How to Understand and Solve Vision Problems
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How to Understand and Solve Vision Problems

Vision problems are part of the deal as you, ahem, mature. Our experts discuss the newest solutions to help you find your focus again.

Vision Solutions

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.

Vision Solutions, cont'd.

Q. I'm pregnant and notice that my vision, which has always been great, is becoming blurry. What's happening?

A. Some vision changes during pregnancy can signal such serious health problems as high blood pressure and gestational diabetes, so you should see your doctor immediately. But chances are the very same hormones that are causing your ankles to balloon and your pelvis to relax are also altering the shape and structure of your cornea, changing the way it focuses. Most vision problems disappear four to six weeks after delivery, so if the blur is bearable, your best bet may be to just sit tight and wait for clearer days.

Q. I'm considering monovision Lasik to correct my presbyopia, but how long-lasting are the results? If I get it done at 45, will I need it redone at 65?

A. Probably not. "Because Lasik involves permanent removal of tissue from the cornea," says Dr. Dougherty, "the effects are long-term." A small number of patients may need a redo, he says, but it's not typical. Even if there is some regression, the eye will never revert to where it started. And additional surgery, which involves removing surface cells that have grown into the area that was treated, is simple to perform. But Lasik won't prevent the development of cataracts, an age-related clouding of the lens that blurs vision. "By the time you're 65, any change in vision will likely be due to cataract formation," says Dr. Dougherty. And, of course, there's surgery for that, too.

Sight Savers

Yes, some vision changes are inevitable. But there are things you can do to stop or at least slow the damage.

Stop smoking

The noxious chemicals create inflammation and cause damage to the small vessels of the eyes. That double whammy makes smokers more prone to cataracts and macular degeneration, a disease that damages central vision, meaning the sight you use to recognize faces or read a book.

Wear sunglasses

Shades act as a physical shield, protecting your eyes from the sun's UV radiation, which over time increases your risk of cataracts and macular degeneration. Experts say lens color and price point have no bearing on how effectively sunglasses block light. Just look for a pair that knocks out 100 percent of UVA and UVB radiation -- and make sure you wear them.

Improve tech habits

More than 40 percent of us experience eyestrain after prolonged computer use, according to a survey from the American Optometric Association. Make sure your computer monitor is at eye level (when it's too high your eyelid moves up, exposing more of your eye to the air's drying effects). Turn the screen away from a window to cut down on glare, turn off harsh overhead lights and use shaded desk lamps. Give your eyes a break from the computer screen for a few minutes once an hour. And if you wear glasses, ask your doctor for computer glasses, which have a larger-than-normal portion of the lens devoted to intermediate vision.

Watch your diet

More and more research is linking good nutrition to good eyesight. For example, those who eat a diet rich in omega-3 fatty acids have a lower risk of age-related macular degeneration (AMD), a leading cause of blindness, according to two recent studies. And those who eat one to two servings a week of nuts rich in omega-3s have a 35 percent lower risk of early AMD, says an Australian study.

Get moving

It will help you avoid diabetes, which can affect your vision. Regular exercise also seems to decrease the risk of AMD. Adults with an active lifestyle (working up a sweat three or more times a week) were 70 percent less likely to develop AMD than those who were more sedentary, says a study from the University of Wisconsin-Madison. "Evidence suggests that exercise could protect against development of AMD, but more research is needed to understand why," says Dr. Bishop.

Make an appointment

Be as vigilant about eye checkups as you are about mammograms -- especially if you have risk factors like diabetes and high blood pressure or a family history of glaucoma or AMD. Even if you've never had vision problems, you should start with a baseline eye exam at age 40, says the American Academy of Ophthalmology. Your eye-care professional will recommend when to follow up.

Beyond Bifocals

A lot has happened in vision correction in the 200-plus years since Benjamin Franklin invented bifocals. Here, some of the latest advances in contact lenses and glasses.

Contact options

You can wear a contact in one eye to correct for nearsightedness and a different type in the other eye for farsightedness. Or you can try bifocal contact lenses to help you see up close and at a distance with both eyes. Multifocal progressive lenses let you see at every distance -- near, far, and intermediate. And ortho-k lenses reshape the cornea of the eye while you sleep, temporarily reducing nearsightedness so you can get through the day without contacts or glasses.

Eyeglass improvements

Progressive lenses allow you to see near, intermediate, or distance without a discernible line to obstruct vision (or scream "I'm old"). Wavefront-optimized lenses are an enhanced type of progressive lens that provides less distortion and a wider viewing area so you can see clearly at all distances. Other advances include super-lightweight lenses (in some cases up to 50 percent lighter than traditional lenses) and lenses with new coatings to reduce scratches and wick moisture. You don't have to look down through your glasses to read or up to see distance anymore. TruFocals are glasses with a slider at the bridge of the nose. Like binoculars, they let you zoom in for close work, move out for computer work and dial out even farther for distance vision.

Originally published in Ladies' Home Journal, December 2010/January 2011.

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