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Macular Degeneration – Don’t Risk Losing Sight

Age-Related Macular Degeneration (AMD) is a progressive disease that can destroy you central vision, which can affect your ability to read, drive, watch TV and recognize friends and loved ones. Experts have calculated that one in ten people will lose vision vision from AMD in their lifetime.

Your central vision is controlled by a part of the retina called the macula. Early changes due to AMD usually only mildly distort this central vision, but approximately 20% of those with AMD will progress to advanced AMD, and if not caught early enough they will experience significant vision loss. One eye is usually affected before the other, and unfortunately because of this almost 80% of people don’t see their eye doctor until it is too late to protect the vision in that eye. To catch vision loss early, regular eye examinations are very important.

Approximately 30% of a persons risk of AMD comes from modifiable risk factors (things you can control).  Things that will help reduce your risk of developing AMD are stopping smoking and increasing dietary antioxidants (dark green and brightly colored vegetables). It is also important to control blood pressure, cholesterol and body weight.  You want to protect your eyes from Ultraviolet light (UV) with UV-protective eyewear and also supplement your diet with specific supplements designed to help boost macular health.

The other 70% of a persons risk of AMD comes from inherited factors (from our DNA). There is now a genetic test called “Macula Risk” that has a predictive power of over 80% in determining the chance of a person developing advanced macular degeneration. The genetic test detects eight variations within four genes that are known to be indicators for risk of vision loss. The results of those four genes along with your smoking status are used to determine which of five risk categories you are placed into.  This risk level is then used to determine which preventative measures and therapeutic interventions best suit your individual needs.

As with most things health care related, early detection is the key.  If you haven’t already, plan to schedule you eye health examination today!

“Sunglasses – Protection and Style”

Spring means Sunscreen and Sunglasses.  As the weather begins to warm, more and more people wake from their winter slumber and begin to venture out doors. When you are outside this Spring and Summer don’t forget to wear sunscreen and don’t forget to wear your sunglasses.

Protect Your Eyes from Damaging UV Light

Good Ultraviolet (UV) protecting sunglasses are critical to your eye health. Leaving your eyes unprotected from the sun leaves you vulnerable to the harmful effects of the sun’s radiation, increasing your chances of developing everything from skin cancer on your eyelid to macular degeneration and premature cataracts.

The skin and the eyes are the only two organs directly exposed to ultraviolet (UV) light radiation.  Studies have shown that 6 percent of skin cancers begin on the eyelid. Sun exposure is one of five contributing factors to macular degeneration.  UV exposure puts the eyes at a greater risk for developing premature cataracts.  Sun glare has been linked as a contributing cause of traffic accidents.

Only Quality Sun Glasses Protect the Best

One question I hear from my patients is “what is the difference between the glasses at a department store and the ones you carry?”  One big difference is the quality of the lenses used.  Eighty percent of mass merchandised sun lenses are punched out of acrylic.  Acrylic is NOT suitable for any lens material. In fact the downside of acrylic lenses had been repeatedly reported to cause eye strain, blurred vision, improper UV filtering/blocking and distorted optics (distorted vision).

Sunglasses can be made both with prescription and non-prescription lenses, polarized and non-polarized lenses, mirrored coats, different lens colors, no glare lenses, etc. The options are so many our opticians can customize your new sunglasses to your vision, your eyes and the activity you use the sunglasses while doing.

Give us a call at Annandale EyeCare (703) 941-4111 and we’ll be able to help you have fun in the sun, both in high style and fully protected!

“Court”

Courtney D. Thelen, O.D.
Optometrist
Annandale EyeCare
Annandale, Virginia

“February is Macular Degeneration Awareness Month”

Macular Degeneration is one of three leading causes of blindness. It affects the most sensitive portion of the retina called the macula. The macula is responsible for your central vision (reading, driving, watching TV, etc.). According to the American Optometric Association, over 1.6  million Americans age 50 and older are affected by Macular Degeneration. There are two types of Macular Degeneration; Wet macular degeneration and Dry macular degeneration.

The symptoms of Macular Degeneration vary, but generally they start with blurry or distorted vision when reading or watching TV, for example.  Straight lines such as the edge of books or telephone poles may appear distorted. There may also be dark spots or spaces in your central vision. The symptoms may be similar for both Wet and Dry Macular Degeneration.

There are some risk factors that you can control. High Blood Pressure and High Cholesterol both can raise your risk of Macular Degeneration. Obesity can also raise your risk. Studies have shown that smoking will double your risk of developing Macular Degeneration.

There are also some risk factors that you can not control. Some of these are age; People over the age of 60 are at higher risk. Another is family history; if Macular Degeneration runs in your family, you may be at a higher risk. Gender is another factor, women develop Macular Degeneration more than men.

What is the difference between Wet and Dry Macular Degeneration?

Both types of ARMD usually affect both eyes and lead to progressive loss of vision.  Both can cause decreased vision and distortion, the two most common symptoms of macular degeneration.  The biggest difference between the two forms is that the wet form progresses much more quickly and aggressively.

Fortunately, Dry Macular Degeneration is more common that the Wet Form. In fact, almost 90% of the cases are Dry. Dry is also slower in it’s development, than the Wet form. Wet Macular Degeneration is much more severe, and in many cases the vision can become severely damaged in a very short period of time. Wet implies the formation of abnormal blood vessels in the retina.

What are the treatment options for Macular Degeneration?
There are currently no treatment options for Dry Macular Degeneration. A lot of doctors will advocate the use of vitamin supplements to help try to slow the progression of the disease.
Wet Macular Degeneration has treatment options available, from anti-VEGF injections, Photodynamic Therapy and Laser Photocoagulation.

A lot of research has been and is being done to improve treatment options.  But one thing that all specialists will agree on is to have your eyes checked regularly. Early detection is the key in all eye related conditions.

For more information about macular degeneration, we recommend you visit www.RetinaEyeDoctor.com.  We work closely with Dr. Wong, a retina specialist for our patients in Northern Virginia, who has created this website for patients with retinal disease.

“Do you have Dry Eye Syndrome?”

If your eyes burn, itch, or water  or if you have a sandy, gritty, “feels like something is in my eye” sensation you may have Dry Eye Syndrome.  If your eyes get red, especially after using the computer or reading, and if your vision fluctuates between clear and blurry you may have Dry Eye Syndrome.

The front of your eyes are covered by a thin layer of tears.  Tears are vital to keep your eyes healthy and your vision clear. The tear layer (tear film) consists of three layers; a oily layer at the top which prevents tear film evaporation, a thicker watery layer in the middle which contains water and nutrients, and a thin mucus layer at the bottom which allows the tear film to spread evenly over the eye.

Every time you blink a new layer of tears spreads across the front of your eye. If the tear film begins to evaporate before your next blink, the front of your eye (the cornea) begins to dry out. If the cornea begins too dry you can become symptomatic. These symptoms can range from a gritty, sandy feeling in the eyes, to a severe foreign body sensation, feeling like you have something stuck in your eye.  Sometimes the eyes will burn, sometimes they will itch. A lot of times the eyes will water, which may not make a lot of sense. If the eyes are dry why are they watering? When this occurs the body is trying to compensate for a lack of moisture or nutrients and does so by flooding the eye with the watery part of the tears. This would seem to solve the issue, however, more isn’t always better.  We need good quality and quantity of tears.

Studies have shown that we make fewer tears as we get older. In fact, when someone is 60 years old they make almost 40% fewer tears than they did when they were 18.  If the quality of your tear film isn’t optimum, and/or if the volume is too low you are on the way to developing Dry Eye Syndrome and the symptoms are soon to follow.

Dry Eye Syndrome is both chronic and progressive. That means the eye will continue to be dry in one form or another most of your life, and also, if we don’t do something to improve the tear film in the early stages, it will most certainly get worse, and sometimes very uncomfortable and blurry. As your eye doctor I look at the quantity and quality of your tears during your annual eye health and vision evaluation. Depending on the cause of your Dry Eye Syndrome I can tailor a treatment plan designed to help your body make better tears and help keep those tears on the eye longer.

What is Glaucoma?

More than 2 million Americans have glaucoma, yet many don’t even know they have this potentially blinding disease.  Glaucoma is a potentially blinding disease that increases in prevalence (it affects more of us) as we get older.

January is National Glaucoma Awareness Month.  Most people don’t understand the disease, do you?

Glaucoma describes a progressive disease of the optic nerve.  While there are various types of glaucoma, there is one common denominator…blindness is caused by damage to the optic nerve.  The optic nerve is the major connection between the eye and the brain.  If the optic nerve is damaged, or disease, we don’t see.

Symptoms of Glaucoma

The initial symptoms of glaucoma or so subtle, and so slow, that patients with glaucoma report no symptoms.  Only in cases of advanced glaucoma does the central vision become impaired.  Glaucoma typically affects the peripheral (side vision) first.  Damage from early glaucoma can be detected using a visual field or an HRT machine.

Advanced glaucoma may cause “tunnel vision” and/or complete blindness.  Obviously, early testing and treatment is essential to diagnose early cases.

Risk Factors for Developing Glaucoma

The major risk factors for developing glaucoma include race, increasing age, and a family history of glaucoma.  While Asians are at highest risk for developing “narrow angle” glaucoma, “open angle” glaucoma is the most common form of the disease in the U.S.

High intraocular pressure is only a risk factor for glaucoma, it does not cause glaucoma.  While there is a high correlation between high eye pressure and glaucoma, patients with “normal” pressures may still have the disease.

Making the Diagnosis

During your annual eye wellness exam, we check your pressure, dilate your eyes and examine your optic nerve.  In cases where we suspect glaucoma, additional testing with a visual field and HRT may be necessary.

Making the diagnosis of glaucoma is very difficult.  It is a disease that is best diagnosed over time, looking for subtle, gradual changes over several exams.  If you are at risk for glaucoma, regular and routine examination is critical.

Treating Glaucoma

While a high pressure is not diagnostic of glaucoma, glaucoma treatment is focused on lowering the intraocular pressure.  There are a variety of drops, laser treatments or even surgery that may be required.

What Can You Do?

Regular examination is the only way to detect glaucoma.  Routine evaluation of your eye pressure, periodic visual fields and evaluation of your optic nerves are the best ways to detect this disease.

During your eye wellness exam, we carefully check all these parameters in addition to a comprehensive interview to see if you are at risk for this “silent” disease.

“Protection from Ultraviolet (UV) Light”

Protection from Ultraviolet light (UV for short) is a concern for a lot of people, but most are thinking about their skin, not their eyes. In a recent survey, sponsored by Transitions Optical, found that 79% of Americans knew that extended exposure to sun could cause skin caner, but only 6% knew the same exposure could damage the eyes and ultimately affect vision.  The affects of Ultraviolet (UV) light are cumulative, which means the longer your eyes are exposed to UV, the greater the chance of developing conditions of the eye.

There are three types of Ultraviolet light; UV-C, UV-B and UV-A. UV-C is absorbed by the Earth’s ozone layer and doesn’t pose any threat. On the other hand, UV-A and UV-B can cause sunburns and other damage potentially leading to skin cancer. But it can also play a role in a vast number of eye disorders, such as cataracts, macular degeneration, pterygium (growths on the white part of the eye) and photokeratitis (a “sunburn” of the cornea, or clear part of the front of the eye). As your eye doctor, I always check for the tell-tale signs of too much sun exposure during your eye examination.

UV light is reflected off of surfaces such as snow, water and sand, so exposure is particularly high at the beach, while boating and on the ski slopes.  The risk of exposure is greatest during the mid-day hours (10 AM – 3 PM) and during the summer months, but exposure occurs during all daylight hours, rain or shine, and all seasons of the year. The exposure is also greater the closer your are to the equator, so residents of the southern United States are at greater risk. UV levels are also greater at higher altitudes, such as in the mountains.

The eyes should be protected from Ultraviolet (UV) light any time they are exposed, even on cloudy days or during winter months. UV protection can come from shading the eyes with a wide brimmed hat or cap and from Ultraviolet (UV) absorbing eye wear. The UV absorbing eye wear has the greatest measure of UV protection, especially if it is a wraparound design which limits light from the side entering the eye.

Ultraviolet protection is most commonly thought of as sunglasses, however, UV protection can also be found in clear, non-tinted lenses as well as lenses that change color depending on the amount of sunlight you are experiencing. All options have their benefits, and as your eye doctor I can help you decide which option fits your lifestyle the best. Whatever lens we choose, I want to make sure it blocks 100% of both UV-A and UV-B light, and helps protect your precious vision.

“Computer Vision Syndrome”

How many hours do you spend on the computer each day?  A recent study claims that the average American spends 8 1/2 hours in front of a screen of some sort; whether that’s on a computer, television, mobile phone, PDA or other gadget. When you look at objects close to you muscles inside of the eye contract and allow the eye to focus or accommodate.  The longer you use your eyes looking at close objects, the more tired the focusing muscles (ciliary muscle) get. Studies have shown that between 50 and 90% of computer users have some vision strain symptoms related to their use of computers, PDA’s, mobile phones, etc.

Symptoms of “Computer Vision Syndrome”

As your eyes begin to get tired the symptoms start gradually, perhaps rubbing the eyes, perhaps vague discomfort between the eyes or at the base of your head. As the eyes continue to tire the symptoms begin to become more severe; headaches, blurry vision, double vision, burning eyes, red eyes, watery eyes, neck and shoulder pain and sometimes general body fatigue.  This has been termed “Computer Vision Syndrome.”

What can be done about “Computer Vision Syndrome”

Short of not using the computer, the Blackberry or the iPhone what can be done about “Computer Vision Syndrome?”  As your eye doctor I am able to measure the amount of focusing ability your eyes naturally have and then I can develop a prescription lens specifically designed to help your eyes work on the computer as well as reading printed material held closer than the computer monitor. The lens is designed to help the eyes focus easier on the computer screen, and when paired with a non-glare lens material the glasses can help the eyes focus easier and longer and help reduce the symptoms of “Computer Vision Syndrome.”

In addition there are computer and visual ergonomics you can try to implement that can also help with some of the symptoms of “Computer Vision Syndrome.”

Sit with your head and neck upright and lined up with your spine, not bent down or tilted back. Using good posture can help avoid neck and back strain.

Directly face your computer screen, don’t look at the screen to the side. This helps with good posture.

Use a chair that supports your lower back.

Position the computer screen so that it sits slightly below eye level. Helps avoid having to tilt your head back to see upper portions of the screen.

Try to prevent reflections from overhead or outdoor lighting.

Take frequent vision breaks; try to look away from the monitor every 20 – 30 minutes.

“Contact Lenses Need a Special Examination”

Designing a contact lens prescription requires a series of measurements typically called a “Contact Lens Fitting and Evaluation.” The measurements are additional tests done above and beyond your eyeglasses prescription and annual eye health evaluation.

The tests are designed to measure the size and shape of your cornea (the clear part of the front of the eye), recalculate your eyeglasses prescription to the new contact lens power, examine the contact lens to make sure it fits your eye properly and to make sure the contact lenses don’t change the health of the eye.

Why is this important?  When a contact lens is inserted onto your eye the amount of oxygen the eye receives is reduced, sometimes drastically; I need to monitor this to make sure your eye is “breathing” adequately.

Also, the contact lens has a tendency to dry throughout the day.  When a contact lens dries out the only source of moisture it has is your eye’s tear supply.  A lot of people’s eyes don’t have enough tears (dry eye), and if the contact lens is soaking up too much moisture discomfort is sure to follow. This could be as minor as being aware of the contact lens in the eye, to more extreme symptoms and the need to take the contact lens out sooner than you would like.

Additionally, as you wear the contact lens you come into contact with all sorts of foreign material; dust, pollen, bacteria, etc. The contact lens solutions you have been recommended are designed to clean and disinfect your contact lenses, but I need to make sure the eyes are as healthy as they were when you started to wear contact lenses.

Contact lens prescriptions are only valid for one year, and Contact Lens Fitting and Evaluation are performed yearly.

“Refraction: The Art of Developing Your Eyeglasses Prescription”

The portion of an eye examination that develops the prescription for eyeglasses is called a refraction, and causes a lot of anxiety in my patients. Since I first became an eye doctor I’ve heard patients grumble “oh I hate this test,” or “I can never seem to get this one right.”  But what exactly is going on….what exactly am I looking for when I ask “which is better?”

The process was originally designed by Dr. Edward Jackson in 1893, and eye doctors have been tormenting their patients since then.

The procedure is called subjective refraction, but let’s not get bogged down in a lot of lofty scientific terminology. Basically what the process involves is comparing lenses from an initial lens power with the end goal of clear comfortable vision; your final glasses prescription.

The initial lens could be your current glasses prescription, it could be computer generated (auto refractor), or manually obtained (retinoscopy). That initial lens power will be entered into an instrument called a phoropter. Much like a mechanics tool box, the phoropter has every combination of lenses your eye doctor can use to determine how strong to make your glasses. Your eye doctor will ask you to look at a lens power one step stronger and one step weaker (one or two) and ask you which looks clearer. Depending on which lens you choose, your eye doctor will then compare that choice to another lens power, one step stronger and one step weaker (“Which is better: three or four”).

Clearer being the key word…..because in many cases neither lens choice is very clear, and sometimes both are pretty good.

Don’t worry about picking the wrong number, because if you do happen to choose the wrong one, the next pair of lenses takes you back to where we were.

But in the end, when one and two look almost identical we’re at the end point and your eyes should be able to see their very best; this is your glasses prescription!

“How Often do you need an Eye Exam?”

I recommend annual exams to all of my patients.  Annual eye health and vision examinations are so important to ensure that you see and function properly.

As your eye doctor I am interested in helping you see your very best.  Sight is probably our most important sense.  Think about how many things you do on an average day that require the use of your eyes (e.g. seeing the alarm clock, reading the paper, looking at the metro sign, reading email, watching television, just to mention a few).  During your annual eye exam, I measure how your eyes see in the distance, how well they focus up close and how well they work together.  I then develop a customized plan to help you see better at all distances.

“Well, I’m seeing pretty good, so I guess I don’t need to come in this year.”  If vision was the only thing we evaluated at an annual eye exam that might be true. However, as your eye doctor I am also very concerned about the health of your eyes and the clues the eyes give us as the health of the rest of your body. Many of the eye conditions and diseases that can affect health of the eye and the quality of the vision don’t have any symptoms, at least until very late in the process. Early detection is crucial in many of these conditions to help control the disease and also help protect your vision; glaucoma and macular degeneration are only two examples of some of these conditions.

Beyond the eye conditions that can be detected during an eye health exam I also monitor some of the conditions that affect the rest of the body. The eye, more specifically the retina, is the only part of the body where blood vessels may be seen directly. So in conditions such as high blood pressure and diabetes evaluating the health of the blood vessels becomes a key part of the control of both these conditions. In fact, there are a number patients in our practice that did not know they had diabetes until I saw them for their eye health examination. Based on my examination alone, I was able to initiate the diagnosis of diabetes in my patients simply by looking at the retina.  They had no symptoms.

Annual eye examinations help to maximize your your health and visual function.  You ability to see well is only half of my concern.  I want to make sure you are healthy, too.