As a society, we are spending more time looking at computer screen in the form of monitors, tablets and smartphones than ever before. While long hours spent looking at screens can cause eye strain, this is related to decreased blinking which is associated with dry eyes. There is no evidence that the type or amount of light coming from the screens causes any permanent damage to the eyes.
Companies selling glasses that filter out the blue light from computers claim that overexposure to blue light causes disruption of the sleep-wake cycle, dry eyes and macular degeneration. Exposure to ultraviolet light from the sun is associated with cataract formation and other eye diseases. However, no measurable UVA or UVB radiation is emitted from computer monitors, tablets or smartphones. Special glasses are therefore not necessary.
Some simple measures are recommended to reduce eyestrain. The simplest is to look away from the computer every 20 minutes and to gaze far away (eg out of a window or down a long corridor). This will relieve the prolonged focusing. Further, when the eyes feel dry use artificial tears to moisten them.
Source: AAO EyeSmart
Michelle Akler, MD Akler Eye Center Sterling Heights & Dearborn
Happy Thanksgiving! I hope everyone has been enjoying the wonderful fall weather! Last month I attended the American Academy of Ophthalmology Annual Meeting in Chicago. I am going to share some exciting research being done overseas on novel approaches to reducing the dependence on reading glasses as we age.
PEARL Treatment for Presbyopia
Presbyopia refers to the gradual loss of the eye’s ability to focus on near objects. This occurs as the lens inside the eye grows more stiff as we age. There is much interest in developing treatments for this condition that would reduce dependence on reading glasses and bifocals.
There are currently two FDA-approved devices for surgically treating presbyopia, the Kamra inlay and the Raindrop inlay. These are both small rings made of synthetic material that are implanted in the cornea (clear window in the front of the eye). To qualify for this procedure, the patients need to have good distance vision without glasses or contacts and have healthy eyes. Potential complications of the procedure are inflammation and scarring around the synthetic device.
A novel treatment for presbyopia called PEARL was presented at the American Academy of Ophthalmology Annual Meeting last month. In this technique, donor corneal tissue is implanted in the cornea. Since the material is not synthetic, there is less loss of distance vision and reduced risk of severe inflammation in the cornea.
PEARL has only been performed on a small number of patients in India, but larger studies with longer term follow up may show this technique to work well and possibly even be combined with LASIK or other refractive procedures for full vision correction at distance and near.
Source: AAO Annual Meeting, Refractive Surgery Original Papers, Chicago IL October 2016
Michelle Akler, MD Akler Eye Center Sterling Heights & Dearborn
I just returned from the American Society of Cataract and Refractive Surgeons Annual Meeting. It is a wonderful opportunity to meet with colleagues and leaders in my profession. This month I will be sharing exciting data presented by the US Navy which showed that modern LASIK is extremely safe with excellent visual results.
Patient Satisfaction Following LASIK – Update on the PROWL 1 & 2 Studies
LASIK is one of the most common elective surgeries in the USA with approximately 700,000 procedures performed annually. It is designed to correct nearsightedness, farsightedness and astigmatism. A rigorous 2 hour screening examination is performed in our office to determine whether a patient is a good candidate for the procedure. Despite it’s overall safety, many patients still fear the side effects of LASIK.
The PROWL studies used anonymous online patient questionnaires to collect data on patients’ visual and dry eye symptoms as well as their satisfaction with their LASIK results. PROWL 1 studied active duty sailors, and PROWL 2 a civilian population.
Both studies found patients reported improvement in both dry eyes and night vision symptoms such as halos compared to before their LASIK. PROWL 1 vision data showed 99% of patients were 20/20 or better at 6 months following surgery. The majority of patients (>96%) were extremely satisfied with their vision after LASIK.
In summary, the PROWL studies demonstrated that the vast majority of patients have excellent vision and satisfaction with their procedure following LASIK. Many of the symptoms patients are concerned about, including dry eyes and glare and haloing at night, are in fact improved compared to before LASIK in the majority of patients at 3-6 months following their procedure.
Source: Presentation of Dr. Elizabeth Hofmeister, US Naval Medical Center, ASCRS Annual Symposium and Congress, New Orleans LA May 2016
Michelle Akler, MD Akler Eye Center Sterling Heights & Dearborn
This is a very special edition of Akler Eye Center news. We are celebrating our 5th anniversary this month. It is hard to believe how quickly the years have flown by! I want to think everyone for their support and for the privilege of taking care of your most precious organ – your eyes!!
Cataracts are the commonest cause of worldwide blindness, affecting tens of millions of people. Cataracts are caused when the normally clear crystalline proteins in the lens begin to clump together, causing the lens to become cloudy, blurring of the vision. Currently the only treatment for cataracts is cataract surgery, where the cloudy lens is replaced by an artificial lens.
Dr. Zhang and colleagues studied a family with congenital cataracts (where cataracts are inherited and develop early in a family) and discovered that this family did not synthesize a compound called lanosterol, hence causing early cataract formation. Further, he gave eye drops containing lanosterol to 7 dogs with cataracts for 6 weeks, and all the dogs showed either partial or complete resolution of the cataracts.
This is very interesting early research on alternate cataract treatments. Future directions will focus on preparing for trials in humans with the hope that this type of treatment may be useful to prevent cataracts from forming.
Myopia, commonly known as nearsightedness, is the commonest reason children require eyeglasses, and it tends to progress rapidly in childhood. In the United States, 42% of the population is myopic, compared with 25% in the 1970’s. People with severe nearsightness (high myopia) are at higher risk for serious eye problems such as retinal detachment, macular degeneration, premature cataracts and glaucoma. Researchers in Singapore posed a question: what if there is a way to slow down the progression of myopia in children?
Dr. Tan’s group used several different concentrations of the eye drop atropine in children over a period of 5 years and analyzed the progression of myopia in these children. They found that the lowest dose of atropine (0.01%) resulted in the lowest level of nearsightedness over time with few to no side effects. The pupil dilation was less than 1 mm and there was no impairment of the near vision (a common side effect of higher doses of atropine).
This interesting study showed that low doses of atropine in children resulted in up to a 50% reduction in the progression of myopia. More studies will be needed to determine when it is safe to begin the treatment and for how long it is needed. Further, the exact mechanism by which atropine affects the progression of nearsightedness is not known.
Source: American Academy of Ophthalmology Annual Meeting, November 2015
I was contacted last month by Yahoo news regarding a new technology that allows patients to take a vision test and check for glasses via their home computer. The company, Opternative, was designed to create an easier way to obtain a prescription. The website asks several questions of the user, including age and general health questions, then asks you to measure 10 feet from the computer, which is where you stand when the vision exam is administered. Within 24 hours a licensed optometrist in your state dispenses a digital prescription for glasses.
The questions posed to me were: can a computer evaluate your eyes as well as a real doctor?
My answer – it depends.
The refraction exam when well performed detects nuances in the speed the patient answers and adjusts for squinting and lighting conditions, which the computer cannot do. Of course, the computer cannot administer a medical eye examination which screens for conditions such as glaucoma, dry eyes and diabetic eye disease.
At this point, while the concept is interesting and innovative, I still recommend having your eye examinations done by an eye care professional. A computer is simply not a substitute for a doctor.
Glaucoma is a condition in which the optic nerve is progressively damaged by elevated eye pressure and/or reduced blood flow to the optic nerve. It is a leading cause of blindness worldwide. One of the major risk factors for glaucoma development is advancing age – or as I like to tell patients – the longer you are alive the more likely it is to develop.
Metformin is a medication that is commonly used to treat diabetes. It is a drug that mimics caloric restriction; this class of drugs has been shown to reduce risk of other diseases associated with advancing age. A research team based at the University of Michigan decided to investigate whether patients on metformin have a reduced risk of developing glaucoma.
Over 150,000 diabetic patients over age 40 years with no history of glaucoma were studied. After 10 years, 4% of the patients developed glaucoma. The patients who were taking the highest dose of meformin had a 25% reduced risk of developing glaucoma compared to those who did not take metformin. The research team estimated that taking a standard dose of metformin (2 grams per day) for 2 years would reduced the risk of developing glaucoma by 21%.
This data applies only to diabetics as this was the population studied. Taking metformin to prevent glaucoma if you are not diabetic can cause complications such as low blood sugar. Further studies are planned to see if this result can be extended to non-diabetics and if oral metformin can prevent glaucoma progression in those with the disease.
Source: JAMA Ophthalmology, Association of Geroprotective Effects of Metformin and Risk of Open-Angle Glaucoma in Persons with Diabetes Mellitus. August 2015 pp 915-23
Recently, I was contacted by Health Magazine to comment on the safety of extended wear contact lenses. The trending story that prompted the interview was regarding a 39 year old man who wore extended wear contact lenses and woke one morning with eye pain and very blurry vision. He was seen by an eyeMD and was diagnosed with an infection of the cornea caused by Pseudomonas aeruginosa. This organism causes a severe, rapidly progressive ulcer in the cornea, the clear window on the front of the eye. Corneal scarring and reduced vision is the usual result despite treatment with antibiotics. The patient in question will likely require a corneal transplant to regain his sight.
The American Academy of Ophthalmology released a statement regarding extended wear contact lenses in 2013. Although the lenses are FDA approved for overnight use, studies have shown a 10-15% increase in corneal infection in these lenses compared to daily use lenses. Further, patients who wear these contact lenses are more likely to not properly take care of the lenses or remove them at the recommended intervals. Patients who choose these lenses must be properly educated about the importance of good hygiene and proper cleaning methods. Overnight lenses should be removed and not worn overnight once weekly. When I encounter patients who have been less than perfect with their contact lens regimen, I remind them that LASIK vision correction is safer than their current contact lens habits.
To read the full article in Health Magazine, visit this link.
Simplifying our patient’s postoperative cataract regimen with “Near Dropless” cataract surgery
When discussing cataract surgery with patients, I used to counsel that taking all of the eyedrops afterwards was the hardest part of the procedure. The eye drop regimen was confusing and expensive, requiring 3 different drops be taken four times daily for up to 4 weeks after cataract surgery. I am pleased to report that a new technique has allowed us to dramatically reduce the number of drops used after surgery.
TriMoxi is a combination of antibiotic (moxifloxacin) and steroid (triamcinolone) that is injected into the eye at the conclusion of the cataract surgery. Delivering this medication into the back part of the eye (vitreous body) allows prevention of both infection and inflammation after cataract surgery without the use of multiple eye drops.
This technique has been safe and effective for our patients. Our current regimen is to use only one non-steroidal anti-inflammatory drop for 3 days prior to surgery and 2 weeks after surgery. This has been especially well-received in our elderly population who previously would have had to rely on family members to administer their drops multiple times daily. Of course, inflammation may still develop in a small percentage of patients who would then require additional drops.
How Diet Can Prevent Age-Related Macular Degeneration
The National Institute of Health (NIH) conducted a landmark study called the Age-Related Eye Disease Study (AREDS) that followed nearly 5,000 patients for more than a decade. The patients’ dietary habits were examined as part of the research. Patients eating the highest amounts of leafy greens such as kale, collard greens and spinach had a 40% reduction in the likelihood of developing age-related macular degeneration (ARMD). Further, the same risk reduction was found in those patients eating fish high in omega-3 fatty acids such as salmon at least twice a week.
Lutein and zeaxanthin are members of the carotenoid family and are present in large amounts in leafy greens. These compounds are concentrated in the macula, the part of the retina needed for sharp central vision. Omega-3 fatty acids are present in the macula as well. Interestingly, for those of you wondering about carrots and eye health, no beta-carotene was found in the retina, debunking the myth that eating carrots is good for your eyesight.
In patients with macular degeneration, taking a supplement that contains lutein and zeaxanthin (AREDS-2 formula vitamins) reduces the risk of the macular degeneration progressing. There has not been a study that shows that omega-3 supplements prevent macular degeneration, although eating fish can.
In those patients without macular degeneration wanting to keep their eyes healthy, a diet rich in leafy vegetables and fish containing omega-3 fatty acids is recommended.
Source: The Relationship of Major American Dietary Patterns to Age-Related Macular Degeneration, American Journal of Ophthalmology, July 2014.
Akler Eye Center, Michelle Akler, M.D.
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