PROTECTING YOUR EYES FROM UV/SOLAR RADIATION

As the weather warms up and we get closer to the start of summer, our families tend to spend more time outdoors and in the sun. While most of us are aware of the harm UV (solar) radiation can do to the skin, we may not realize that exposure to UV radiation from the sun can also harm the eyes and affect vision. Because the damage from UV radiation is cumulative, much of the sun/UV exposure during childhood and early adulthood can increase the risk for developing diseases and disorders later on in life.

There are three types of UV radiation: UV-A (long-wave), UV-B (short-wave), and UV-C. Most UV-C radiation is absorbed by the ozone layer in the upper atmosphere, and does not pose a significant threat to eye and skin health. However, both UV-A and UV-B radiation do penetrate the atmosphere and can play a role in the development of many health conditions such as:

  • Skin cancer (especially around the eyelids and lower eyelash line)
  • Eye cancer/melanoma of the eye
  • Cataracts (a cloudiness of the intraocular lens that causes blurry vision and glare)
  • Macular Degeneration (permanent loss/distortion of central vision)
  • Premature aging of the skin and the eye structures
  • Photokeratitis (“sunburn of the eye”)
  • Damage to the retina (the nerve layer of the eye that allows you to see)

To protect your eyes from solar radiation it is important to invest in a good quality pair of sunglasses. If you need to wear glasses for clear vision, sunglasses can be made with your prescription, or you can wear non-prescription sunglasses over contact lenses. (Ask your eye doctor for recommendations tailored to your specific vision needs.) Also, beware of poor quality sunglasses – the pupils of the eye increase in size behind dark tinted lenses and if the lenses are not properly filtering UV radiation, you have now created a larger “hole” for UV to get inside and damage the eye.

Features to look for in a quality pair of sunglasses:

  • 99% to 100% UV-A and UV-B blocking
  • Lenses should screen out 75 – 90% of visible light
  • Gray tinted lenses to reduce color distortion (maintain colors true to life) or
  • Brown/Amber tinted lenses to increase contrast (great for sports)
  • Polarized lenses to reduce glare/reflections
  • Properly fitting frame with few gaps around the tops and sides (so that there is little space for unfiltered stray light to reach the eye)
  • Polycarbonate or Trivex lens material (for impact protection) for sports or potentially eye-hazardous work
  • Ask your eye doctor for specific brand recommendations

In addition to wearing a good quality pair of sunglasses, wear a hat or cap with a wide brim whenever you spend time outdoors. Certain brands of contact lenses can also help to screen out some UV (but are not considered a substitute for sunglasses). Make sure to visit your eye doctor for yearly comprehensive eye exams to monitor eye health, maintain good vision, and keep track of your sun protection needs.

-Dr. Mika Fu

VISION BEYOND THE AGE OF 40

Around the age of 40, most people (even those with “perfect vision”) begin to experience problems focusing on near objects and fine print. These normal age-related changes, called presbyopia, are caused by a hardening and loss of flexibility of the intraocular lens (inside the eye). As these changes begin, reading and focusing become harder causing eyestrain, blurry vision, and headaches.

Reading glasses and Bifocal glasses can help with these changes – but most people have trouble multi-tasking with these types of glasses. Reading glasses only work for a short range of close distances, and Bifocals do not provide any intermediate vision (the area between 24 inches and 10ft) – and have visible lines etched into the lenses. As the world has become more technology-focused, Progressive glasses have replaced these other types of glasses as the best option for meeting every day vision needs, as they allow multi-tasking at all ranges – and are more attractive cosmetically (no lines).

In a Progressive lens, the distance prescription is set in the top “straight ahead” position (perfect for tasks such as driving or watching TV). As your eyes travel downward in the lens, the prescription changes gradually in a gradient fashion, allowing you to focus on closer and closer objects (such as the computer screen or dashboard of your car). The bottom portion of the lens gives the strongest “reading” prescription, giving clear vision for close objects and fine print. There are no “lines” or harsh transition zones in a Progressive lens – the lenses are smooth and clear, and look like a regular pair of glasses.

Benefits of Progressive glasses over bifocals or reading glasses:

  • Vision for all distances (near, far, and in between)
  • Ability to multi-task without removing glasses or switching pairs
  • No “lines” etched into the lenses (lenses are smooth and clear)
  • Smooth transitions for the eye between different distances (no harsh “jumps” in vision)

However, not all Progressives are created equal. Older style progressives utilize a “hard” design that gives a very narrow intermediate and reading corridor. These older progressives are pre-made, in a “one size fits all” approach. Many people have a hard time adjusting to these older lenses due to the very narrow reading areas, and enormous amounts of side distortion. In contrast, the newer styles of Progressive lenses are “freeform” and “digital” – they have a much wider reading and intermediate area, and a lot less side distortion than the older style Progressives. These modern Progressives are custom lenses designed specifically for your measurements, your prescription, and the frame that you have chosen. “One size fits all” may be adequate for a t-shirt, but it is not the best approach when it comes to something as important as your vision.

In my office, we offer the latest in technology – digitally surfaced, freeform, custom Progressive lenses. Each pair is custom-made to a patient’s own measurements and prescription, and takes into account the width and depth of the frame selected. My staff of American Board of Opticianry certified opticians have the up-to-date skills and knowledge to correctly fit and measure these lenses that I prescribe for my patients. We are currently accepting new patients, and would be happy to discuss these types of lenses with you – please stop by or call for an appointment!

-Dr. Mika Fu

VISION NEEDS OF SCHOOL-AGED CHILDREN

Children need many skills for effective learning. Being able to see clearly and comfortably is one of the most important abilities for success at school, as it is estimated that 80% of the learning that a child does happens through his or her eyes. As children graduate to different levels of learning, the visual demands expected of them increase – font size becomes smaller, the amount of time reading and studying increases, and more school work/homework increases the strain on the child’s eyes. If the visual skills and abilities are not functioning properly, education can suffer because learning turns into a difficult and stressful task.

Children may not have the experience to know that they are having trouble with their vision, and may not specifically complain about their eyes or their ability to see. However, children might:

  • Avoid reading and other close work
  • Attempt to do the work, but struggle with comprehension and efficiency
  • Experience discomfort, tiredness, and short attention spans

These undetected vision problems can sometimes be confused with symptoms of other learning disorders/disabilities, such as ADHD or dyslexia.

Other signs that might indicate your child has a vision problem include:

  • Squinting, or moving close to objects to see them clearly
  • Excessive eye rubbing or blinking
  • Frequent headaches
  • Covering one eye, or tilting the head to one side
  • Holding reading materials very close to the face
  • An eye turning in or out (“crossed eyes”), or double vision
  • Losing place when reading, difficulty remembering what was read

Because children have many visual demands in the classroom – and because their bodies are growing rapidly – it is important to have a comprehensive eye exam performed yearly (or sooner if any vision changes are noticed). In my experience, it is not uncommon that a child may be seeing 20/20 in both eyes one year, and the following year, vision can become worse than 20/100 – all while the child is reporting they “see just fine”. I have also seen many instances where a child might have 20/20 vision in one eye – but extremely poor vision in the other eye – leading to problems with depth perception, and if not corrected, the development of a “lazy eye”.

There is much more to vision than the ability to see clearly, or “20/20″ vision. Children also need to be able to focus their eyes, and use their eyes together as a team. Every child needs the following visual abilities in order to learn and be able to comprehend what they read and observe:

  • Visual Acuity – the ability to see clearly at all distances (far: whiteboard/overhead screens, intermediate: computer, near: reading/homework)
  • Eye Focusing – the ability to quickly and accurately maintain clear vision when looking from near to far or vice versa (like changing focus from the distance whiteboard to books/reading material on the desk)
  • Eye Tracking – the ability to keep the eyes on target while moving (like reading words across a page)
  • Eye Teaming – the ability to coordinate and use both eyes together (judge distances, depth perception)
  • Visual perception – the ability to organize images seen (such as letters on a paper) into words and ideas to understand and remember what was read
  • Hand-Eye Coordination – the ability to use visual information to direct the hands what to do (like when writing or playing sports)

The summer months are the best time to bring your children to your eye doctor for a comprehensive vision exam. If vision problems are detected, or their prescription changes, we are able to get the necessary glasses for your child before school begins. Also, a dilation can be performed to check the health inside the eye (which causes temporary blurry vision of 4-6 hours) – without interfering with any school work your child may need to complete (as during the school year).

In my office, we offer the latest in technology for your child’s visual needs – UV protecting and impact resistant lenses, high quality frames with 1 year warranty, and superior anti-glare coatings to reduce eyestrain and glare. We are currently accepting new patients, and would be happy to address the vision needs of your entire family. Ask me about the latest in research on controlling myopia (near-sighted) progression in children with contact lenses – please stop by or call for an appointment!

-Dr. Mika Fu

Understanding Dry Eye

Dry eye is a very common problem where the eye lacks enough tears for lubrication and nourishment. Because tears are essential in keeping the front surface of the eye healthy, vision quality and comfort can suffer when the eye surface is not maintained by healthy tears. Usually, people with dry eye either do not have enough tears or the tears that they do produce are of poor quality. Symptoms can vary depending on time of year, and are often chronic – meaning, the condition never fully goes away.

Common symptoms of “Dry Eye” include:

  • Watery eyes (the eye tries to compensate for the dryness by watering)
  • Stinging/burning sensation
  • Foreign body sensation (feels like something is in the eye)
  • Blurred vision that clears slightly when blinking, or worsens depending on time of day
  • Difficulty wearing contact lenses
  • Mild itchiness
  • Redness
  • Pain/irritation
  • Light sensitivity

In dry climates, like we have here in San Diego, many people also experience environmental dry eye. The dry air causes the tears to evaporate at a faster rate from the surface of the eye, producing bothersome symptoms. Computer use and extended periods of reading can also contribute to symptoms – when focusing, our blink rate tends to decrease, reducing the amount of times the eyelids spread tears over the surface of the eye. When the Santa Ana winds kick up in the fall, the dry hot air from the Mojave Desert and Great Basin blow down towards coastal areas, exacerbating dry eye – or even causing dry eye in normally healthy individuals.

Risk factors for dry eye:

  • Age (tear production decreases as we get older)
  • Hormonal changes (pregnancy, menstruation, menopause)
  • Contact Lens (contacts act like sponges and absorb your tears)
  • LASIK/Refractive surgery (reduced corneal nerve sensitivity which normally triggers tear production)
  • Medications (antihistamines, nasal decongestants, birth control pills, antidepressants, Accutane, and many others)
  • Autoimmune conditions (Lupus, Rheumatoid Arthritis, Sjogren’s syndrome, etc.)
  • Blepharitis or other eyelid problems
  • Environmental Factors:
    • Wind/Dry Climate
    • Computer Use/Prolonged periods of reading or TV
    • Air conditioning/fans/hair dryers
    • Cigarette smoke/Dust

One of the best (but least expensive) methods to treat dry eye is to add Omega-3 fatty acid (fish oil) nutritional supplements to your everyday diet. The typical starting dosage for the Omega-3 fish oils is 1200 mg/day (typically one large sized gel capsule), and these supplements can be found as an odorless version that do not cause a fishy aftertaste or smell. It may take several weeks for the effects to show – and use of artificial tears is recommended concurrently. Other benefits of the Omega-3 fatty acids include a lower risk of heart disease and reduction of chronic inflammation that can lead to conditions such as stroke or cancer. There is also evidence that the DHA/EPA in omega-3 fish oils can reduce the risk of Macular Degeneration and Cataracts.

Ask your eye doctor for more information on the treatment of dry eye, including prescription strength artificial tears and medications that can increase tear production.

-Dr. Mika Fu

The Retina & Retinal Eye Exams

The light-sensitive tissue that lines the back of the inner eye is called the “retina”. Images that you look at are projected through the pupil and focused onto the retina. The rod and cone cells in the retina then convert that image into electric signals, which are then sent to the brain through the optic nerve. Understandably, the retina is vital to your visual system, and if damaged or diseased, can cause blindness or loss of vision.

There are 3 important structures in the retina:

  • Optic Nerve: The ‘wire’ that connects the eye to the brain. This nerve carries visual signals to the brain, much like the cables that connect a DVD player to your TV.
  • Macula: This is the area of the eye with the highest density of rods and cone cells. Much like more pixels in a digital photo give you a clearer higher resolution image… the higher density of rods and cone cells in the macula give you more detailed and higher resolution central vision.
  • Retinal Blood Vessels: These are the arteries and veins that feed the eye nutrients and oxygen and are responsible for removing waste materials. The retina needs a constant blood supply to function properly and provide good vision.

There are many diseases and disorders that can affect the retina. Systemic disorders such as high blood pressure, high cholesterol, diabetes, atherosclerosis, blood disorders, and many more can negatively affect retinal health. External factors such as accidents/injuries, UV light, lasers, smoking, occupational hazards, and medications can also cause damage to the retina and affect your vision. Some conditions like glaucoma, macular degeneration, retinal detachments/holes, can have some genetic inheritance ? but can also occur spontaneously in individuals with no family history of these issues.

Because there are so many known (and unknown) conditions that can cause problems for the retina, it is important to have the health of your retina assessed yearly at your comprehensive eye exam – even if you do not wear glasses or have perfect vision.

The latest technology that we have to screen central retinal health is the retinal camera. This camera uses a special set of focusing lenses to take a quick and painless digital image of your retina. Most of the time, good images can be taken without dilation eye drops, and there are no side effects (other than the temporary brightness from the camera flash). In addition, these photos can be used as a baseline to look for changes that can occur to your retina through the years. Although this instrument is not yet considered the standard of care, it is quickly becoming so. In our office, we offer digital retinal photography to all patients for a nominal fee, and are happy to email these photos to our patients at no charge.

A more comprehensive way to assess eye health is with the dilated eye exam. Without dilating the pupils, peripheral portions of the retina are not viewable. It is important to view these parts of the retina in order to properly assess eye health and screen for potentially vision threatening conditions. The dilation also allows for a much more thorough assessment of the central retina, as it increases the field of view for the doctor to see inside the eye – much like viewing the inside of a room is easier through a big open doorway vs. an old fashioned keyhole in the door. In order to dilate the eyes, the technician or doctor will put eye drops into the eyes, and when the pupil widens, the doctor will exam the retina using a special head-mounted scope. In my office, we offer the dilated eye exam free of charge within 30 days of your comprehensive eye exam. The main side effects of dilation include blurry vision, light sensitivity, and inability to focus for a few hours ? because of this; it is usually a good idea to have a driver take you home.

Ask your eye doctor for more information on how you can keep your retina healthy, and what tools they use to check your retinal health.

-Dr. Mika Fu