Search for tag: "eye care"

Interviewer: Age-related macular degeneration is a leading cause of vision loss in adults in the United States. The effects on the central vision caused by this disease can significantly impact your life, including the ability to do daily activities, the things you enjoy, and it could also lead to a loss of your independence. However, the good news is, if caught early, the progress of the disease can be slowed.

Dr. Monika Fleckenstein is a professor of ophthalmology and vision sciences at the Moran Eye Center. She's a retina specialist with an emphasis on this condition. Dr. Fleckenstein, let's start with what is age-related macular degeneration. What's going on?

Dr. Fleckenstein: Yeah. So age-related macular degeneration, and we usually say AMD, this is a disease in the back of your eye, and it causes that your central vision may get worse over time. As the name says, the most important risk factor is your age, where you cannot do a lot about it. But we also know other risk factors, which is, for example, smoking or unhealthy lifestyle. And we also know that there's a strong genetic component in this disease.

Interviewer: You called a . . . it impacts your central vision. Is that what you said? Explain what that means.

Dr. Fleckenstein: Yes. So if you look at a paper and try to read, you do this with your very central vision. So this is the area of sharpest vision. This is an area in your eye which we call the macula. And the very center of this macula is the fovea. This is actually the area of sharpest vision, and this is the area you need for reading, for recognizing faces. So this is the highest resolution in your eye.
How Age-related Macular Degeneration Impacts Daily Functioning

Interviewer: I want to know how age-related macular degeneration impacts people's vision in their daily functioning. Talk to me about that, from what you've seen with your patients.

Dr. Fleckenstein: We have different stages of age-related macular degeneration, early stages where you may not experience any symptoms, and then we have the later stages of the disease that you may develop a grayish area in your central vision. In certain subtypes of the disease, you may even develop a central dark area where you're not able anymore to recognize faces or read.

The symptoms patients experience is dependent on their disease stage, but usually, when I see patients with earlier stages, I actually ask them, "Do you have difficulties in dim light?" And so when you go to a restaurant and if you try to read the menu and the light is dimmed and maybe candlelight, this is actually where the patients realize first symptoms. Then also, when they come from bright light outside entering a room, and they may realize it takes them longer to adjust to these changing light conditions as before in their life or compared to the people they are surrounded by. So these are typically the first symptoms of the disease.

And so in later stages, when there is the real damage of the cell layers, the photoreceptors, patients may experience that they have difficulties to read. In very late stages, patients may even not be able anymore to recognize faces. And this is probably, you know, the end stage of the disease where they are not able anymore to read or recognize faces.
Early Detection of Age-related Macular Degeneration

Interviewer: And the importance of early detection in age-related macular degeneration, it's pretty critical, from what I understand. Can you expand on that?

Dr. Fleckenstein: Most sad situations are those where patients have the wet stage and did not receive treatment, and then you face a stage where treatment is not possible anymore or is not really effective anymore if patients have developed scar tissue. And this is why it's so important that if you realize symptoms, never hesitate to reach out to your doctor and ask to have a look.

And when I'm seeing actually my patients with earlier stages of the disease, I explain to them the symptoms of the later stages and tell them, "Please never hesitate to contact me and my team if you experience these changes." And I even tell them it's, you know, "Even if you do not have these specific changes, but if you have a weird gut feeling, please reach out," because sometimes, you know, patients just experience something is off, something is weird here. I cannot really say what it is. Never hesitate. Try to be seen by an ophthalmologist just to make sure that nothing is going on.

Interviewer: And if it's caught early, there are some things you can actually do about it. Tell me about that.

Dr. Fleckenstein: In the earlier stages of the disease, there are certain constellations or certain findings in the back of your eye where we would recommend that you take certain nutrition supplements. So it has been shown in a large clinical trial, the AREDS study, that a certain combination of supplements may delay the progression to late stages, but just if you have a certain constellation of the disease. So the study has also shown that just taking these supplements without having any sign of AMD will probably not have a positive effect. But if you have certain signs, it has been shown that the disease may be slowed down.

In general, we would always recommend, but this is more or less a general recommendation to the whole population, to have a healthy lifestyle, not to smoke. And actually Mediterranean diet has been shown, not only in age-related macular degeneration but also in cardiovascular diseases, that this can be beneficial to prevent the development of macular degeneration and also of the late stages. And Mediterranean diet, this means vegetables, fruits, olive oil, fish. So more a combination of nutrition into this direction.
When to Get Checked for Age-related Macular Degeneration

Interviewer: So since catching it early is so crucial, how often should somebody actually get their eyes checked for macular degeneration?

Dr. Fleckenstein: Yeah. So this really depends on age. So the American Society of Ophthalmology, they actually recommend to have an eye check when you become 40. Then it highly depends if your ophthalmologist finds anything, if you have any signs of a disease in the back of your eye. With ages of 65, we would recommend yearly eye exams. But of course, if you have a positive family history for age-related macular degeneration or if you have certain risk factors, I would recommend to be seen by an ophthalmologist more often and even in earlier ages.
Diagnosing Age-related Macular Degeneration

Interviewer: And in the diagnosis part, are you able to diagnose the disease? How far in advance before a person starts experiencing symptoms are you able to diagnose the disease with the equipment you have?

Dr. Fleckenstein: So we can see on a micron level changes in the back of the eye. Within the last decades, we have seen such a rapid improvement on resolution. And again, we can see tiniest changes in eyes. We indeed also see patients without any symptoms who are not aware of having any problems, and we may pick up earlier signs of the disease, and we can certainly see if macular degeneration is present or not.

Interviewer: That peace of mind is probably great for a lot of patients when you tell them, no, that's not it, that's something else.

Dr. Fleckenstein: Yes. But, you know, I tell my patients as well, as the time has changed so much and we have these dynamics right now, having the diagnosis of AMD today is something completely different than 20 years ago.

Interviewer: And why is that?

Dr. Fleckenstein: Because first of all, I believe within the next 10 years, you know, we will have more treatments available, and for the wet late stage where everyone is so scared about, we have wonderful treatment available, and this treatment really works well. And I always say I have respect for the wet late stage, but I'm not scared of it anymore because if this is treated well, patients can keep their vision for many, many years.

Dr. Gellner: We'd all have x-ray vision if we could, am I right? Do certain activities we've been warned about actually hurt our eyes? Old wives' tales about eyes today on The Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering The Healthy Kids Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: They say eating carrots will improve your eyesight, not true. But this old wives' tale has a really cool back story. It may have started during World War II when British intelligence spread a rumor that their pilots had remarkable night vision because they ate lots of carrots. They didn't want the Germans to know they were secretly using radar.

Carrots and many other vegetables high in vitamin A, do help maintain healthy eyesight, but eating more than the recommended daily allowance won't improve your child's vision. In fact, it can turn your child orange like a Oompa Loompa. That's called beta-carotenemia. Not good.

Reading in dim light will damage your eyes. False. Although reading in a dimly lit room won't do your child's eyes any harm, good lighting can prevent eye fatigue and make reading easier during the pile of homework they have to do every night.

Too much TV is bad for your eyes. Well, watching television won't hurt your child's eyes no matter how close to the TV they sit. But too much TV is a bad idea for kids. Two hours of screen time or less people. Research shows that kids who consistently spend more than 10 hours a week watching TV are more likely to be overweight, aggressive, and be behind in school. So get them outside playing instead.

And we've all heard this one growing up. If you cross your eyes they'll stay that way. Sorry mom, not true. Only 4% of children in the United States have strabismus, a problem with the eyes are not aligned correctly giving the appearance that they're looking in different directions. Eye crossing however does not lead to strabismus.

And no, your child will not shoot their eye out if they play with BB guns responsibly. But when it comes to your child's eyes, if they have any problems, see a pediatric eye doctor right away.

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Dr. Miller: Rubbing your eyes might feel good, but it is really bad. Is that true? We're going to talk about that next on Scope Radio.

Hi, I'm here with Dr. Mark Mifflin. He's a professor of ophthalmology at the University of Utah. Mark, is rubbing your eyes too much a problem? Can that lead to some bad outcomes?

Dr. Mifflin: Yes, actually, it wouldn't be necessarily intuitive that rubbing one's eyes could result in actual damage to the eye, but it's fairly common.

Dr. Miller: Now everybody at some time has got to be rubbing their eyes. So are we talking about a small number of people?

Dr. Mifflin: Well, we actually see a category of disease, perhaps two, that are related to chronic eye rubbing. Certainly, short term eye rubbing is probably not going to cause a problem except for maybe a very few patients who may have some kind of severe problem underlying their eye condition. But chronic eye rubbing can result in the weakening of the cornea and distortion of the cornea called keratoconus.

And it's often associated with people with very bad allergic conjunctivitis or itchy eyes and, unfortunately, some of these people are so itchy that they nothing feels better that . . . I call it the knuckle rub to the eye. Unfortunately, over time, that can actually weaken and distort the eye.

Another thing that can be associated with chronic eye rubbing is actually laxity of the eyelid. The eyelid can, over time, lose its elasticity and that's a less serious problem, but still not something that we want to happen.

Dr. Miller: So if somebody was rubbing their eyes because they have severe allergies in the spring or even year-round, how do they end up at your doorstep? Is it that their vision is blurred at some point?

Dr. Mifflin: Yes, typically, most of the patients who we feel that actually there is an association between chronic eye rubbing and disease fall into the diagnosis of the condition called keratoconus, which is a structural abnormality of the cornea causing poor vision due to an abnormal shape to the surface of the eye. The shape causes irregular astigmatism, which often cannot be corrected by glasses or even contact lenses in its severe stages.

One really important is that this disease may run in families and, typically, may start even in childhood. So certainly, parents should be advised to try to seek treatment for their young children who may have severe allergic disease and in the case of eyes, typically allergy eye drops are very effective in eliminating itch. And behavior modification just through teaching can help children not rub their eyes.

Dr. Miller: Now, how do you know if you're rubbing your eyes too hard?

Dr. Mifflin: I tell my patients that the amount of pressure needed to wash one's face with a washcloth gently or dry with a towel is the appropriate amount of pressure to put on one's eye. Anything more than that is probably unhealthy for the eye.

Dr. Miller: So if you're rubbing to the point where you're seeing stars, then it's a bad thing?

Dr. Mifflin: It is possible to induce the sensation of light or the perception of light without actually seeing light. And this can occur with the eyelid closed and these little sparks of light are called photopsia and certainly, when one rubs their eye hard enough to induce photopsia, that is not a good thing.

Dr. Miller: And if you do that repetitively, you might end up in the ophthalmologist's office.

Dr. Mifflin: I would say that there is a good chance that if you do it over a period of years, you could end up with even worse than that.

updated: October 12, 2018
originally published: April 17, 2016

Dr. Miller: Treatments for a damaged cornea. We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Dr. Miller: Hi, I'm here with Dr. Mark Mifflin. He's a Professor of Ophthalmology here at the University of Utah. I'd like to talk a little bit about what patients might expect if they go in for corneal transplantation or mention of some of the newer technologies related to corneal repair. I know you're an expert in that area so you might just tell us a little bit about that.

Dr. Mifflin: Traditionally, corneal transplantation involves basically replacing the front of the eye, the windshield, if you will, which is the curved clear dome of our eye is the cornea. And so in the traditional technique that is actually cut with a special instrument and replaced with a clear cornea from a human donor cadaver eye. The cadaver tissue is processed through an eye bank and it's very safe. It's much safer than obtaining, for example, a unit of blood from a transfusion.

The tissue is carefully screened and selected and amazingly does not need to be tissue-matched, unlike a kidney or a heart or something like that because the cornea does not have blood vessels and the eye has what we call immune privilege, meaning it's designed or evolved or whatever one believes to not scar and to not create an excessive immune response to injury or surgery.

In terms of some of the newer procedures, within the last ten or so years we have made really amazing advances in just transplanting the part of the eye that is actually diseased. So for example, in a condition called keratoconus where basically the structural part of the cornea is weak and distorted, we can replace the anterior part of the cornea, leaving all of the posterior structure intact. This speeds recovery, decreases the rate of rejection and generally results in better vision.

Dr. Miller: How does one choose between the best surgery or technique?

Dr. Mifflin: Well, typically the surgeon has to kind of choose for the patient, and some of the more advanced techniques are not always possible. There are other diseases where only the very inner layer of the cornea is damaged or diseased, and certainly replacing the inner layer only allows for a very quick recovery. For example, comparing traditional cornea transplantation which might take six months for visual recovery, transplantation of the inner layer or the endothelial keratoplasty that we do now may result in good vision in as little as two weeks.

Dr. Miller: That's a huge difference. How many patients do you think would qualify for the partial thickness corneal transplant?

Dr. Mifflin: It's pretty much become the standard of care. It's not that the traditional technique is wrong, but certainly, for example, in our center here at the University of Utah we always try to do the most advanced technique if we believe that it's going to result in the best outcome for the patient. Not all surgeons are necessarily trained in the most advanced techniques, but certainly these things are literally becoming the standard of care for most patients.

Dr. Miller: Dr. Mifflin, could you talk a little about the durability of the corneal transplantation or the partial corneal transplantation?

Dr. Mifflin: Durability in terms of survival rates and longevity of the graft is actually very good. Graft rejection or failure is quite low, in the range of perhaps as low as 1% for some groups or maybe up to 30%. The most difficult transplant patients that we deal with in terms of making the graft work long-term are children. Unfortunately, children do sometimes need corneal transplantation and the success rate is lower, although sometimes there's no option and corneal transplantation is required to prevent irreversible amblyopia or loss of vision due to basically what in layman's terms is known as lazy eye.

Dr. Miller: So either transplantation technique should result in equivalent duration, longevity of the transplant?

Dr. Mifflin: Yeah, and typically transplants will last anywhere from . . . there have been documented successful transplantations lasting more than 60 years. I've only been practicing for 20 years, but most of my transplants from 20 years ago are still doing fine.

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Dr. Miller: Your vision has been changing rapidly over time, could that be a problem with you cornea? We're going to talk about that next on Scope Radio, and I'm Dr Tom Miller.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr Tom Miller is on The Scope.

Dr. Miller: I'm here with Balamurali Ambati, and he's a professor of ophthalmology here at the University of Utah. And we're going to talk a bit about problems that arise with the cornea, which is the foremost part of the eye that faces the environment.

Dr. Ambati: The cornea is the front window of the eye, and it has layers to it. Even though it's very thin, it's only about 0.5mm thick, it has five different layers. And the two most common problems of the cornea are a condition called keratoconus, where the cornea changes from its normal spherical shape into more of a cone-like shape.

Dr. Miller: And it does this over time?

Dr. Ambati: And it does this over time. And usually it does this in the late teenage years, 20s and 30s. So it's a condition primarily of young adults who may know or report that the eye has been unstable and changing. Most people, the eye stops growing by age 20 or 21, and the prescription...

Dr. Miller: Like the bones almost.

Dr. Ambati: Exactly, the prescription is stable. But if someone's astigmatism is changing... Astigmatism is when the cornea is shaped more like a football than a perfect sphere. That can be an early sign of keratoconus, and patients might report needing to go from soft lenses to soft toric lenses, or to hard contact lenses. They might report increasing near-sightedness and increasing astigmatism over the course of years. And this is something that is often undiagnosed till late stages, and so if you do have an unstable refraction or fluctuating vision over time it would be wise to get a cornea scan with an ophthalmologist.

Dr. Miller: What's the difference between, as you mentioned, fluctuating eyesight and progressive worsening of vision? Can you give a definition of that? I know you mentioned that when we talked about keratoconus as a problem.

Dr. Ambati: In fluctuating vision, which can occur especially in Fuchs' Dystrophy, the vision is different between morning and afternoon. In progressive loss of vision over the course of years, people recognize that their vision was not as bad a year ago, or two years ago.

Dr. Miller: The end result of that would bet at some point perhaps the contacts and lenses are no longer are effective in changing the vision, would that be the end stage?

Dr. Ambati: That can occur. The end stage of keratoconus requires what is called a cornea transplant, to replace the cornea with a donated cornea from someone who's passed away and donated their eye. Fortunately now, in the last five years, we've really changed the management of keratoconus to where we can prevent advancement from mild or moderate keratoconus to advanced keratoconus.

With things like intacs, which are rings that are placed inside the cornea that provide structural support, they're essentially an under-wire for the cornea to change it from a cone to a sphere. As well as the emerging technology of cross-linking, where we use a laser to stiffen the cornea and prevent weakening of the cornea.

Dr. Miller: So there are different options in the treatment?

Dr. Ambati: Very much so.

Dr. Miller: So is this a hereditary problem?

Dr. Ambati: It is a hereditary problem with what's called variable penetrance. So if you have a first degree relative with it you're at a higher risk for it.

Dr. Miller: Somewhat like glaucoma.

Dr. Ambati: Indeed.

Dr. Miller: And so if someone has a family history of keratoconus should they seek out an ophthalmological examination and a cornea scan?

Dr. Ambati: I think that would be advisable if they have any significant near-sightedness or astigmatism. And certainly it would be advisable if they are considering LASIK. One of the things that we do at Moran Eye Center is to carefully screen patients coming in for potential LASIK or laser vision correction to make sure they don't have keratoconus or other cornea problems.

Dr. Miller: So just to be sure, if one has keratoconus does it always require a transplant or is there, as you said, variable stages of the development of the problem?

Dr. Ambati: It is definitely a spectrum of progression, and if we can catch it in the mild or moderate stage the goal would be to employ intacs, or cross-linking, or some of these other options to prevent the need for cornea transplant.

Dr. Miller: Are there any other problems with the cornea? I notice since the cornea is the forward facing part to the environment, UV radiation, sunlight, does that affect the cornea more so than other parts of the eye such as the lens or retina?

Dr. Ambati: Certainly patients who are exposed to a lot of sunlight and UV light can develop pterygium, which is a growth on the surface of the cornea.

Dr. Miller: So that's a result of UV exposure sometimes?

Dr. Ambati: Indeed. And the UV radiation can also damage the back layer of the cornea, which is the endothelium. And those cells are actually what's called post-mitotic, they can't replace themselves. And so that can contribute to a condition called Fuchs' Dystrophy, where the cells of the back of the cornea slowly die. And that does require a partial thickness cornea transplant, but not a full cornea transplant, just replacing the back layer of the cornea. And those two conditions, Fuchs' Dystrophy and keratoconus, are probably the two most common causes of needing a cornea transplant procedure.

Dr. Miller: So in summary, would it be advisable if one has a family history of either of these problems to probably seek an ophthalmologic examination sometime in their 20s, or perhaps if they are having changing vision or astigmatism?

Dr. Ambati: Yeah, if you have fluctuating vision it is advisable to see an ophthalmologist at any time of your life. If you have a family history of keratoconus, in your brothers, sisters or parents, I think it would be advisable to see an ophthalmologist in the early or mid 20s. And if you have a family history of Fuchs' Dystrophy, that usually presents itself in the 40s or 50s, so that would be the best time to present.

Dr. Miller: Untreated what would be the end result of this if it continues untreated?

Dr. Ambati: Without therapy you would eventually lose vision, your eye would become cloudy and scarred. But generally people come well before that.

Dr. Miller: Thank you very much.

Dr. Ambati: Thank you.

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Your child's eyes, when do you think they need glasses? When do you think something's wrong? Is this something you can pick up or something your pediatrician needs to pick up? Eye problems, we are going to discuss them today on The Scope.

So when do you start worrying about kids: their eyes, glasses, things like that? The good news is that for most kids, they don't start needing to wear glasses until they are about elementary school age. And you notice they are squinting when trying to do their school work or they have to get moved up to the front of the classroom because they can't really see that well, or complaining of really bad headaches after reading. That's another sign that your child might need glasses.

We actually start vision exams at three and your child should have a vision exam by your pediatrician every year at a well visit starting at age three.

They have different eye charts. You can do letters or you can do ones that just have pictures and the kids can tell us what pictures they are until they are able to learn their letters.

But what about littler kids? What do we start looking for in littler kids when we start shining those lights in their eyes during exams? Well, we are looking for different things in terms of making sure that their eye balls are focusing properly.

So one thing that a lot of people start asking about is, "My newborn baby looks cross-eyed." Well, your newborn baby can't focus their eyes very well and they don't have good control over their eye muscles until they get about two months old. After that, you should be able to notice your child is able to move their eyes in the same directions.

What if your child can't? What if one eyeball is looking down or up or to the left or to the right and the other eyeball's looking forward? That's different.

Strabismus is the fancy name for that. That is where your child's eyes point in different directions. One is pointed straight ahead, the other is pointed in a different direction. Sometimes you get what's called "walleyed" where one or more of the eyes turn outwards towards your child's ears. And then you got cross-eyes, which means they are looking towards your nose.

But both of them are forms of strabismus. Strabismus happens when the six muscles that work together to move your child's eyes don't work together. It can be caused by a problem with the muscles, with the nerves, or problem in your child's brain, but most people with strabismus are born with it and it does tend to run in families.

So when your child's eyes don't tend to work together to look at an object, the brain pays attention to the image from only one eye and ignores the image from the other eye. So what you need to do is to watch: does this happen more when your child is tired or sick? That's usually when we pick this up. When you can see they're getting tired and one of the eyes is just kind of wandering away, it's time to mention that to your doctor.

A good thing is we don't normally see your children when they are tired and tiredness is usually when it happens. Take a picture. That's great because you'll often notice to the red eye reflex, you know when you take a picture and you've got to use that red-eye reduction thing on Photoshop because their child looks like they've got bright red eyes? Okay, those bright red eyes--that's actually good. That's looking at the back of the eye. It's called the retina, and you're looking at all the blood vessels in the back.
We like seeing that. That's what we are looking for when we use that ophthalmoscope and we look in your child's eyes. We are looking for that red reflex. If they are not the same, then you might have a problem with how the eyeball muscles are working.

So that's what we are looking for and if we find it, what do we need to do? Well we usually refer to an eye doctor because they will be able to help with actually managing this. They usually start with patching, or sometimes using eye drops, depending on the age of the child to force your child's brain to pay attention to the weak eye. And then the weak eye works harder and develops more normally.
In severe cases, your child may need surgery on their eye muscles to help re-position where the eyeballs go. They might need glasses, especially if your child has farsightedness from the eyeballs not being in the right direction. The glasses often do help this when started early. And eye exercises.

The eye doctors can tell you about some different eye exercises and what that does is that also helps with helping the eyeballs focus at the right spot. Unfortunately, a lot of the forms of strabismus do not improve with eye exercises, but it's always something that they try.

What's the other kind of thing that we hear most with the eye balls not focusing right? Lazy eye. We hear this a lot too. Lazy eye, the fancy name is amblyopia, and that's also where the eyes just don't go in the right spot.
You see again, you'll notice both eyes normally straight but the one just sort of slightly drifts a little bit too. And the difference is in most kids when you find this early, you can still have normal vision in both eyes. After age eight, the treatment is less successful, so you want to try to watch for it early.

It works the same way in the fact that the brain is getting images from the good eye and not the bad eye and this is more due to the eye ball shape and also the eyeball muscles. So there's more things going on to try to cause amblyopia.
Babies don't often show any symptoms of lazy eye. They may have trouble following objects with their eyes or continue to have the crossed eyes after two months old. Toddlers, they may favor one eye. And if you cover the eye that's really strong, then they kind of fuss because they can't see as well.

So you've tried the patching and the eye doctor says it's time for glasses. So how do you help your child adjust to wearing glasses? Well, that can be hard.
You all remember kids who wore glasses, they're called four-eyes and all sorts of things like that and it's really not very nice. So kids will sometimes "forget" to put them on, "forget" to take them to school because they don't like being teased, they don't want to wear them, they're uncomfortable, they think they look ugly, they can't play sports in their glasses.

You know, it's hard to transition to glasses, but if you help your child understand why they need to wear glasses, they'll be more likely to wear them. Make sure that your school-age kid understands wearing their glasses will help them read. If they get headaches from their vision problems, it will decrease their headaches, and actually a lot of people wear glasses, so it's not like they are alone. Point out people who do wear their glasses, because then you'll be able to say, "See, look at that person wearing their glasses, look how good they can see."
If your child continues to get teased by other students because they are coming to school with glasses now, talk to your child's teacher about it. They often are used to having to deal with situations like this and they can help your child.

Another thing, have your child involved in picking out what kind of frames they like. Have them pick their favorite color, what matches with their wardrobe, some of them have characters on them that they like. Make it something so it's more of a fashion statement than a medical device.
Make sure that the glasses fit properly. Any place that you get your glasses from will have someone who is qualified to make sure that the glasses fit properly around the ears and around the nose piece. And you can usually have them re- adjust them whenever you need them to at no charge.

Again, you should also remember to keep safety in mind. Kids will break their glasses, I will guarantee you that one, so make sure that their lenses, instead of being made with glass, are made with something called polycarbonate. It's a safe material. It's lighter than other lenses and if your child plays sports, you can also get sports goggles made with the same material that will help protect them against eye injury.
Another big thing is to make sure you don't nag. Don't nag at your child if you see them taking their glasses off. Have your child remember to put them on and when you see your child wearing their glasses, compliment them. Just say, "Oh I see that you are wearing your glasses, thanks that really helps me to know that you can see well."

And make sure that your child is getting regular appointments with the eye doctor to make sure their prescriptions are up to date. Again, we check their eyes at every well visit, so we do every year and if we notice that their vision is off with their glasses on, then we can even say it's time, even though you saw the eye doctor six months ago, something has changed with your child's eyes and you should go ahead and get your eye doctor to check the prescription again and make sure it's the right one or that they don't need a different prescription.

So the bottom line is if you think you notice something wrong with how a child is looking at things, go ahead, have your pediatrician take a look at them. We can check out the eyes. We can do a vision exam, see how they are looking, if they are old enough to do a vision exam. The main thing is that for children, their eyes are still developing, so the sooner you get an eye problem identified and corrected, the better it will be for their overall vision health.

updated: January 18, 2021
originally published: July 15, 2014

Interviewer: Are women more likely to get macular degeneration than men? We'll examine that next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Dr. Margaret DeAngelis is at the Moran Eye Institute. She also is on the Utah Women's Eye Health Board. Let's talk about women and macular degeneration. Maybe I'm wrong on this. I kind of thought generally it was men that got it, but that's not the case.

Dr. Margaret DeAngelis: No. Women, it's actually been shown, in two studies done ten years apart from each other in what's called a meta analysis where you combine all the studies that are out there, that women are at higher risk of getting age-related macular degeneration than men. Now, why is that you might ask.

Interviewer: Why is that?

Dr. Margaret DeAngelis: Why is that? Well, we're not sure. So some people, some groups have looked at that it may be due to hormone replacement therapy or estrogen that increases one's risk so certain groups are studying that. Some groups have found an association while other groups have not so there's a lack of consistency from study to study. So we still don't have the answer for why women are at risk. Some people have argued that maybe women are more inclined to join studies, to sign up for studies, but that hasn't been the answer either. Or maybe women smoke more cigarettes or these other things, but after you've controlled for all these external factors, there hasn't been the answer there so we're still looking for the reason for why women are at a slightly higher risk. And we do know that genetics plays a strong role but that is equally so in men and women so what that means is if you have a first degree relative, either a parent or a sibling, a brother or sister, with age-related macular degeneration, you're at six to twelve times higher risk than somebody from the general population of getting age-related macular degeneration yourself. So it's highly recommended if you have a family member with age-related macular degeneration you should get your eyes checked age 50 and over at least once a year.

Interviewer: Six to twelve times more. Put that in perspective for me in relation to other things like smoking which has also been shown to cause macular degeneration or a relationship. How much does that increase my risk?

Dr. Margaret DeAngelis: It depends. Different groups including our group have shown that that's based on the number of pack year so if you smoked a pack of cigarettes a day for one year, the more cigarettes you've smoked or pack years your risk increases exponentially, and smoking by everybody has been shown to increase risk.

Interviewer: Got you.

Dr. Margaret DeAngelis: Please understand that that increases your risk, you're susceptibility. It doesn't mean that you will get the disease because you have a first degree relative or you smoked cigarettes. It means your susceptibility has increased. That's a difference between susceptibility and causality.

Interviewer: Is the direct relative susceptibility? Are we talking susceptibility if I have a first...?

Dr. Margaret DeAngelis: We're talking it increases your susceptibility, correct.

Interviewer: How significant is six to twelve times more susceptible? Put that in a perspective for me. Is it like, "Oh wow, that's a lot. That's frightening. Like you should go see the eye doctor right now."

Dr. Margaret DeAngelis: Six to twelve is a lot. If you're 50 years old and older, the American Academy of Ophthamology recommends that.

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Interviewer: What is a physician trying to find when they look into your eyes? That's next on The Scope.

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Interviewer: A lot of times on TV you'll see, or if you've ever even gone to the doctor yourself, they got the little flashlight and they start looking in your eyes and I've always wondered, what are they looking for? We're with Dr. Troy Madsen, emergency medicine at the University of Utah Hospital. In your particular situation, in the emergency room, if you get out the light and are looking into somebody's eyes, what are you trying to figure out?

Dr. Madsen:It's going to vary depending on who I'm looking at. But it's just part of a standard physical exam that when I see a patient I will document something that says on the chart, PERRL. What that stands for is the pupils are equal and reactive to light. And the pupil is the black part of your eye so I'm looking at that. I'm looking at are they the same size, and when I shine a light into it does it close? Does it react to that light and constrict like you'd expect?

And the relevance of that kind of varies from person to person. I mean, in the average person, it's not really a big issue. I can just kind of look at you and look at your eyes and say, "Oh, yeah, they look fine." But in different situations I'm looking for different things.

So if someone comes in after a head injury and they've been in a trauma, I really want to get a good look at those eyes to make sure the pupils are equal, because if they're not, that can be the sign of potentially something very serious in the brain that is affecting the brain's ability to send that message to the eye to have that pupil squeeze down and constrict. That can be a sign of some kind of bleeding in the brain, which is the more serious thing I'm really looking for there. So that's kind of the number one thing I'm looking when I do that.

The other thing I'm looking for often times, and this is a tough thing to do sometimes in the E.R., but sometimes I'll try and get a look at the back of the eye at what's called the fundus of the eye, called a fundoscopic exam, where I'm looking at optic nerve, so where the nerve inserts into the back of the eye. And if a person has a lot of pressure in their brain from bleeding in the brain or something like that, I can actually see swelling on that nerve. So that for me says this person potentially has something that's raising the pressure in their brain, like bleeding, a tumor, something like that. So that's kind of the other big thing I'm looking for when I do that.

Interviewer: All right. So two reasons you would look into somebody's eyes, none of them related to the eyes. Are there things you're looking in somebody's eyes for if they have an eye issue?

Dr. Madsen: Oh, certainly. Yep. And that's one of these things where if someone . . . and usually there I need to have something that's going to push me toward that, someone saying I'm having a lot of pain in my eye or I feel like just something is scratching my eye. And there, I'm going to do an even more detailed exam. I'll kind of flip their eyelid out, kind of like kids do to gross people out. So I'm doing that to look for some kind of piece of dirt or a splinter or something like that in the eyelid itself that's scratching the eye.

Interviewer: And that actually happens?

Dr. Madsen: It does.

Interviewer: That's gross.

Dr. Madsen: Oh, it does, yeah. And then I'm looking at the cornea, so the front part of the eye and sometimes you'll look at that, you'll see little pieces of metal that are stuck on there, say, from a welder or someone who is working with metal. I can see that. Sometimes I'll see a rust ring there. You can actually see rust on the eye itself from a piece of metal that may have been there and then came off.

And then I'll do a very detailed exam, something called a slit lamp exam. It's basically a microscope where I'm sitting down kind of with this microscope that focuses right on the person's eye. I'm looking in the front part of the eye for any, what we call just any cells, any inflammation there that would suggest a lot of irritation in the eye itself. And then I actually put a little thing on the eye that's kind of like a dye that will light up to look for any scratches.

Interviewer: Okay.

Dr. Madsen: Which is what's called a corneal abrasion.

Interviewer: Sure.

Dr. Madsen: So lots of different things you're looking for there on the eye.

Interviewer: So any of these tricks that people can try at home? For example, taking the flashlight and if a person's pupils aren't dilating properly, knowing that you might potentially have an issue?

Dr. Madsen: Yeah, and that's something you can do. If you've had a head injury and you feel comfortable looking at that, you can even look at your own eyes in a mirror and just say, "Do my pupils look like they're the same size?" If you have a family member who's had a head injury, you can shine a light in their eye, just watch, does that pupil squeeze down? And at the same time that one squeezes down does the other one do the same thing? And if it's not, those are concerning things.

Interviewer: Is time of the essence for any sort of eye injuries, generally?

Dr. Madsen: It is, yeah. So time is really of the essence for eye injuries if you actually have something that cuts the eye open. So if we have what's called an open globe injury, so the globe being the eye, the big eyeball, if something actually gets in there and cuts that where there's fluid coming out, time is absolutely of the essence. You need to get to the emergency department. We call our ophthalmologist and they'll oftentimes get you to the operating room to repair that emergently.

Interviewer: All right. Any final thoughts on the eyes?

Dr. Madsen: Final thoughts on the eyes. Obviously, a lot of these things are things we are going to need to do in the E.R. but, like you said, you can kind of take a look at the eyes at home. And certainly if anything comes up, make sure you come in so we can evaluate you further.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: October 31, 2018
originally published: March 19, 2014