription or the need for a different contact lens solution, to a condition that may be life-changing or even life-threatening. One optometrist found this out first hand when he did what he does every day, an eye examination. But this was no ordinary examination. When he looked into his 48-year old patient's eyes, he noticed that blood and other fluids were leaking out of the tiny blood vessels at the back of her eyes. He suspected that this was a sign of diabetes, referred her for further testing, and his suspicion was confirmed.

Why are our eyes so vulnerable? Small blood vessels and nerves are very sensitive to changes in blood sugar levels in the body. As sugar levels rise in the blood of someone with diabetes, nerves and blood vessels are damaged. While this happens everywhere in the body, it is not visible because skin and bones block our view. Our eyes, on the other hand, provide an unobstructed view where the damage done to the delicate blood vessels and nerves in the retina can easily be seen by an optometrist, who is often the first professional to notice these changes.

Diabetic eye disease comprises a group of eye conditions that affect people with diabetes. These conditions include diabetic retinopathy, diabetic macular edema (DME), cataract, and glaucoma, all of which have the potential to cause severe vision loss.

Diabetic Retinopathy

Over a prolonged period of time, high blood sugar levels from diabetes damage the tiny blood vessels in the retina, causing them to leak fluid or blood and distort vision. Diabetic retinopathy may progress through four stages. In mild non-proliferative retinopathy, the earliest stage of the disease, small areas of swelling or micro-aneurysms may leak fluid onto the retina. As the disease progresses to moderate non-proliferative retinopathy the blood vessels may swell and distort, and begin to lose their ability to transport blood and essential nutrients to the retina. Severe non-proliferative retinopathy occurs as many more blood vessels are blocked, depriving areas of the retina of blood supply. These areas signal the retina to grow new blood vessels, leading to proliferative diabetic retinopathy as new blood vessels grow along the inside surface of the retina and into the vitreous gel, the fluid that fills the eye. These new blood vessels are fragile, making them more likely to leak, bleed or break. Resultant scar tissue can contract and cause retinal detachment, the pulling away of the retina from the back of the eye. If left untreated, this can lead to permanent vision loss.

Symptoms of Diabetic Retinopathy

In the early stages of diabetic retinopathy there are usually no symptoms. The disease progresses until it affects vision, at which stage it is often quite advanced. Changes in vision may be so gradual that they go unnoticed for some time. Blurred vision is often one of the first warning signs of diabetes. When other symptoms are present they may include floaters and flashes, poor night vision, sensitivity to light and glare, distortion of vision, and frequent changes in prescriptions for glasses. Some of these symptoms may indicate eye conditions other than diabetes, and need to be investigated. It is important to have a comprehensive eye examination if any changes in vision are noticed, and particularly if diabetes has been diagnosed.

Blurred vision may occur when insulin treatment for diabetes is started, but this should resolve once blood sugar levels stabilise.

"My vision changes along with my blood sugar levels. Some days I can see better than others." This comment by a person with diabetic retinopathy is typical of the nature of this eye condition.

Diagnosis of Diabetic Retinopathy

The optometrist will do a thorough eye examination, which includes visual acuity testing to assess clarity of vision at different distances and tonometry to measure pressure inside the eyes. The pupils may be dilated with eye drops, to allow the optometrist to examine the retina and optic nerve at the back of the eyes. He will check for changes to blood vessels, leaking blood vessels, and damage to the optic nerve which carries signals from the eye to the brain. If severe retinopathy is suspected, referral for further testing by an ophthalmologist may be necessary.

Treatment of Diabetic Retinopathy

The key to successful treatment is early detection! Although treatment cannot restore lost vision, it can slow the progression of the condition and prevent it from getting worse. Depending on the stage of the disease, treatment may include laser therapy to minimise leakage from blood vessels and reduce the proliferation of new blood vessels, or surgery to repair the most severe damage.

Control of blood sugar levels and maintaining a healthy lifestyle are fundamental to treatment, as expressed by someone with diabetes. "I learned that if I do everything I'm supposed to do, my vision seems to stabilise. My diabetes is now under control, and I'm able to use my magnifier, so I can see to test my sugar."

Diabetic Macular Edema

Diabetic macular edema, a consequence of diabetic retinopathy, occurs when the macula, the central area of the retina, swells from the build-up of leaking fluid. The result is the loss of central vision. It is the most common cause of vision loss among people with diabetic retinopathy.

Symptoms of Diabetic Macular Edema

Initially, it may be asymptomatic, with symptoms being noticed only once the condition has progressed to the point that changes in vision occur. When symptoms are evident, they are similar to those of diabetic retinopathy, and may also include wavy vision and changes in the perception of colour.

Diagnosis of Macular Edema

A comprehensive dilated eye examination is essential. As well as assessing visual acuity, eye pressure, and examining the back of the eye for blood vessel and nerve changes, the optometrist will notice that areas of the retina reveal spaces filled with fluid.

Treatment of Diabetic Macular Edema

The therapies for treatment of macular edema may be used separately or in combination. Treatment options include anti-VEGF injections into the back of the eyes to block the protein which stimulates the growth of abnormal blood vessels, steroid injections into the eyes to reduce the leaking of fluid, and laser therapy to seal leaking blood vessels and reduce swelling. In advanced proliferative diabetic retinopathy, surgery may be performed to replace the gel-like fluid in the eye with a clear solution. Some of these therapies may require more than one administration over a period of time.

Cataracts

Although aging is the primary risk factor for the development of cataracts, people with diabetes tend to develop cataracts at a younger age and more rapidly than those without diabetes. With the clouding of the lens of the eye, symptoms may include blurry vision, double vision, sensitivity to light, halos around lights, faded colours, and frequent changes to the prescription for glasses or contact lenses.

Glaucoma

Glaucoma is a group of diseases that damage the eye's optic nerve due to elevated pressure within the eyes. While it can affect anyone, the risk for glaucoma is doubled for people with diabetes. People with diabetes may also have a less common form of glaucoma, neovascular glaucoma, which develops as a complication of severe diabetic retinopathy. Symptoms of glaucoma include loss of peripheral vision or tunnel vision, halos around lights, reddening of the eyes, and eye pain.

ABC Reminder of Diabetic Eye Disease

ASYMPTOMATIC - there are usually no symptoms in the early stages of the disease. If you know you have diabetes, don't wait for symptoms to appear.

BOOK AN APPOINTMENT - Visit your optometrist for a dilated eye examination when diabetes is diagnosed, and at least once a year thereafter, or as often as your optometrist recommends. Early detection is the key to minimising visual complications of diabetes.

CONTROL YOUR BLOOD SUGAR LEVELS - While diabetic eye disease can be treated, treatment goes hand in hand with management of blood sugar levels and maintaining a healthy lifestyle.

14th November 2017


EYES ON THE BALL

Sport is an important aspect of the South African way of life. Whether just enjoying playing with a ball in the garden, participating in team sports, or taking sport more seriously, vision plays a fundamental role, and there are a number of factors to take into account. These range from the necessary visual skills for sport to the importance of eye protection and the enhancement of sporting performance with different types of eyewear.

VISUAL SKILLS FOR SPORT

Dynamic Visual Acuity - This is the ability to see clearly objects that are moving fast at the same time as the player is moving.

Visual Concentration - Our eyes normally react to what is happening around us and in our field of vision. Visual concentration is the ability to shut out distractions and remain focused on the activity.

Eye Tracking - Eye tracking helps us to maintain balance while following a ball or opponent with our eyes, without movement of the head.

Eye-Hand-Body Coordination - This is an essential element in most sports, affecting timing and body control. Eye-hand-body coordination is the ability of the hands, feet and body to respond to the information gathered through the eyes.

Visual Memory - Using the skill of processing and remembering a fast-moving complex picture, the athlete with good visual memory always seems to be in the right place at the right time.

Visualisation - Picturing yourself doing it can actually help you do it! Through visualisation, you see yourself performing well in your "mind's eye" while your eyes are concentrating on the activity.

Peripheral Vision - Much of what happens in sports does not happen directly in front of us in our line of vision. The ability to see action to the side without having to turn the head is important.

Visual Reaction Time - This is the speed with which the brain interprets and reacts to an opponent's action.

Depth Perception - Depth perception enables you to quickly and accurately judge the distance between yourself, the ball, your opponents, teammates, boundary lines and other objects.

If visual skills are not adequate, this can lead to poor performance, which in turn can affect enjoyment of the sport. Correction of vision problems with glasses or contact lenses, or a programme of eye exercises can help enhance vision skills, improve sports vision performance and build confidence. Discuss the best management option with your optometrist.

SPORTS INJURIES

Sports injuries, including eye injuries, are reported to make up a considerable percentage of doctors' visits and hospital admissions. Eye injuries include corneal abrasions (damage to the transparent front surface of the eye), blunt trauma (injury to the eye through sudden impact), swelling and bruising of the eyelids and surrounding tissue, bleeding behind the conjunctiva (the membrane in front of the eye), and penetrating injuries.

Flying objects are not the only hazard; in contact sports, eye injuries can occur from jabs in the eyes from fingers and elbows. Sometimes a black eye can mask a more severe injury, so it is advisable to have the eye examined by an optometrist or doctor. The absorption of ultra violet (UV) radiation from the sun is cumulative, and can damage the cornea and retina in the long term, causing future problems such as cataracts and macular degeneration.

CHOOSING PROTECTIVE EYEWEAR

As the saying goes, prevention is better than cure. With the guidance of your optometrist, the careful selection and fitting of protective eyewear for sport can help eliminate or minimise the dangerous effects of sporting injuries. While children may be resistant to the idea, eye protection is becoming more common, much as helmets have become accepted wear for cycling. A great deal of research is being conducted into the design of safe eyewear.

Ordinary glasses are not a substitute for protective eyewear, and can be more dangerous in situations where they could shatter.

Most sports frames are constructed of highly impact-resistant plastic or polycarbonate. Choose a lightweight frame for comfort, one that fits well, and cannot fall or be knocked off easily. Ensure that the frame covers the entire eye socket to protect the eyes against impact as well as UV radiation.

While side protection is important, peripheral vision should not be compromised. The frame should have padding at the temples and over the nose bridge to cushion impact. Some frames have a system that directs air through vents, preventing condensation on the lens during sport. For sports requiring helmets, frames are available to fit into helmets safely and comfortably.

Polycarbonate lenses are strong, lightweight and thin, and will not shatter on impact. Ensure that the lenses offer 100% UV protection. If it is necessary to wear glasses during sport, prescription lenses can either be fitted directly into the frame or inserted as a clip-in lens.

Discuss the best option with your optometrist.

Lens tints are an important component of sports eye wear, both for eye protection and enhancement of performance, by reducing glare, improving contrast and increasing depth perception. Green lenses transmit all colours evenly, dimming glare while brightening shadows. They are suitable for all outdoor activities in all weather conditions. A brown or amber tint contains a red element to enhance depth perception. It improves contrast in partly cloudy conditions, helping the player to distinguish the ball better against the sky or the surrounding grass. While a yellow tint may cause some colour distortion, it provides greater clarity in fog, haze and low-light conditions, such as dusk. Grey lenses are dark enough to provide overall protection and to reduce glare, particularly over water. They have anti-fatigue benefits, and offer true colour perception. For enhanced visual depth, reduced eye strain, good contrast, and comfort to the eyes, pink or red would be a suitable choice.

WHAT TO DO IN AN EMERGENCY

Even if an injury seems minor at first, the eye should be examined by a doctor or optometrist as soon as possible, as a serious injury is not always obvious immediately. Do not rub or apply pressure to the eye, or try to remove an object stuck in the eye. Gently cover a cut over the eye without applying pressure.


A JUMBO-SIZED OPERATION!

Win Thida, a 45-year old Asian elephant in an Amsterdam zoo, suffered an injury to her cornea after what was thought to be a tussle with another elephant. She was obviously in pain and struggling to keep the eye open, so the zoo called in vet Anne-Marie Verbruggen, who decided to fit a contact lens to protect and soothe the eye. She had often fitted horses with contact lenses, but this was her first attempt with an elephant.

Daily training sessions prepared the elephant for the procedure which took less than an hour. She had to remain standing during the anaesthetic, because elephants can't lie down for long as their immense weight hampers their breathing. As the vet climbed a ladder to reach her patient's eye, Win Thida remained calm and relaxed, was cooperative throughout, and was reported to be happier and more able to keep her eye open immediately after the operation. Protected by the contact lens, the wound on her cornea will now remain clean and be able to heal.

Win Thida has resumed her position as the dominant matriarch of the Amsterdam herd of elephants, and a favourite among visitors to the zoo.

While she may be the first of her species to be fitted with a contact lens, Win Thida is not the first animal to undergo such a procedure. The World Wildlife Fund has sponsored lens transplants for brown bears in a nature reserve in China, as it has been found that vision loss, often due to cataracts, has been found to stop endangered animals from reproducing. Special contact lenses that absorb ultraviolet light are sometimes fitted for horses suffering from "head-shaker syndrome", a painful and life-threatening condition. Rhinos have received contact lenses, which are the size of a man's fist!


WHAT GOES AROUND, COMES AROUND

I'm no fashionista. But every November I check out the fashion blogs and magazines to see what trends we can expect in 2018. And this year I thought they were getting mixed up - were they talking next year or were they talking fifty years ago?!

Lemme explain what I mean...

My friend Charlene is a pair of marble frames, and she hasn't seen the light of day in a while. But then she heard from her friend Lois that they're destined to make a big comeback in 2018. Lois saw something on the Fashion Channel, and now she's convinced all the major labels will try to do what she and Charlene were doing in the Seventies.

My friend Jimmy is a pair of aviators. And according to him, his kind never goes out of style. (Trust a pair of aviators to say that. I mean, they're nice guys and all but super-confident if you know what I mean...) So anyways, Jimmy has been talking for years about how he doesn't need to make a comeback - because he's never really gone away.

I was a bit suspicious when it came to Jimmy. Then I saw how many Hollywood celebs are wearing aviators, and now I think he might be onto something. After all, it only takes one movie star to set off an entire fashion trend.

Speaking of which, I saw a magazine that said 2018 will also be the year of oversized sunglasses. You know... the Sophia Loren kind. They're already making an appearance on the catwalks, so it looks like they're on their way back.

Same goes for ombre lenses, which is very good news for my friend Rochelle. She's a pair of ombres, and she tells the story of how she was laughed off the catwalk because "her time was up". She was declared Out Of Style by... well, I don't know... whoever declares what's stylish and what's not.

I think Rochelle has been living in Mauritius or something. Just wait until she hears she's back in fashion.

And I couldn't believe it when I heard that good old wire rims are back in vogue for next year. Back in the day, I guess frames were made from wire because it was the only way people knew how to make frames.

Imagine those pioneers were alive today. What would they think if they saw that their old-school frames are now classified as a hot fashion trend?

As they say, fashion is one big carousel where old becomes new... and so it goes, around and around and around. To be honest it makes my head spin, but I just try to relax and enjoy the ride.