Warning Signs of
Eye Trouble
Blurry vision,
spots, glare at night -- these are common eye complaints that can be harmless
annoyances or an early sign of disease. In the slides ahead, we explore several
eye problems and offer two quick eye tests. You'll see the world through eyes
that have floaters, cataracts, myopia, and glaucoma. Be sure to see an eye
doctor promptly for any concerns.
Color Blindness
Test
Which number do
you see in the far left? If it's "3," you probably have normal color
vision. If it's a "5," you may be colorblind. This view is
simulated in the center panel and represents a mild color vision
deficiency. About 10% of men are born colorblind, but few women. Complete
color blindness (very rare) is simulated at right. No number is visible. Tinted
glasses may help the colorblind see better.
Nearsightedness
(Myopia)
About 33% of
Americans (ages 12-54) have a blurry view of distant objects, called
myopia, up from about 25% in the early 1970s. Risk factors include:
- Family history (one or both parents)
- Lots of prolonged, close-up reading
Trouble with
driving, sports, or seeing a blackboard or the TV may ensue. Symptoms include
headaches, squinting, and fatigue. Myopia can be treated with glasses,
contacts, or surgery in some cases.
Farsightedness
(Hyperopia)
Most of us are
born with mild farsightedness, but normal growth in childhood often corrects
the problem. When it persists, you may see distant objects well, but books,
knitting, and other close objects are a blur. Hyperopia runs in families.
Symptoms include trouble with reading, blurry vision at night, eyestrain, and
headaches. It can be treated with glasses, contacts, or surgery in some cases.
Presbyopia
Just like gray
hair or wrinkles, trouble reading fine print is a sign of aging.
Called presbyopia -- or "old eye" in Greek -- symptoms appear
in the 40s. The eyes' lenses become less flexible and can't change shape
to focus on objects at reading distance. The solution: reading glasses or
bifocals, which correct both near and distance vision. If you wear contacts,
ask your eye doctor about contacts made for people with presbyopia.
Nearsightedness:
What Happens
Typically, an
eyeball that's too long causes myopia. But an abnormally shaped cornea or lens
can also be to blame. Light rays focus just in front of the retina, instead of
directly on it. This sensitive membrane lines the back of the eye (seen in
yellow) and sends signals to the brain through the optic nerve. Nearsightedness
often develops in school-age children and teens, who need to change glasses or
contacts frequently as they grow. It usually stabilizes by the early 20s.
Farsightedness:
What Happens
In hyperopia, the
cause is often an eyeball that is too short. Light rays focus behind the
retina, causing close objects to be blurry. In severe cases of hyperopia,
especially after the age of 40, distance vision can be blurred as well. An
abnormal shape in the cornea or lens can also lead to farsightedness. Children
with significant hyperopia are more likely to have crossed eyes (strabismus)
and may have difficulty reading. That’s one of the reasons eye doctors
recommend vision exams for young children.
Astigmatism
Your vision may
be out of focus at any distance with an astigmatism in one or both eyes. It
occurs when the cornea, the clear “window” that covers the front of the eye, is
misshapen. Light rays can be scattered in different points on the retina,
rather than focusing on a single point. Glasses or contact lenses correct the
problem, and surgery may be another option. Along with blurred vision, symptoms
may include headaches, fatigue, and eye strain.
Refractive Eye
Surgery
Do you dream of
seeing clearly without glasses? Surgery to reshape the cornea can correct
nearsightedness, farsightedness, or astigmatism with a success rate of better
than 90%. People with severe dry eye, thin or abnormally shaped corneas, or
severe vision problems may not be good candidates. Possible side effects
include glare or sensitivity to light.
Glaucoma: View
You can't feel
it, but deterioration of the optic nerve oftentimes with elevated eye
pressure can silently steal your sight, a condition called
glaucoma. There may be no symptoms until central vision is lost
(following gradual loss of peripheral vision), so regular eye exams are
critical to find it early. Those at higher risk include:
- African-Americans over 40
- Anyone over 60, especially Mexican-Americans
- People with a family history
Fortunately,
glaucoma can be treated with medications or surgery. Regular eye exams every
1-2 years after age 40 can catch it early.
Glaucoma: What
Happens
In the most
common form of glaucoma, increased eye pressure leads to optic nerve damage and
loss of vision. The eye is filled with circulating fluid that nourishes its
internal structures. Sometimes the balance between fluid creation and exit is
abnormal. The buildup of fluid increases pressure and damages the optic nerve
at the back -- the bundle of 1 million nerve fibers that carry information to
the brain. Without treatment, glaucoma can cause total blindness.
The bright
yellow circle shows an optic nerve head that is damaged by glaucoma. The dark
central area is the macula, responsible for finely-detailed central vision.
Macular
Degeneration: View
Age-related
macular degeneration (AMD) damages, then destroys, the eye's finely-detailed
central vision, making it difficult to read or drive. Symptoms can include a
central blurry spot or straight lines that appear wavy. Finding and treating
AMD promptly can help slow vision loss. Being over 60, smoking, high blood
pressure, obesity, and a family history of AMD increase your risk.
Macular
Degeneration: What Happens
In AMD, the
central part of the retina, called the macula, deteriorates. In the dry form,
doctors often see yellow deposits called drusen in the macula. As dry AMD
progresses, the macular tissue deteriorates, gradually shutting down the
delivery of images to the brain. In the wet form, abnormal blood vessels grow.
They leak blood and fluid (seen here), causing scarring and further damage to
the macula. Both types lead to a central blind spot.
Macular
Degeneration: Test
Cover one eye and
stare at the center dot in this Amsler Grid, from a distance of 12 to 15
inches. (You can wear your reading glasses.) Do you see wavy, broken, or blurry
lines? Are any areas distorted or missing? Repeat the procedure for your other
eye. While no self-test can substitute for an eye exam, this grid is used to
help detect early symptoms of AMD.
Macular
Degeneration:Signs
As seen here, the
Amsler Grid can look quite distorted to someone with significant macular
degeneration and may include a central dark spot. Straight lines that appear
wavy are also cause for concern, as they can be an early symptom of
"wet" AMD, the more serious and fast-moving type of macular
degeneration. Your eye care professional will want to evaluate you right away,
starting with a thorough dilated eye exam.
Diabetic
Retinopathy: View
Type 1 and type 2
diabetes can cause partial vision loss (seen here) and lead to blindness. The
damage involves tiny blood vessels in the retina and can often be treated, but
don't wait for symptoms. By the time they occur -- blurry vision, spots,
shadows, or pain -- the disease may be severe. People with known diabetes need
annual eye exams, sometimes even more often if diabetic eye changes have begun.
The best prevention is keeping your blood sugar in check.
Diabetic
Retinopathy: What Happens
When high blood
sugar levels go unchecked, it can damage the tiny blood vessels that support
the retina. These blood vessels can swell, break, and leak fluid. In some
cases, dozens of new, abnormal blood vessels grow, a condition called
proliferative retinopathy. The abnormal vessels are very fragile and break open
easily. These processes gradually damage the retina, causing blurred vision,
blind spots, or blindness.
Cataracts: View
Age is not kind
to our eyes. By the time we're 80 years old, more than half of us will have had
a cataract, or clouding of the lens. Vision gradually gets foggy and makes it
hard to read, drive, and see at night. Diabetes, smoking, or prolonged
sunlight exposure may increase the risk. Surgery that replaces the clouded lens
with an artificial lens is highly effective.
Cataracts: What
Happens
In good health,
the lens focuses light into a sharp, clear image on the retina, which captures
the image like film in a camera. As we age, protein builds up in the lens,
clouding it, and sending scattered rays of light to the retina, instead of one
sharp clear image. The result can be blurred vision, changes in color vision,
and glare, especially at night. Very advanced cataracts are visible to the
naked eye -- the muddy-colored circle at the center of this picture.
Retinitis
Pigmentosa
RP is an
inherited disorder that often begins with night vision problems, followed by a
gradual loss of side vision, developing into tunnel vision, and finally, in
some cases, blindness. One in 4,000 American have RP. A promising study showed
that high-dose vitamin A supplements can reduce vision loss. However, you should
consult a health care expert before taking supplements because too much vitamin
A can be toxic.
Retinitis
Pigmentosa: What Happens
The
light-sensitive tissue of the retina slowly deteriorates over many years in
people with RP. As this tissue dies, it stops sending signals to the brain, and
some vision is lost. Eye exams show abnormal dark spots (pigments)
sprinkled around the retina. Early cataracts can also occur, as well as a
swelling of the retina called macular edema (the central orange mass seen here).
Floaters and
Specks
Blurry spots or
specks in your vision that move may be floaters -- debris in the eye's vitreous
gel. They don't block vision and are more easily seen in bright light. Floaters
are common and usually harmless. But if they appear or increase suddenly, or
are accompanied by light flashes, you should see a doctor. Vision abnormalities
that tend to be more serious include persistent white or black spots and
a sudden shadow or loss of peripheral vision. These require immediate
evaluation.
Ambylopia (Lazy
Eye)
During childhood,
when vision is reduced in one eye, the brain sometimes favors the other eye.
This condition, called ambylopia, may stem from a misalignment of the eyes
(strabismus or crossed eyes) or poorer vision in one eye. A patch or drops that
blur the vision in the "good" eye can prod the brain to use the other
eye. If untreated during childhood, vision loss from amblyopia can be permanent.
Eye Care: Object
in the Eye
Many nerve
endings lurk just beneath the surface or your cornea, so a tiny speck can be
surprisingly painful. Don't rub the eye, or you may cause serious damage.
Gently flushing the eye with lukewarm water is often recommended. If it doesn't
dislodge the foreign body, or you have any questions, call a medical provider
who can remove the object and provide antibiotic drops to protect the cornea
from infection.
Eye Care: Tears
and Dry Eye
Tears are the
lubrication for our eyes. When not enough flow, perhaps due to dry air, aging,
or other health conditions, the eyes can become painful and irritated. For
people with mild cases of dry eye, occasionally using eye drops labeled
artificial tears may do the trick. Others with more pronounced and frequent dry
eye symptoms may need other medications or a procedure to block the exit ducts.
Eye Care:
Pinkeye
Pinkeye, or
conjunctivitis, is an inflammation caused by a virus, bacteria, irritant, or
allergy. Along with the telltale redness, you might have an itching or burning
sensation and a discharge. If itching is the main symptom, the cause is likely
to be allergy. Most cases of infectious pinkeye are viral, which don't require
antibiotics. Bacterial conjunctivitis is typically treated with antibiotic eye
drops. Bacterial and viral conjunctivitis are very contagious, so wash your
hands frequently while you wait for it to clear up.
Eye Care: Stye
A stye is a
tender red bump that looks like a pimple on or near the edge of the eyelid. It
is just one type of infection of the eyelids (blepharitis). Styes usually heal
in a week, but using a very warm, wet compress three to six times a day can
speed the healing. Don’t wear contact lenses or eye makeup until it heals.
Eye Care:
Allergies
Millions of
Americans suffer from allergies -- and watery, itchy eyes. Pollen, grass, dust,
weeds, and pet dander are common triggers. Reduce the allergens in your home
with allergen impermeable covers on mattresses and pillows, thorough cleaning,
and allergen filters in the furnace and air conditioner. Allergy eye drops,
artificial tears, and antihistamines also may soothe the symptoms.
Eye Care:
Regular Exams
Everyone needs
regular eye exams. This is particularly important if you have risk factors
or a family history of eye problems. Children need their vision checked at
6 months, 3 years, and before first grade. Adults should see an eye doctor at
least every two years and annually after age 60. Beyond vision issues, the eyes
can reveal underlying health problems, such as diabetes and high blood
pressure, or serious disorders like stroke or brain tumor. Bulging eyes are a
sign of thyroid disease, and a yellow tint of the whites of the eyes may
indicate liver problems.
Tips to keep your eyes healthy
:
Eye Protection:
Sun
UV rays can
damage your eyes, just as they do your skin. Regular overexposure to sun can
cause cataracts 8-10 years early, and a single lengthy exposure can actually
burn your corneas. The solution is sunglasses that block UV rays and a hat.
People with light-colored eyes are likely to have a greater sensitivity to
light. New or pronounced sensitivity to bright light can be a sign of a more
serious eye condition.
Eye Protection:
Everyday Hazards
Grease splatters
from a pan, yard debris flies up from the lawn mower, cleaning solution
splashes in a bucket. Some of the greatest hazards to the eyes are in the home.
The American Academy of Ophthalmology recommends that
every household have ANSI-approved protective eyewear. Even if an eye injury
seems minor, go to the emergency room immediately to check it out.
Foods for Eye
Health
Carrots really
are good for your eyes. So are spinach, nuts, oranges, beef, fish, whole
grains, and many other foods in a healthy diet. Look for foods with
antioxidants such as omega-3 fatty acids; vitamins C, E, and beta-carotene; as
well as zinc, lutein, and zeaxanthin. Research suggests those nutrients may
reduce the risk of age-related macular degeneration.
All about "EYE"
We may associate
cholesterol with fatty foods, but most of the waxy substance is made by our own
bodies. The liver produces 75% of the cholesterol that circulates in our blood.
The other 25% comes from food. At normal levels, cholesterol actually plays an
important role in helping cells do their jobs. But cholesterol levels are
precariously high in more than 100 million Americans.
High cholesterol
does not cause any symptoms. But it does cause damage deep within the body.
Over time, too much cholesterol may lead to a buildup of plaque inside the
arteries. Known as atherosclerosis, this condition narrows the space available
for blood flow and can trigger heart disease. The good news is high cholesterol
is simple to detect, and there are many ways to bring it down.
People older than
20 should have their cholesterol levels checked at least once every five years.
This is done with a simple blood test known as a fasting lipoprotein profile.
It measures the different forms of cholesterol that are circulating in your
blood after you avoid eating for nine to 12 hours. The results show your levels
of "bad" cholesterol, "good" cholesterol, and triglycerides.
Most of the
cholesterol in the blood is carried by proteins called low density lipoproteins
or LDL. This is known as the bad cholesterol because it combines with other
substances to clog the arteries. A diet high in saturated fats and trans fats
tends to raise the level of LDL cholesterol. For most people, an LDL score
below 100 is healthy, but people with heart disease may need to aim even lower.
Up to a third of
blood cholesterol is carried by high-density lipoproteins or HDL. This is
called good cholesterol because it helps remove bad cholesterol, preventing it
from building up inside the arteries. The higher the level of HDL cholesterol,
the better. People with too little are more likely to develop heart disease.
Eating healthy fats, such as olive oil, may help boost HDL cholesterol.
The body converts
excess calories, sugar, and alcohol into triglycerides, a type of fat that is
carried in the blood and stored in fat cells throughout the body. People who
are overweight, inactive, smokers, or heavy drinkers tend to have high
triglycerides, as do those who eat a very high-carb diet. A triglycerides score
of 150 or higher puts you at risk for metabolic syndrome, which is linked to
heart disease and diabetes.
Total cholesterol
measures the combination of LDL, HDL, and VLDL (very low density lipoprotein)
in your bloodstream. VLDL is a precursor of LDL, the bad cholesterol. A total
cholesterol score of under 200 is considered healthy in most cases. People who
score in the "high" range have an increased risk of developing heart
disease compared to those who score below 200.
To calculate your
cholesterol ratio, divide your total cholesterol by your HDL cholesterol. For
example, a total score of 200 divided by an HDL score of 50 equals a
cholesterol ratio of 4 to 1. Doctors recommend maintaining a ratio of 4 to 1 or
lower. The smaller the ratio, the better. While this figure is useful in
estimating heart disease risk, it's not as important in guiding treatment.
Doctors look at total cholesterol, HDL cholesterol, and LDL cholesterol to
determine treatment.
Cholesterol-rich
foods, like eggs, shrimp, and lobster are no longer completely forbidden.
Research shows that the cholesterol we eat has only a small effect on blood
cholesterol levels for most people. A few people are "responders,"
whose blood levels spike up after eating eggs. But for most, saturated fat and
trans fats are bigger concerns. Daily cholesterol limits are 300 mg for healthy
people and 200 mg for those at higher risk. One egg has 186 mg of cholesterol.
Cholesterol comes
from two sources -- the body and food -- and either one can contribute to high
cholesterol. Some people inherit genes that trigger too much cholesterol
production. For others, diet is the main culprit. Saturated fat and cholesterol
occur in animal-based foods, including meat, eggs, and dairy products made with
milk. In many cases, high cholesterol stems from a combination of diet and
genetics.
Several factors
can make you more likely to develop high cholesterol:
Until menopause,
women typically have lower total cholesterol levels than men of the same age.
They also have higher levels of HDL cholesterol, the good kind. One reason is estrogen: The female sex hormone raises
the level of HDL cholesterol. Estrogen production peaks during the childbearing
years and drops off during menopause. After age 55, a woman's risk of
developing high cholesterol begins to climb.
There's evidence
that cholesterol can begin clogging the arteries during childhood, leading to
atherosclerosis and heart disease later in life. The American Heart Association
recommends kids and teenagers with high cholesterol take steps to bring it
down. Ideally, total cholesterol should be below 170 in people ages 2 to 19.
High cholesterol
is one of the major risk factors for coronary artery disease, heart attacks,
and strokes. It also appears to boost the risk of Alzheimer's disease. As we
saw earlier, high cholesterol leads to a buildup of plaque that narrows the
arteries. This is dangerous because it can restrict blood flow. If the blood
supply to a part of the heart or brain is completely cut off, the result is a
heart attack or stroke.
Diet changes
offer a powerful way to fight high cholesterol. If you've ever wondered why
some cereals claim to be heart-healthy, it's the fiber. The soluble fiber found
in many foods helps reduce LDL, the bad cholesterol. Good sources of soluble
fiber include whole-grain breads and cereals, oatmeal, fruits, dried fruits,
vegetables, and legumes such as kidney beans.
No more than 35%
of your daily calories should come from fat. But not all fats are equal.
Saturated fats -- from animal products and tropical oils -- raise LDL
cholesterol. Trans fats carry a double-whammy, boosting bad cholesterol, while
lowering the good kind. These two bad fats are found in many baked goods, fried
foods (doughnuts, fries, chips), stick margarine, and cookies. Unsaturated fats
may lower LDL when combined with other healthy diet changes. They're found in
avocados, olive oil, and peanut oil. 
Meat and full-fat
milk offer plenty of protein, but they are also major sources of cholesterol.
You may be able to reduce LDL cholesterol by switching to soy protein, such as
tofu, at some meals. Fish is another great choice. It's rich in omega-3 fatty
acids, which can improve cholesterol levels. The American Heart Association
recommends eating fish at least twice a week.
There's growing
evidence that low-carb diets may be better than low-fat diets for improving
cholesterol levels. In a two-year study funded by the National Institutes of
Health, people who followed a low-carb plan had significantly better HDL (good
cholesterol) levels than those who followed a low-fat plan.
If you're
overweight, talk to your doctor about beginning a weight loss program. Losing
weight can help you reduce your levels of triglycerides, LDL, and total
cholesterol. Shedding even a few pounds can also boost your good cholesterol
level -- it tends to go up one point for every 6 pounds you lose.
Giving up tobacco
is tough, but here's one more reason to try. When you stop smoking, your good
cholesterol is likely to improve by as much as 10%. You may be more successful
if you combine several smoking cessation strategies. Talk to your doctor about which
options are best for you.
If you're healthy
but not very active, starting an aerobic exercise program could increase your
good cholesterol by 5% in the first two months. Regular exercise also lowers
bad cholesterol. Choose an activity that boosts your heart rate, such as
running, swimming, or walking briskly, and aim for at least 30 minutes on most
days of the week. It doesn't have to be 30 continuous minutes; two 15-minute
walks works just as well.
If high
cholesterol runs in your family, diet and exercise may not be enough to get
your numbers where you want them. In that case, medication can give your
cholesterol levels an extra nudge. Statins are usually the first choice. They
block the production of cholesterol in the liver. Other options include
cholesterol absorption inhibitors, bile acid resins, and fibrates. Your doctor
may recommend a combination of these medications.
Certain dietary
supplements may also improve cholesterol levels. These include flaxseed oil,
fish oil, and plant sterols, such as beta-sitosterol. Prescription niacin, a
B-complex vitamin, has been found to raise good cholesterol while reducing bad
cholesterol. Niacin found in ordinary supplements should not be used to lower
cholesterol.
Some studies
suggest garlic can knock a few percentage points off total cholesterol. But
garlic pills can have side effects and may interact with medications. Other
herbs that may reduce cholesterol include:
Many people are
able to lower cholesterol levels through a combination of medication and
lifestyle changes. But how low is low enough? For people with diabetes or a high
risk of developing heart disease, an LDL score of less than 100 is desirable.
If you already have heart disease or coronary artery disease, some doctors
recommend reducing LDL to 70 or lower.
It takes years
for high cholesterol to clog the arteries with plaque. But there is evidence
that atherosclerosis can be reversed, at least to some degree. Dean Ornish, MD,
has published several studies showing that a low-fat vegetarian diet, stress
management, and moderate exercise can chip away at the build-up inside the
coronary arteries. Other research supports the idea that big drops in
cholesterol can somewhat help open clogged arteries.
