Maintaining Healthy Eyes

1. Maintaining Healthy Eyes Robert C. Arffa, M.D. Ophthalmic Specialists

2. How Often To Have an Eye Exam • Many people want to know how often they should have their eyes examined. The answer depends on your age, medical background and risk factors for disease.

3. Children • Screening for eye disease by trained personnel — Eye doctor, pediatrician or trained screener • Ages • Newborn to 3 months • 6 months to 1 year • 3 years (approximately) • 5 years (approximately)

4. Adults Comprehensive medical eye exam by an Eye doctor • Once between age 20 and 39 • Age 40 to 64, every two to four years • Age 65 and older, every one to two years

5. Increased Risk for Eye Disease • Developmental delay • Premature birth • Personal or family history of eye disease

6. Increased Risk for Eye Disease • African-American heritage (increased risk for glaucoma) • Previous serious eye injury • Use of certain medications (plaquenil) • Certain diseases that affect the whole body (such as diabetes or HIV infection)

7. Dry Eye • Some people do not produce enough tears or the appropriate quality of tears to keep the eye healthy and comfortable.

8. Tear Production • slow, steady rate and is responsible for normal eye lubrication • constantly produced by a healthy eye • Another mechanism produces large quantities of tears in response to eye irritation or emotions.

9. Symptoms • stinging or burning eyes • Scratchiness • stringy mucus in or around the eyes • excessive eye irritation from smoke or wind • excess tearing • difficulty wearing contact lenses.

10. What Causes Dry Eye? • We don’t know • Tear production normally decreases as we age. • Women are most often affected, especially after menopause. • Sjogren's syndrome: dry eyes, dry mouth and arthritis

11. Medications that can reduce tears • diuretics • beta-blockers • antihistamines • sleeping pills • medications for "nerves“ • pain relievers.

12. Treatment • Artificial tears • Preservative-free • if you are sensitive to the preservatives in artificial tears. • If you need to use artificial tears more than every two hours • You can use the tears as often as necessary — once or twice a day or as often as several times an hour. • Restasis

13. Conserving the Tears • Punctal plugs • Preventing evaporation • Humidifier • Wrap-around glasses

14. Glaucoma — The Sneak Thief of Sight • If you're one of the 1 million Americans who have been diagnosed with glaucoma ... Consider yourself lucky! • vision loss from glaucoma can be prevented if it is caught and treated in time

15. Glaucoma – Sneak Thief of Sight • affects 2.2 million Americans • Half have no symptoms and, therefore, do not know they have the disease • glaucoma is one of the leading causes of preventable blindness in the United States, and the single most common cause of blindness among African-Americans

16. Risk Factors • Over age 50 • African American over age 40 • Family history of glaucoma • Past serious eye injury • Other health conditions, such as diabetes

17. Detection of Glaucoma • The only way to detect glaucoma is by examination by an eye doctor • Intraocular pressure • Optic nerve • Field of vision

18. Examination for Glaucoma • Applanation tonometry

19. Examination for Glaucoma • Optic nerve

20. Examination for Glaucoma • Visual Field

21. Treatment of Glaucoma • Eyedrops • Surgery • Laser • Provide alternate outflow mechanism • Almost always can preserve sight

22. What are floaters? • small specks or clouds moving in your field of vision • often see them when looking at a plain background, like a blank wall or blue sky • Floaters can have different shapes: little dots, circles, lines, clouds or cobwebs.

23. Floaters • Floaters are actually tiny clumps of gel or cells inside the vitreous, the clear jelly-like fluid that fills the inside of your eye

24. Flashing lights • twinkling lights • lightning streaks • present even if you close your eyes • can appear off and on for several weeks or months

25. What causes floaters? • As you age the vitreous gel may start to thicken or shrink, forming clumps or strands inside the eye • Also, the vitreous gel pulls away from the back wall of the eye, causing a posterior vitreous detachment

26. What causes flashing lights? • Flashes are the vitreous tugging on the retina

27. Posterior vitreous detachment is more common: • If you are nearsighted • If you have undergone cataract operations • If you have had inflammation inside the eye

28. Can floaters be serious? • The retina can tear if the shrinking vitreous gel pulls away from the wall of the eye • A torn retina is always a serious problem, since it can lead to a retinal detachment

29. You should see your ophthalmologist as soon as possible if: • even one new floater appears suddenly • you see sudden flashes of light • If you notice other symptoms, like the loss of side vision

30. Floaters - course • Floaters can get in the way of clear vision, which may be quite annoying, especially if you are trying to read • You can try moving your eyes, looking up and then down to move the floaters out of the way • Many of them will fade over time and become less bothersome

31. Migraine • flashes of light that appear as jagged lines or "heat waves" in both eyes, often lasting 10-20 minutes • can occur without a headache

32. The Age-Related Eye Disease Study (AREDS) • conducted at 11 major medical center research facilities around the country • looked at the effects of zinc and antioxidants on cataracts and age-related macular degeneration (AMD)

33. What Were the Results? • High doses of antioxidants and zinc can reduce the risk of vision loss from advanced AMD • patients with intermediate AMD or advanced AMD in one eye but not the other

34. What Were the Results? • Supplements do not provide significant benefit to patients with minimal AMD • These nutritional supplements do not prevent the initial development of AMD, nor do they improve vision already lost to AMD • Nutritional supplements do not seem to prevent cataracts or to keep them from getting worse over time

35. Should I Take Nutritional Supplements? • If you have intermediate (or advanced) AMD in one eye only

36. Supplement Dosages • Vitamin C 500 mg • Vitamin E 400 IU • Beta-carotene 15 mg (approximately 25,000 IU) • Zinc 80 mg, as zinc oxide • Copper 2 mg, as cupric oxide (copper should be taken with zinc, because high-dose zinc is associated with copper deficiency.)

37. Cautions • It is very important to talk with your physician before taking large-dose supplements and to follow his or her dosage recommendations carefully. Some supplements may interfere with each other or other medications. Smokers and ex-smokers probably should not take beta-carotene, as studies have shown a link between beta-carotene use and lung cancer among smokers.

38. Custom LASIK • Excimer laser correction of • Myopia (nearsightedness) • Hyperopia (farsightedness) • Astigmatism

39. Excimer laser • Precise evaporation of corneal tissue to reshape the surface • Changes the focusing power of the cornea

40. LASIK procedure • Create a partial thickness flap in the corne

41. LASIK procedure • Lift and retract the flap

42. LASIK – laser ablation

43. LASIK Procedure

44. Customized procedure