Presbyopia: Symptoms, causes and treatment

Presbyopia is the normal loss of near focusing ability that occurs with age. Most people begin to notice the effects of presbyopia sometime after age 40, when they start having trouble seeing small print clearly — including text messages on their phone.

You can’t escape presbyopia, even if you’ve never had a vision problem before. Even people who are short sighted will notice that their near vision blurs when they wear their usual spectacles or contact lenses to correct distance vision.

The eye’s lens stiffens with age, so it is less able to focus when you view something up close.

 

Researchers estimate that nearly 2 billion people worldwide have presbyopia.

Though presbyopia is a normal change in our eyes as we age, it often is a significant and emotional event because it’s a sign of ageing that’s impossible to ignore and difficult to hide.

In parts of the world where there is no access to vision care, presbyopia is much more than an inconvenience — it’s a leading cause of vision impairment that reduces people’s quality of life and productivity.

Presbyopia symptoms

When you become presbyopic, you either have to hold your mobile phone and other objects and reading material (books, magazines, menus, labels, etc.) further away from your eyes to see them more clearly.

Unfortunately, when we move things further away from our eyes they get smaller in size, so this is only a temporary and partially successful solution to presbyopia.

If you can still see close objects pretty well, presbyopia can cause headaches, eye strain and visual fatigue that makes reading and other near vision tasks less comfortable and more tiring.

What causes presbyopia?

Presbyopia is an age-related process. It is a gradual thickening and loss of flexibility of the natural lens inside your eye.

These age-related changes occur within the proteins in the lens, making the lens harder and less elastic over time. Age-related changes also take place in the muscle fibres surrounding the lens. With less elasticity, it gets difficult for the eyes to focus on close objects.

Presbyopia treatment

Presbyopia can be treated with spectacles (including reading glasses), contact lenses and vision surgery.

Spectacles

Spectacles with progressive lenses are the most popular solution for presbyopia for most people over age 40. These line-free multifocal lenses restore clear near vision and provide excellent vision at all distances.

Another presbyopia treatment option is spectacles with bifocal lenses, but bifocals provide a more limited range of vision for many people with presbyopia.

It’s also common for people with presbyopia to notice they are becoming more sensitive to light and glare due to ageing changes in their eyes. Photochromic lenses, which darken automatically in sunlight, are a good choice for this reason.

Reading glasses are another choice. Unlike bifocals and progressive lenses, which most people wear all day, reading glasses are worn only when needed to see close objects and small print more clearly.

If you wear contact lenses, your optician, can prescribe reading glasses that you wear while your contact lenses are in. You may purchase reading glasses at a retail shop, or you can get higher-quality versions prescribed by your optician.

Regardless which type of spectacles you choose to correct presbyopia, definitely consider lenses that include anti-reflective coating. Anti-reflective coating eliminates reflections that can be distracting and cause eye strain. It also helps reduce glare and increase visual clarity for night driving.

Contact lenses

People with presbyopia also can opt for multifocal contact lenses, available in gas permeable or soft lens materials.

Another type of contact lens correction for presbyopia is monovision, in which one eye wears a distance prescription, and the other wears a prescription for near vision. The brain learns to favour one eye or the other for different tasks.

While some people are delighted with this solution, others complain of reduced visual acuity and some loss of depth perception. Because the human eye changes as you grow older, your presbyopia glasses or contacts prescription will need to be increased over time as well. You can expect your optician to prescribe a stronger correction for near work as you need it.

Presbyopia surgery

If you don’t want to wear spectacles or contact lenses for presbyopia, a number of surgical options to treat presbyopia are available as well.

One presbyopia correction procedure that’s gaining popularity is implantation of a corneal inlay.

Typically implanted in the cornea of the eye that’s not your dominant eye, a corneal inlay increases depth of focus of the treated eye and reduces the need for reading glasses without significantly affecting the quality of your distance vision.

The first step to see if you are a good patient for presbyopia surgery is to have a comprehensive eye exam and a consultation with a refractive surgeon who specialises in the surgical correction of presbyopia.

Presbyopia is a part of growing older

Presbyopia is a normal part of the ageing process, and we’re all going to have to deal with it sometime after age 40. Whichever option you choose – spectacles, contact lenses or surgery – you’ll be able to easily read messages on your phone or a book to your granddaughter without any trouble.

If you are beginning to notice signs and symptoms of presbyopia, contact us for an eye exam and consultation regarding the best presbyopia treatment options for you.

Source: https://www.allaboutvision.com/en-gb/conditions/presbyopia/


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.

 

Image Credit: Lucky Business / Shutterstock

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.

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, for instance above 85°F (29°C), the preservatives in the products are at a 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 of 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 lipids, epithelial cells and other debris) loaded with mascara. Other reports in literature reviews on problems caused by 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 into 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.

Sources

https://www.news-medical.net/health/Risks-Associated-with-Eye-Make-Up.aspx
http://www.scielo.br/pdf/abo/v79n6/0004-2749-abo-79-06-0411.pdf
journals.lww.com/…/…anifestations_of_Long_Term_Mascara_Use.29.aspx
https://wexnermedical.osu.edu/blog/eye-makeup-risks
https://www.aaojournal.org/article/S0161-6420(17)33788-0/fulltext
https://www.ajo.com/article/0002-9394(75)90798-9/pdf
www.sciencealert.com/mascara-make-up-remove-health-effects-dangerous-eyes
https://www.sciencedirect.com/science/article/pii/S1529183908003795


Eye spots, floaters and flashes

Vitreous detachment and floaters within the eye

Eye floaters are those tiny spots, specks, flecks and “cobwebs” that drift aimlessly around in your field of vision. While annoying, ordinary eye floaters and spots are very common and usually aren’t cause for alarm.

Floaters and spots typically appear when tiny pieces of the eye’s gel-like vitreous break loose within the inner back portion of the eye.

At birth and throughout childhood, the vitreous has a gel-like consistency. But as we age, the vitreous begins to dissolve and liquefy to create a watery centre.

Some undissolved gel particles occasionally will float around in the more liquid centre of the vitreous. These particles can take on many shapes and sizes to become what we refer to as “eye floaters.”

You’ll notice that these spots and eye floaters are particularly pronounced if you gaze at a clear or overcast sky or a computer screen with a white or light-coloured background. You won’t actually be able to see tiny bits of debris floating loose within your eye. Instead, shadows from these floaters are cast on the retina as light passes through the eye, and those tiny shadows are what you see.

You’ll also notice that these specks never seem to stay still when you try to focus on them. Floaters and spots move when your eye and the vitreous gel inside the eye moves, creating the impression that they are “drifting.”

When are eye floaters and flashes a medical emergency?

Noticing a few floaters from time to time is not a cause for concern. However, if you see a shower of floaters and spots, especially if they are accompanied by flashes of light, you should seek medical attention immediately from an optician.

The sudden appearance of these symptoms could mean that the vitreous is pulling away from your retina — a condition called posterior vitreous detachment.

Or it could mean that the retina itself is becoming dislodged from the back of the eye’s inner lining, which contains blood, nutrients and oxygen vital to healthy function. As the vitreous gel tugs on the delicate retina, it might cause a small tear or hole in it. When the retina is torn, vitreous can enter the opening and push the retina farther away from the inner lining of the back of the eye — leading to a retinal detachment.

A detached retina is a medical emergency that requires immediate treatment to prevent permanent vision loss. Treatment consists of surgery to reattach the retina to the back surface of the eyeball, reconnecting it to its source of blood, oxygen and other nutrients.

Posterior vitreous detachments (PVDs) are far more common than retinal detachments and often are not an emergency even when floaters appear suddenly. Some vitreous detachments also can damage the retina by tugging on it, leading to a tear or detachment of a portion of the retina.

What causes eye floaters and spots?

As mentioned above, PVDs are common causes of vitreous floaters, and retinal tears and detachments also can contribute to floaters and spots.

What leads to vitreous detachments in the first place?

As the eye develops, the vitreous gel fills the inside of the back of the eye and presses against the retina and attaches to the surface of the retina. Over time, the vitreous becomes more liquefied in the centre. This sometimes means that the central, more watery vitreous cannot support the weight of the heavier, more peripheral vitreous gel. The peripheral vitreous gel then collapses into the central, liquefied vitreous, detaching from the retina.

It’s estimated that more than half of all people will have a PVD by age 80. Thankfully, most of these vitreous detachments do not lead to a torn or detached retina.

Light flashes during this process mean that traction is being applied to your retina while the PVD takes place. Once the vitreous actually detaches from the retina this traction pressure is eased, and the light flashes should subside.

What causes eye flashes?

Ordinarily, light entering your eye stimulates the retina. This produces an electrical impulse, which the optic nerve transmits to the brain. The brain then interprets this impulse as light or some type of image.

If the retina is mechanically stimulated (physically touched or tugged), a similar electrical impulse is sent to the brain. This impulse is then interpreted as a flash or flicker of light called a photopsia.

When the retina is tugged, torn or detached from the back of the eye, a flash or flicker of light commonly is noticed. Depending on the extent of the traction, tear or detachment, these photopsias might be short-lived or continue indefinitely until the retina is repaired.

Photopsias also may occur after a blow to the head that is capable of shaking the vitreous gel inside the eye. When this occurs, the phenomenon sometimes is called “seeing stars.” In some cases, photopsias are associated with migraine headaches and ocular migraines.

Other conditions associated with eye floaters and flashes

When a PVD is accompanied by bleeding inside the eye (vitreous hemorrhage), it means the traction that occurred may have torn a small blood vessel in the retina.

A vitreous hemorrhage increases the possibility of a retinal tear or detachment. Traction exerted on the retina during a PVD also can lead to development of conditions such as macular holes or puckers.

Vitreous detachments with accompanying eye floaters also may occur in circumstances such as:

  • Inflammation in the eye’s interior
  • Short sightedness
  • Cataract surgery
  • YAG laser eye surgery
  • Diabetes (diabetic vitreopathy)
  • CMV retinitis

Inflammation associated with many conditions such as eye infections can cause the vitreous to liquefy, leading to a PVD.

When you are shortsighted, your eye’s elongated shape also can increase the likelihood of a PVD and accompanying traction on the retina. Shortsighted people also are more likely to have PVDs at a younger age.

PVDs are very common following cataract surgery and a follow-up procedure called a YAG laser capsulotomy.

Months or even years after cataract surgery, it’s not unusual for the thin membrane (or “capsule”) that’s left intact behind the interocular lens (IOL) to become cloudy, affecting vision. This delayed cataract surgery complication is called posterior capsular opacification (PCO).

In the capsulotomy procedure used to treat PCO, a special type of laser focuses energy onto the cloudy capsule, vaporising the central portion of it to create a clear path for light to reach the retina, which restores clear vision.

Manipulations of the eye during cataract surgery and YAG laser capsulotomy procedures cause traction that can lead to posterior vitreous detachments.

How to get rid of eye floaters

Most eye floaters and spots are harmless and merely annoying. Many will fade over time and become less bothersome. In most cases, no eye floaters treatment is required.

However, large persistent floaters can be very bothersome to some people, causing them to seek a way to get rid of eye floaters and spots drifting in their field of view.

But the risks of a virectomy usually outweigh the benefits for eye floater treatment. These risks include surgically induced retinal detachment and serious eye infections. On rare occasions, vitrectomy surgery can cause new or even more floaters. For these reasons, most eye surgeons do not recommend vitrectomy to treat eye floaters and spots.

Laser treatment for floaters

A relatively new laser procedure called laser vitreolysis has been introduced that is a much safer alternative to vitrectomy for eye floater treatment.

In this in-office procedure, a laser beam is projected into the eye through the pupil and is focused on large floaters, which breaks them apart and/or frequently vaporises them so they disappear or become much less bothersome.

To determine if you can benefit from laser vitreolysis to get rid of eye floaters, your optician will consider several factors, including your age, how quickly your symptoms started, what your floaters look like and where they are located.

Many floaters in patients younger than age 45 may be located too close to the retina and can’t be safely treated with laser vitreolysis. Patients with sizable eye floaters located farther away from the retina are better suited to the procedure.

An ophthalmologist who performs laser vitreolysis also will evaluate the shape and borders of your eye floaters. Those with “soft” borders often can be treated successfully. Likewise, sizable floaters that appear suddenly as a result of a posterior vitreous detachment often can be successfully treated with the laser procedure.

What happens during laser vitreolysis

Laser vitreolysis usually is pain-free and can be performed in an eye surgeon’s office. Just prior to the treatment, anesthetic eye drops are applied, and a special type of contact lens is placed on your eye. Then, the surgeon will look through a medical device and deliver the laser energy to the floaters being treated.

During the procedure, you might notice dark spots. These are pieces of broken up floaters. The treatment can take up to a half hour, but it’s usually significantly shorter.

At the end of the procedure, the contact lens is removed, your eye is rinsed with saline and the surgeon will apply an anti-inflammatory eye drop. Additional eye drops may be prescribed for you to use at home.

Sometimes, you may see small dark spots shortly after treatment. These are small gas bubbles that tend to resolve quickly. There also is a chance that you’ll have some mild discomfort, redness or blurry vision immediately after the procedure. These effects are common and typically won’t prevent you from returning to your normal activities immediately following laser vitreolysis.

If you are bothered by large, persistent eye floaters, ask your optician if laser vitreolysis might be a good treatment option for you.

Remember, a sudden appearance of a significant number of eye floaters, especially if they are accompanied by flashes of light or other vision disturbances, could indicate a detached retina or other serious problem in the eye. If you suddenly see new floaters, visit your optician without delay.

 

Source: allboutvision.com

By Marilyn Haddrill; contributions and review by Charles Slonim, MD


Could Glasses Protect Against COVID-19?

Wearing spectacles may lower your chances of contracting the coronavirus, according to a new study from Hubei Province, China. The findings appeared in JAMA Ophthalmology, a medical journal. But does this mean everyone should wear eye protection to prevent COVID-19? Not exactly, says ophthalmologist Thomas Steinemann, MD, clinical spokesperson for the American Academy of Ophthalmology and a professor of ophthalmology at MetroHealth Medical Center.

Ophthalmologists say there’s not enough information to recommend that people start wearing eye protection in addition to masks.

“It’s a provocative and fascinating study. But in the scheme of things, this is a small portion of the population. We’d require a much larger study before making any conclusions about whether wearing glasses really does mean people are touching their eyes less often, and therefore decreasing infection rates,” Dr. Steinemann said.

Coronavirus can spread through the eyes when an infected person coughs or sneezes near your eye or if you touch an infected object before touching your eye.

A possible link between spectacles and the coronavirus

The study came from a curious observation made by researchers in China. They noticed that very few of their sick patients wore glasses, which was remarkable since nearsightedness is common in China. They examined hospital records from patients with Covid-19 to learn more. Of 276 patients admitted to the hospital over a 47-day period, only 16 patients (5.8%) had myopia or nearsightedness that required them to wear glasses for more than eight hours a day.

Earlier research shows that more than 30% of people in the region needed glasses for nearsightedness.

Dr. Steinemann says it could be that glasses serve as a reminder to avoid touching your eyes. It may also be that glasses act as a partial barrier, protecting eyes from the splatter of a cough or sneeze. There are several factors other than wearing glasses that could explain the study’s finding. It could be that people who wear glasses tend to be older and more likely to stay home during the pandemic, compared with people who do not wear glasses. Or maybe people who can afford glasses in China are less likely to contract the virus because they can afford to live in less-crowded spaces.

Should you wear eye protection to prevent COVID-19?

While it’s too soon to say everyone should wear eye protection, Dr. Steinemann said that wearing goggles or face shields does make sense for frontline health care workers and people who care for those with the virus. For the rest of us, wearing a mask, frequent hand washing and practicing social distancing continue to be our best bet against the virus.

Source: www.aao.org/eye-health/news/eyeglasses-protect-against-covid-19-coronavirus