We want to make sure that you receive all of the information that you need to make educated decisions about your eye health. Dr. Steve Jacobs is always available to answer your questions. Please feel free to send us your eye care questions to drj@stevejacobsod.com
Q: Can anything be done to decrease nearsightedness?
Dr. Jacobs: The only way to actually reduce nearsightedness if you’re already myopic, is a procedure such as LASIK. For appropriate candidates, this can provide clear distance vision without the need for glasses or contact lenses. Unfortunately, it has no effect on the likelihood of eye disease as any tissue “stretching” has already occurred. Myopia often begins and develops most rapidly between the ages of 8 and 16.
What needs to be done is to stop it before it occurs, or slow it down so the more dangerous levels aren’t reached. Fortunately, recent research suggests certain kinds of contact lenses and eye drops can slow myopia’s development approximately by half.
These include what are called “dual-focus” soft contact lenses, a process known as Orthokeratology (or OK), and very low dose drops of a compound call atropine.
Q: Does it really matter if you’re nearsighted, other than having to wear glasses or contact lenses?
Dr. Jacobs: Once myopia reaches a level requiring prescription lenses for important activities such driving, which doesn’t take all that much (usually slightly over 1 unit – called a diopter), it starts to impact life and makes things more complicated. But more important than that, once it reaches higher levels (above 5 diopters) the odds of significant eye disease later in life go up dramatically.
The more nearsighted one is, the larger or more stretched out the eye tends to be. This stretching can thin the eye’s vital neurological tissue and make it more prone to damage and diseases such as cataracts, glaucoma, macular degeneration, and retinal tears. Keeping nearsightedness at bay may reduce the likelihood of these problems.
Q: What exactly is pink eye?
Dr. Jacobs: Pink eye is really anything that makes the eye pink. The official term is conjunctivitis, meaning an inflammation of the conjunctiva, the mostly transparent, skin-like covering over the white of the eye. When the eye is irritated, the conjunctiva swells and blood vessels in it dilate, giving the eye a pink or reddish appearance.
Many different agents can lead to this, including bacteria, viruses, allergens, and toxic or mechanical irritants. Treatment and contagion protection depend on the specific cause. Often the cause can be determined based on history, eye appearance with specialized instruments, and symptoms. Viral pink eye, for example, is typically associated with increased light sensitivity, whereas itching is a key sign in allergic pink eye.
There is a good deal of overlap with all kinds, however. Bacterial and viral pink eye are both contagious, and fairly common. With any pink eye, particularly if it is getting worse, or not getting any better within a day, it’s best to be seen by an eye care practitioner. She or he will have the experience, knowledge and instrumentation to provide the most efficient treatment and recommendations.
Q: What’s the difference between vision insurance and eye insurance?
Dr. Jacobs: “Vision insurance” really isn’t insurance, but rather a benefit that covers some of your costs for eyewear and eye care. It is meant to be used for “routine” care when you aren’t having a problem but want to be sure everything is OK, like having an annual screening exam with your Primary Care Physician.
It often, but not always, includes a discount or allowance toward glasses or contact lenses. It is usually a supplemental policy to your medical health insurance. Medical health insurance covers, and must be used when an eye health issue exists. This includes pink eye, eye allergies, glaucoma, floaters, cataracts, diabetes, headaches, and many other conditions.
Blurry vision is covered medically if it relates to a medical condition, for example the development of a cataract. For some reason, however, it is considered non-medical if the only finding is the need for glasses or a change of prescription. Of course, you can’t know this until you have the exam. In this case, with vision coverage, you would only be responsible for your co-pay, but with medical coverage without vision coverage, you’d be responsible for the usual charge.
Q: My eyes sometimes feel dry. What is going on and what is the best way to treat it?
Dr. Jacobs: Dry Eye is a very common condition, and with our society’s emphasis on work with computers and other devices, becoming more common each year. When you’re concentrating, such as with driving and all sorts of near work, there’s a tendency to blink less often. This makes the eye dry and triggers an immune response further reducing the eye’s moisture level.
Over years, what started as a minor inconvenience can have a real impact on quality of life. Besides discomfort, eye dryness can lead to surface inflammation, increase infection risk and significantly affect vision. Drops can provide partial, temporary relief, but only if they are the right ones. Many, especially store brand, artificial tears are preserved with BAK, and can make symptoms worse if used regularly.
Surprisingly, dry eyes are more often due to poor tear quality, particularly the oil component which prevents tears from evaporating, than poor tear quantity. Here are a few things that may help. 20/20/20 Rule – when reading or on a computer, every 20 minutes take a 20 second break and look 20 feet away. This forces you to blink a few times, re-establishes your tear layer and prevents the eyes from locking in on one focus and straining.
Omega 3 fatty acids – found particularly in fish oils – when taken regularly, these can improve the functioning of the glands in the lids which produce oils to coat the tears. Drops, such as Systane or Refresh brands being 2 good ones, can keep the eyes more moist and comfortable when used at the beginning of a prolonged near work session, and up to a few times more through the day.
A new kind of warm compress or mask is now available and very easy to use. Possessing beads which absorb moisture from the atmosphere, the mask is placed in the microwave for 20 -30 seconds and then attached over the eyes with its Velcro band. The heat melts and releases oils from glands in the lids, and enhances blood flow to the glands improving their everyday function. After 10 or 15 minutes the eyes feel very moist – but will be a little blurry for a while.
Restasis – a prescription eye drop, used twice a day, Restasis increases natural tearing. It feels good right away but takes two to three months to become fully effective.
Q: What exactly is Anti- Glare?
Dr. Jacobs: Anti-Glare lenses are coated with multiple layers of special chemicals to all but eliminate reflections from the surface of the lens, making them look like they’re almost not there. The coating is also known as Anti-Reflection, AR, or Reflection Free. Crizal may be the most well-known brand family.
A regular eyeglass lens reflects about 7% of light that hits it, whereas an AR lens reflects less than ½%, making vision more comfortable and clearer. This is particularly advantageous for night driving.
Newer coatings, such as Crizal Avance and Prevencia are much more scratch resistant, easier to clean, and less likely to attract dust than previous products.
Prevencia is specially designed to protect eyes from some of the potentially damaging effects of high energy visible (HEV) blue light from tablets, phones and computers. More on that next time.
Q: I sometimes see little spots floating around. What are they, and should I be concerned?
Dr. Jacobs: Surprisingly, the medical term for them actually is floaters. They are bits of debris within the eye which may slide or dart away when you try to look at them. They can be different shapes and sizes, or look like cobwebs, and are most noticeable against a light background, like the sky, a computer screen or a blank wall.
Some may be present from early in life, but most develop over time as the jelly-like substance that fills the back of the eye ages. Usually they are only annoying, but they can be a sign of a serious problem. If you first start to notice them, and especially if you notice flashes of light, or if you note any change in their number or appearance, give our office a call very soon.
Q: Are contact lenses today really that different from those of a few years back?
Dr. Jacobs: Every year there are new and different contact lenses. The advances in technology mirror that in many other industries. I love when someone says “I can’t wear contact lenses. They’re not very comfortable.” Or “I have astigmatism.” And when I ask “When did you last try them?” they answer “Oh, about 15 years ago.”
Does the phone you have today do a little better and a little more than the one 15 years ago? I’m sure it does. And for the same reason, if you wear contact lenses, your eye doctor should tell you about and let you try newer technology lenses, even if your current ones “are fine”.
You probably wouldn’t want the gal at Verizon to encourage you to stick with an old flip phone, and so you shouldn’t want your eye doctor to encourage you to stick with 20th century contact lens technology either.
Q: I wear contact lenses, but now I’m having trouble seeing clearly to read things up close. What can I do? I still want to wear my lenses.
Dr. Jacobs: Basically, there are three choices. One is a pair of reading glasses to use over the contact lenses. This will clear near things up quite well, but there is the inconvenience of having to put the glasses on, and the fact that they will make anything further away blurry.
Another option is what’s called monovision, where one eye is set with a contact lens to see things clearly far away and the other eye is fit with a lens to see up close. As strange as it sounds this works pretty well for about 80% of people for about 80% of activities.
Finally, there are some very good multifocal contact lenses available these days, as long as you don’t have much astigmatism (uneven curvature of the eye). All these options have pros and cons, and like most things in life involve some compromise. I’ll go over all the details of what might work best for you after your eye exam, and then you can evaluate them during a trial period.
Q: What does it mean to have a “lazy eye”?
Dr. Jacobs: “Lazy eye” refers to a condition known as amblyopia, where acuity is reduced even with the best prescription lens, and when there is no injury or other physical defect. It develops when the eye doesn’t ‘learn’ how to see clearly from birth or a very early age.
The two most common causes of amblyopia are an eye turn (strabismus) or when the two eyes have very different powers. If one eye constantly turns out or in, the brain will sort of shut it off to prevent double vision.
If this occurs for a long enough time, that eye will never learn how to see properly even with glasses or contact lenses later on. Or if one eye’s vision is always blurred, it also may never be able to see clearly even with a prescription. The sooner amblyopia is discovered the more likely treatments can help.
Since it’s not always obvious, it’s important that children see an eye care professional for an exam by four or five years old. Earlier is even better. A lot of information can be gained through an exam at 6 months to a year (more on that in another post), and this may help prevent a problem before it becomes permanent.
Q: I’ve seen ads on TV selling programs to make it so you don’t need glasses anymore. Are these for real or are they bogus?
Dr. Jacobs: For the most part, they’re bogus. While there is some flexibility in the visual system, most people who wear prescription lenses are not going to see nearly as clearly without them no matter what they do (short of refractive surgery).
Some people may not mind if things are a little fuzzy, and they probably can learn to relax the eyes more and see a little better without glasses with practice. And that will cause no harm and might even help a little.
However, unless the prescription is very mild to begin with, few will achieve significant change or be able to function efficiently without their glasses for the activities for which they are intended.
So, anytime you see an ad saying “Throw your glasses away forever”, it’s probably it’s probably wiser to keep your glasses and throw the ad away.
Q: What does it mean to be color blind?
Dr. Jacobs: There are a number of different kinds of “color blindness”. The most common involves difficulty seeing a difference between reds and greens. They all appear kind of brownish.
This type is hereditary, stable, and much more common in males than females. Typically, it will skip a generation. It arises from the lack of a certain type of color receptor in the eye, and can vary from mild to very strong. Its greatest impact is that it might disqualify one from certain occupations.
Special contact lenses will not cure it, but may help one discriminate between colors. Less common is blue-yellow deficiency. This is usually acquired due to disease or injury. Least common is the absence of all color receptors.
This kind of color blindness results in fairly blurred vision and seeing only shades of grey. Although not really related to color blindness, color vision is always much less sensitive in dim light. It is also reduced when one develops cataracts, and in general when people reach their 70s and 80s.
Q: We have been getting headaches lately. Should I have an eye exam?
Dr. Jacobs: An eye exam may be a good place to start if you can’t readily attribute the headache to another cause. Although headaches occur for many reasons, a significant number are visually related.
In particular, those associated with reading or other sustained visual activities, and those resulting in discomfort around or behind the eyes or the forehead are often visually induced.
Also, if vision is blurred when looking far away or when reading, the strain may lead to a headache. On the other hand, headaches present when you first wake up are much less likely to have a visual contribution.
And some, like those affecting the back of the head and neck may not be directly related to vision, but may arise from trying to look through bifocals when working on a computer.
An eye exam can help determine if the cause is visual or if your Primary Care Physician should be consulted.
Q: Why do some animals see better than people at night?
Dr. Jacobs: A cat is a good example. Although, even with a cat there has to be some light. (A few animals, such as snakes, can actually see prey in, what is to humans, complete darkness by the heat they give off.)
A couple of parts of cat’s eyes are responsible for their excellent night vision. There are two types of cells in the eye that respond to light, rods and cones. Cones help people see colors and details, but need a certain amount of light to do this, whereas rods are stimulated by much less light.
Cats do not have cones, and so do not see in color or with much detail, but are more responsive to movement even in dim surroundings (which comes in very handy if you want to see a mouse scurry across the kitchen floor at midnight).
Also, the inside of cats eyes are lined with a shiny surface which amplifies any light that comes in further allowing them to see in the (almost) dark.
Q: What are cataracts?
Dr. Jacobs: “Cataract” comes from the Latin and Greek for waterfall. As far as the eyes go, it refers to the clouding of the lens of the eye which begins to look like the cloudy white water of a waterfall. The lens sits just behind the pupil and helps focus light onto the back of the eye. It’s made of very precisely arranged molecules keeping it clear.
When this orientation is lost due to aging, trauma, or certain medications, the lens loses its transparency. Once this gets to a point of interfering with normal activities, the lens can be removed (usually by breaking it up with ultrasound and vacuuming it out) and replaced with an artificial lens.
The surgeon can determine what power this needs to be for good distance vision and then there may only be the need for drugstore reading glasses. This is perhaps the greatest quality of life procedure out there. About 3 million are done in the US each year.
Q: What causes nearsightedness and can anything be done about it?
Dr. Jacobs: Nearsightedness, also known as myopia, results when light entering the eye from far away focuses in front of, rather than on the back of the eye. In essence, the nearsighted eye is longer than it should be.
Myopia in the US has nearly doubled since the ‘70s, most often developing during the elementary school years. An association between excessive near visual activities and myopia has been assumed for a long time. Recently however, studies have shown that rather than being related to too much close work, it seems to be more influenced by decreases in time spent outside.
Something about the focusing required when playing outdoors, or the exposure to the much brighter light outside, reduces signals to make the eye grow longer. Nothing can be done to turn back the clock, but certain contact lenses may be able to change the way light is focused and slow down myopic progression. More on this next time.
Q: Are more people nearsighted these days or does it just seem that way?
Dr. Jacobs: Myopia (nearsightedness) is very common and becoming more common every day. In the United States, it’s prevalence appears to have increased more than 50% in the past 40 years, now affecting over 40% of 12 to 54 year old’s.
Worldwide, it’s estimated that over ½ the world’s population will be nearsighted by 2050. In some Asian countries, the rate among university students is more than 80%!!!
Nobody knows precisely what is causing it, but there is a relationship between sustained reading and computer work in childhood and the development of myopia. Genetics also plays a role as nearsighted parents are more likely to have nearsighted children.
