August 2017


DON'T CRY! ITS BAD FOR YOUR EYES??

My grandmother used to tell me to stop crying because it was bad for my eyes. Crying, or to be more precise tears, are not only not bad for the eyes, but serve a vital function in eye health. They provide lubrication and moisture, helping to keep the eyes more comfortable and facilitating vision. When there is an imbalance in the flow or the composition of tears, dry eye syndrome can occur.

What are tears?

The eyes constantly produce tears, not only when we experience emotion. Healthy eyes are covered with a tear film, which prevents the eyes from becoming dry and enables clear vision. The tear film is made up of three layers, oil, water and mucus. The top layer, oil, comes from the melbomian glands which produce fatty oils. The oil lubricates the eyes and slows down the evaporation of tears from the surface of the eyes. The middle layer, produced by the lacrimal or tear glands, consists of water, salt, proteins and antibodies. Their function is to provide moisture to the eyes, cleanse the eyes of irritants, and prevent infection. The inner layer, mucus, enables the tears to spread evenly over the eyes.

What causes dry eyes?

Problems in any of the layers of tear film can lead to dry eyes. Inadequate oil levels can cause the tears to evaporate too quickly, causing dry patches on the surface of the eyes. Any condition that causes blocking of the melbomian glands can cause dry eyes. If the tear glands produce fewer tears or the water layer is too thin, the tear film may become unstable and break down, or cause the oil and mucus layers to touch each other resulting in a discharge from the eyes.

There are a number of factors that can influence adequate production, composition or flow of tears. Although dry eye syndrome can occur at any age, it is more common in older people, particularly post-menopausal women, as part of the natural aging process. Autoimmune conditions such as rheumatoid arthritis, lupus and scleroderma often affect the production of tears, as does diabetes and vitamin A deficiency. Dry eye syndrome can be one of the side effects of certain medications, for example antihistamines, decongestants, diuretics, birth control pills, antidepressants, and some drugs for acne. Sometimes dry eye syndrome is a temporary side effect of refractive eye surgery. Environmental influences include air conditioning or heaters, smoking or a smoky atmosphere, high altitudes or certain climatic conditions. Some contact lens wearers experience dry eyes.

Most people blink about five times a minute. Problems with the eyelids can affect the blinking motion that spreads the tear film evenly across the eyes, causing the eyes to dry out.

Activities that require increased visual concentration, such as extended periods of reading, staring at a computer screen or driving may slow down the blinking rate, leading to dry eyes, but this is temporary.

What are the symptoms of dry eye syndrome?

If you have dry eye syndrome, you may experience a range of symptoms including itching, redness, burning, a gritty feeling in the eyes, blurry vision, extreme sensitivity to light, eye fatigue after reading or watching TV for a short time, discomfort when wearing contact lenses, or mucus in or around the eyes or eyelids particularly on waking up.

Excessive watering of the eyes, which may seem a contradiction to dry eyes, is a typical symptom. This reflex tearing happens because the lack of moisture irritates the eyes, sending a distress signal through the nervous system to the brain for more moisture. A flood of tears is sent to try to make up for the dryness. However, these tears are mostly water, so, although they can wash debris away, they can't coat the surface of the eyes or provide long-term relief.

How are dry eyes treated?

Tests can be performed to reveal the quantity and quality of the tears, as well the tear flow and rate of evaporation of the tears. Generally, the aim of treatment is to keep the eyes lubricated, and there are a number of options to achieve this, depending on the cause and severity of the problem. Discuss these with your optometrist who will guide you to making the most appropriate choice for your condition.

Certain life style changes can help to ease the symptoms of the dry eye condition by making the most of the natural tears. Using a humidifier in the home helps to keep the atmosphere from being too dry. Avoid smoking and smoky places, and wear wrap around glasses outdoors for protection against the drying effects of wind. Be consciously aware of blinking frequently when reading, watching TV or using the computer. There is some evidence that increasing omega-3 and omega-6 fatty acids in the diet may help prevent dry eyes, but this is not conclusive. Sources of these include oily fish, olive oil, walnuts, hemp oil, flax seeds and soybeans.

The most common treatment is artificial tears and ointments. Many types of eye drops are available over the counter to lubricate mildly dry eyes. Your optometrist will be able to recommend suitable products. No one product works for everyone, so you might have to try a few until you find the one that works for you. Eye drops without preservatives are usually preferable, and drops to remove redness often exacerbate the problem so should not be used. If you have chronic dry eye, you need to use the drops even when your eyes feel fine, so that they remain lubricated. The eyes often dry out at night, so it may be best to use an ointment then. A scleral contact lens may be fitted, creating a fluid-filled layer over the eye to prevent it from drying out.

Blocking the tear ducts which drain tears from the eyes may be necessary to conserve tears. This may be temporary, with the insertion of a plug which will dissolve over time, or permanent with a non-dissolving plug or cautery (applying heat to close the tear duct). Either of these may be used in conjunction with artificial tears.

Dry eyes may sometimes result from inadequate closure of the eyelids for a variety of reasons. Some of these may need to be surgically managed.


FLOATERS AND FLASHES – THE INSIDE STORY

Do you ever experience specks, threads or cobwebs in your line of vision, only to see them disappear when you try to focus on them? Or do you see flashes of light or sparks flickering across your field of vision when there is nothing there? Both of these are common occurrences for many people, and, although they may be irritating or alarming, they are usually harmless. Although they seem to be outside the eye, they are actually coming from within the eye itself.

FLOATERS, FLASHES AND HALOES

Floaters are a common complaint, as are flashes, but to a lesser extent. The two may occur separately or together, depending on the underlying reasons. Haloes are less common.

The small specks or threads drifting in the line of vision are called floaters. They may have different shapes, which move as the eyes move, and drift slowly when the eyes are still. Floaters are actually tiny clumps of gel floating inside the vitreous humor, the fluid that fills the inside of the eye.

The vitreous humor is a clear jelly-like fluid with the consistency not unlike raw egg white. It fills the rear two thirds of the eye, providing a pathway to the back of the eye for light entering through the lens. It is contained within a fine membrane attached to the lens at the front of the eye and the retina at the back. As we age, the vitreous gel starts to thicken, shrink or become stringy, forming clumps or strands that move inside the eye. What we see is not the floater itself, but the shadow it casts on the retina.

In some cases, the retina can tear as the shrinking vitreous gel pulls away from the wall of the eye. A torn retina can lead to a retinal detachment, which is a potentially serious problem that needs to be attended to as soon as possible.

Experiencing flashes in the eye, often at the edges of vision, is fairly common. Flashes can vary from a bright light to almost a sparkle, and last a varying length of time. As the shrinking vitreous gel pulls or bumps against the retina at the back of the eye, signals are sent to the optic nerve which transmits them to the brain. The brain interprets the signal as light even though there is no external light present, and the stimulus is coming from within the eye.

Eventually the vitreous tends to pull right off the retina, a condition called posterior vitreous detachment. This condition is not harmful to the eye or vision, and happens to most people as they age, but occasionally it can cause the retina to tear. Increasing, persistent, constant or sudden appearance of flashes may indicate that the retina is at risk of tearing or has been torn or detached. Visit your optometrist immediately, as this could be serious and needs to be managed as soon as possible.

Although not strictly flashes, some people experience what is known as pseudoflashes. These may include photophobia (extreme sensitivity to light) and glare. Some people who suffer with migraines experience flashing lights in the eye. Usually, in the case of migraines, these occur in both eyes at the same time. They can last up to an hour and tend to increase to a maximum before fading away and being replaced by a headache.

Haloes are rainbow-like coloured rings around lights or bright objects. They usually occur because there is extra water in the layers of the eye, due to excessive tears, overuse of contact lenses, cataracts, chronic glaucoma or side effects of some medications. A potentially serious cause of haloes is acute glaucoma, a condition which usually occurs suddenly and is characterised by increased pressure in the eye. This is a painful condition which can threaten sight if not treated promptly.

Although haloes are common and not harmful to vision, they can be uncomfortable and unpleasant. Night driving can be stressful and difficult, because of the halo effect on street lights and the lights of oncoming cars.

CAUSES AND RISK FACTORS

As discussed, changes in the vitreous humor due to the aging process are the most common cause of floaters and flashes. Other risk factors include inflammation in the eye, diabetic eye disease, and recent eye surgery. People who are very shortsighted are at a greater risk for developing floaters earlier than normal, and for retinal tears or detachment. Floaters will result from any internal damage to the back of the eye. Retinal tears and retinal detachments will also cause floaters and these will vary in severity depending on the severity of the damage.

WARNING SIGNS OF PROBLEMS

Sometimes floaters and flashes signal a condition that can lead to vision loss. Retinal tears and detachments are painless, but certain warning signs indicate that you should consult your optometrist as soon as possible. These include a new and sudden onset of floaters or flashes, gradual shading of vision from one side, changes in vision, or a sharp decline of central vision. The earlier a retinal tear or detachment is detected, the earlier it can be treated, and the more positive the outcome is likely to be.

TREATMENT

While most floaters and flashes are not serious, a regular eye examination is advisable to make sure there is no retinal damage and to check the pressure in the eyes. The treatment will depend on the underlying condition, if there is one. There is no specific treatment for the separation of the vitreous gel from the retina, but surgery or laser therapy may be required for retinal detachment or tears.

LIVING WITH FLOATERS

If your floaters aren't a sign of retinal damage, they may disappear, become less noticeable, or stay and become irritating. Floaters can be removed, but for most people the risk to vision from the surgery is greater than the problem posed by the floater. If floaters become a nuisance, move your eyes up and down or left to right – this should provide temporary relief by shifting the floater.


WOMEN IN EYECARE

As Women's Day approaches on 9th August, it is an opportunity to commemorate the courageous deeds of women in history, as well as to celebrate the contributions made by women in all fields. One such woman is Patricia Bath, a pioneer in ophthalmology.

Born in Harlem, New York, on November 4, 1942, Patricia Bath became the first African American to complete a residency in ophthalmology in 1973, and to receive a medical patent in 1988.

At the age of 16, Bath became one of only a few students to attend a cancer research workshop sponsored by the National Science Foundation. The program head, Dr. Robert Bernard, was so impressed with Bath's discoveries during the project that he incorporated her findings in a scientific paper he presented at a conference. The publicity surrounding her discoveries earned Bath the Mademoiselle magazine's Merit Award in 1960.

While pursuing a fellowship in ophthalmology at Columbia University, her research led her to the development of a community ophthalmology system, which increased the availability of eye care to those who were unable to afford treatment.

In 1976, Bath co-founded the American Institute for the Prevention of Blindness, which established that "eyesight is a basic human right." Its motto is "to protect, preserve, and restore the gift of sight".

In 1981, Bath began working on her most well-known invention: the Laserphaco Probe (1986). Harnessing laser technology, the device created a less painful and more precise treatment of cataracts. She received a patent for the device in 1988, becoming the first African-American female doctor to receive a patent for a medical purpose. (She also holds patents in Japan, Canada and Europe.) With her Laserphaco Probe, Bath was able to help restore the sight of individuals who had been blind for more than 30 years.

Among her many roles in the medical field, Bath is a strong advocate of telemedicine, which uses technology to provide medical services in remote areas.

When asked in an interview about her most special moments during her career she answered: "The ability to restore sight is the ultimate reward".


HER EYES

With Women's Month upon us, I gotta say something. If I ever find myself on a plane travelling through dark, stormy skies, I'd want a woman to be my pilot. Why? Because women's eyes are so much better than men's. I'm talking super-advanced exceptional vision.

Think about it...

A man looks for something three times, but he still can't find it. It could be a missing sock or a TV remote or one of his very own children. His wife looks and finds it first time around. In fact, she told him where to find it before she even started looking. And of course she was right (which he hates to admit).

A woman's eyes can find a parking space from at least one hundred metres away. No matter how crowded the parking lot is, her laser eyes would put Superman to shame in their ability to seek out the free space. Her man would rather park in the first space he sees, which is exactly... you guessed it... one hundred metres from the mall entrance. And then he has to pretend he doesn't see the parking space right next to the entrance. You know, after he's just made his wife walk a distance of one hundred metres.

A woman and a man have the same number of eyes. But a woman can use those eyes to watch three kids, a boiling pot on the stove and a TV show... all at the same time. For generations, moms have warned kids they have eyes at the back of their heads. And you know what? I believe it. I mean... just look at the proof.

A woman knows how to read the fine print, and not just when it comes to paperwork. She can read the words between the words, and find out what people are actually saying. A man will listen to a friend talk about a first date, and all he'll find out is the quality of the steak. A woman listens to the same story and builds an entire case file about both parties – full relationship history included.

A woman can see potential. She can look at a rundown old house and already see the colour of the paint on the newly-renovated walls. A woman can see when her kids are hungry just by looking at them. She can also see when someone really needs to have a good chat.

Okay, I'm getting soppy now and it's not really in my nature. Point is a woman's eyes are unlike anything else in the world. A man's hearing is pretty amazing too. He can hear a rugby match all the way down the street. Then again, he can't hear a woman calling from the room next door. But that's another story for another time.