How to Understand and Solve Vision Problems
Life isn't exactly easy on the eyes. For starters, there's the normal decline in your vision that comes with aging. (Is anyone out there finding it hard to read the restaurant menu by candlelight or those microscopic instructions on your hair products?) Then there are hormonal fluctuations owing to pregnancy and perimenopause, which also do a number on all parts of your body, including your eyes. And let's not forget about the general wear and tear of all that time spent squinting at a computer monitor or trying to read e-mails on the tiny screen of your cell phone. But before you reach for the bifocals, read on. We asked the experts about some common vision problems you might be encountering -- and the very latest on what you can do about them.
Q. After I've worked at my computer for a couple of hours, my distance vision seems blurry. What's going on?
A. Nearsightedness, technically known as myopia, has increased 66 percent in the past 30 years or so, according to a recent study by the National Eye Institute, and experts say one possible reason may be the rise in computer usage. While your "near work" (like reading, looking at a computer screen, or texting on your BlackBerry) vision may be fine, distant objects may appear blurry when you look up.
"Graduate students tend to have higher rates of nearsightedness than those who go to school for shorter periods of time," says Paul Dougherty, MD, a clinical instructor of ophthalmology at the Jules Stein Eye Institute at UCLA's David Geffen School of Medicine. "That adds to the theory that close work can cause nearsightedness."
Even the experts don't understand what causes nearsightedness. But some think it may result from changes that happen in the eyes when you're doing a lot of close-up tasks rather than moderate- or distance-vision activities our ancestors probably spent more time doing -- like conversing across a table or hunting outdoors.
Q. Once I hit my early 40s, my eyes started feeling tired and irritated. Why?
A. Welcome to perimenopause. The same hormonal fluctuations that cause erratic periods, mood swings, and night sweats may also cause dry eye. This common condition can make your eyes red and irritated and may make you feel as though you have sand under your lids. It can occur when you have a decrease in tear production (common as estrogen decreases) or when the tear ducts are inflamed (which just happens sometimes; doctors aren't sure why). You can get dry eye if you take antihistamines, antidepressants, diuretics, birth control pills, or anti-anxiety drugs. It can also happen if you have an autoimmune disease such as Sjogren's syndrome or rheumatoid arthritis, says Ilene K. Gipson, PhD, a professor of ophthalmology at Harvard Medical School and the chairman of WomensEyeHealth.org.
While dry eye usually doesn't affect your ability to see, it can be annoying and painful. Over-the-counter artificial tears are the first line of defense. Doctors also often recommend using humidifiers to moisten dry air and eating fish rich in omega-3 fatty acids, which help combat inflammation. In a study published in the American Journal of Clinical Nutrition, women who ate five or more four-ounce servings of fish (such as salmon or sardines) rich in omega-3 fatty acids each week had a 68 percent lower risk of dry eye than those who averaged less than one serving a week. Supplements can also help, but the quality varies. Ask your doctor to recommend the right dosage and brand.
Restasis is the only FDA-approved drug to treat dry eye. It helps suppress inflammation, explains ophthalmologist Ruth D. Williams, MD, a spokesperson for the American Academy of Ophthalmology. Patients can use the drops over a long period of time and many feel better, she says.
Another option is punctal plugs, which your ophthalmologist inserts into your tear-duct openings. By at least partially blocking tear drainage, the plugs allow more moisture to be available to the eyes. Researchers are also exploring whether hormone-replacement eyedrops could improve dry-eye symptoms without exposing the rest of the body to the potential side effects of hormone therapy.
"Dehydration at any age can also increase the risk of ocular dryness," says Rachel Bishop, MD, chief of the consult services section at the National Eye Institute. "If you don't have a healthy amount of tears coating your eyes, they will feel irritated and scratchy, and if it's bad enough, it can even create blurred vision." The easy fix? Drink more water. Make sure you're hydrating before, during, and after exercise. And don't forget to replenish fluids regularly throughout your day -- every day. If you're not thirsty and your urine is pale yellow to almost clear, then you're probably drinking enough.
Q. I have to hold this page away from my face just to read the print. Why can't I focus on the words when they're up close?
A. Blame it on presbyopia, a normal phenomenon in which the lens of the eye begins to harden, thanks to aging. "When you're young, the muscles inside the eye contract and allow the lens to increase its power and focus. But as you hit your 40s, the lens begins to lose its elasticity, which makes focusing increasingly difficult," says Dr. Dougherty. "You lose your ability to use your eyes like a zoom lens."
Traditionally, eyeglasses have been the mainstay of treatment. But as boomers age and technology evolves, more cutting-edge procedures are taking center stage. Monovision Lasik, for example, is a popular surgical option that strengthens close-up vision in the weaker eye. (If you have presbyopia and are nearsighted, a surgeon can correct one eye for distance.) A refractive surgeon first creates a flap in the eye, then lifts it to gain access to the cornea. Using a laser, he then reshapes and steepens the cornea, making it better able to zoom in. "The brain learns to favor whichever eye it needs at that moment, so you need glasses less often," says Dr. Bishop. Nearly 90 percent of patients getting monovision Lasik for presbyopia were satisfied with the results, according to a study. "But I definitely recommend that anyone considering this surgery first try out monovision contact lenses to see if that works for her," she says.
Another option? PresbyLasik, a type of refractive surgery that applies different curves to the cornea for clear vision at all distances. Other techniques to correct presbyopia include conductive keratoplasty, which uses radio waves to steepen the cornea, says Dr. Dougherty. "But over time, the area often relaxes and the eye reverts to where it was." Replacing the lens of the eye with an artificial implant is an option if you have cataracts, but implants don't provide perfect vision, so you still may need glasses.