Interviewer: Now, rubbing your eyes can feel so good but, actually, could be really bad for your eye health. Ophthalmologist Dr. Mark Mifflin, tell me more.
Dr. Mifflin: It wouldn't be necessarily intuitive that rubbing one's eyes could result in actual damage to the eye, but it's fairly common. Chronic eye rubbing can result in a weakening of the cornea and distortion of the cornea called keratoconus. The shape causes irregular astigmatism which often cannot be corrected by glasses or even contact lenses in its severe stages. And, unfortunately, some of these people are so itchy that nothing feels better than, I call it, "the knuckle rub." Unfortunately, over time, that can actually weaken and distort the eye.
Interviewer: So, if you struggle with itchy eyes, don't rub them. Try allergy drops or go see your eye doctor instead.
updated: February 3, 2021
originally published: April 29, 2020
Today on The Scope, we talk with Dr. Mark Mifflin about the dangers of rubbing your eyes.
Announcer: Need reliable health and wellness information? Don't listen to the guy in the cube next to you. Get it from a trusted source, straight from the doctor's mouth. Here's this week's listener question on The Scope.
Interviewer: All right, today's patient question is from a gentleman named Ken. He says that his dad is starting to lose his eyesight, and they're concerned that his driving isn't as good as it needs to be.
So how do you have that conversation to take away the keys? It can be a scary thing to do. And to help answer this question we have Lisa Ord. She's a licensed clinical social worker. She also has a PhD in social work and is the Patient Support Program Director at the Moran Eye Center.
So how do you have that conversation?
Lisa: Having that conversation with one of your parents is probably one of the toughest conversations you're going to have, especially here in the West where we rely so much on driving and how much of our individual freedom is attached to be able to get in the car and go where you want when you want to. But the problem is that when someone isn't seeing as well as they need to be seeing, it gets frightening.
And it's not only frightening for them, but it's frightening for anybody else that's on the road or walking on the side of the road. So being able to have the conversation with your parents is very important. And to start with saying, "You know, dad, you've just had your eye checkup, and I see that it's not getting better. They can't correct it. Have you thought about other ways of getting to where you need to go other than driving yourself?"
Interviewer: And then you just pause and wait for that answer?
Lisa: And you pause and wait. Exactly. And it may be met with anger and just being able to be with that and say, "I know that this is a tough conversation, not something you even want to talk to me about." But the tougher conversation is the conversation after you've hit somebody because you didn't see them.
Interviewer: So this is a conversation that if you feel that somebody that you love is not seeing well, you need to have a . . . you outlaid a very direct approach. Are there other ways, if you don't think the direct approach is going to work with your particular loved one?
Lisa: I've had patients use different approaches. One patient said, excuse me, one daughter of one of my patients said that she finally said, "My children will not ride with you in the car. We either need to have someone else drive, or you're not going to be able to take them where you want to take them." So it was kind of like putting it in terms of, "I don't feel safe enough to be in the car with you. I don't feel safe enough for you to take my children in the car with you."
Interviewer: And that really kind of brought the reality to bear?
Lisa: To bear, yeah.
Interviewer: Is there somebody else you could involve, like a health care professional perhaps, because maybe they would be more willing to take it from a third party?
Lisa: I have a lot of patients that say, "But my license doesn't expire for another two years, so I don't have to worry about it." And that's not the case. You're still going to be very much liable whether your license is expired or not. If you're not safe to be driving, your eye care professional will have to fill out a medical form stating what your visual acuity is, and your visual field if you are not being able to be corrected to 20/40 or better. So that is something that they're going to have to do. Having the health provider have that conversation with your parent is sometimes easier because it does kind of put that onus on the healthcare professional.
The other thing is that if you really can't have the conversation, you really are concerned about your parents' driving or anyone's driving, you can make a report to the DMV, and they will take it upon themselves to have that person do a driving test.
Interviewer: Okay. All right. Probably not the way that most people would want to handle it. But I guess as a last resort . . .
Lisa: As a last resort. And I have had some family members who say their parents are so adamant that they're, you know, having extra keys made every time the keys are taken away from them, things like this. And so you're left with no other resort, except for to call in the people whose ultimate responsibility is to take away the license, and that is the driver's license division.
Interviewer: Ultimately, though, if somebody is faced with a vision impairment that could endanger them or others while driving, whatever you do, you would recommend something has to be done.
Interviewer: Don't leave it to chance.
Lisa: Don't leave it to chance. Not a good plan.
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Announcer: Health information from experts supported by research. From University of Utah Health, this is thescoperadio.com.
Interviewer: Sometimes when people lose their vision, they start having hallucinations. It's a condition called Charles Bonnet Syndrome. CBS might not be well-known or documented, but it is extremely common and harmless. Lisa Ord is a licensed clinical social worker. She also has a Ph.D. in social work, and is the Patient Support Program Director at the Moran Eye Center.
So, first of all, Lisa, it's fascinating that many people might actually have this condition but don't say anything about it because they're afraid they'll be diagnosed with mental illness or dementia. So tell me more about that part of it first.
Lisa: Well, I think it's really important for people to realize that they're not going crazy. So the big difference between Charles Bonnet Syndrome and say psychosis caused from mental illness or dementia is the level of insight for number one. People realize that what they're seeing isn't really there. It can't be there. If they don't realize that when it is explained to them that this is caused because your brain hates to have a void, it's used to a lot of visual stimulation. And so it's creating this for you, then it's like, "Oh, okay." Whereas somebody with psychosis or dementia, you can't get them off of that idea that it's real.
Interviewer: And when a lot of people that have this condition are in a support group and they hear that their loss of eyesight also might be related to these hallucinations, they sigh a sigh of relief.
Lisa: Yes. Yes, because here they've kept it a secret. They haven't wanted to tell their family. They haven't wanted to tell their healthcare provider for fear that they're going to be carted off and not able to live alone anymore. A lot of our patients do live alone and quite independently.
Interviewer: Yeah. It's fascinating. So if you start losing your vision, your brain wants to see so badly that it just starts. Tell me more about how it's filling that void.
Lisa: Well, it's interesting to me. We don't know a lot about it, but what we do know is that through some fMRI studies that it's the same visual pathways that are engaged when somebody is seeing a hallucination from the Charles Bonnet Syndrome as when they're actually seeing the object. But when they're just imagining the object or visualizing the object, it doesn't engage those same pathways. So we do know that it is as if we are seeing that thing that we're seeing, and people see a variety of different kinds of things.
Interviewer: Yeah. Do you have any examples?
Lisa: Yeah. So I have a patient who saw the Grand Canyon opening up in front of her. Rather disconcerting. She knew it wasn't there, but still it was a little bit unnerving.
Interviewer: Like the ground opening up . . .
Lisa: The ground opening up.
Interviewer: . . . as if it's a Grand Canyon. Wow.
Lisa: Yes. I've had people that saw flowers or patterns. I've had a gentleman who saw a train and just passing in front of his eyes. A lot of people actually see other people, and these are not necessarily people they recognize.
Lisa: In fact, most the time they don't recognize them.
Interviewer: Can those hallucinations be dangerous?
Lisa: No. They're not dangerous at all.
Interviewer: Not even the person that thinks they see the train? I guess that's better than not seeing a train. Of course, they can't . . .
Lisa: I guess it depends what do you do with it, right?
Interviewer: Yeah. If they're losing their vision, then they're not seeing it. Yeah. Right.
Lisa: Right. But there are lots of things you can do to get the visions to go away.
Interviewer: So is there a point in vision loss where it starts to happen? Is there a threshold where if it's going to happen, it might start happening at that point?
Lisa: Well, what we see is usually people who have more of a severe vision loss also maybe a field. A visual field defect where they have a blind part of their vision and that's actually where they're going to see the hallucination is in that blind spot.
Interviewer: And do some people still see some real things and then that's also the hallucinations are on top of that as well?
Lisa: Yes. Hallucinations can be almost superimposed on top of that as well. Yes.
Interviewer: Like virtual reality in a way.
Lisa: Yes. Exactly.
Interviewer: Yeah. So is it primarily older people that get the condition, or is it just we tend to think of it in older people because they're more likely to have lost their vision?
Lisa: Exactly. It can happen to anyone who has had vision before. Your brain has to know how to see. It has to be used to that visual stimulus. But like you said, most blinding conditions are happening in the elderly or they're age-related conditions. So that's the population that we're more likely to see them in. It can happen in children.
Interviewer: What are some of the specific conditions where it starts happening? So macular . . .
Lisa: Macular degeneration . . .
Interviewer: . . . could be one of them. Yeah.
Lisa: The big one. Glaucoma, diabetic retinopathy. There's many different kinds of conditions that cause blindness. It doesn't really matter. It's not really tied to one condition or another.
Interviewer: Got you. Is it curable?
Lisa: It is not necessarily curable. There are things you can do to get the hallucination to stop. Sometimes they just stop on their own.
Interviewer: Okay. So just because it happens once doesn't mean it's going to continually happen?
Lisa: I have some patients who have it continually quite a bit. Other patients it's like, "Yeah, that's happened to me once or twice."
Interviewer: Okay. All right. And what are some of the strategies for managing it?
Lisa: So one thing that you want to do is change the lighting in your room. So if you are in a dim room, turn on the lights, open the drapes. Another thing that you can do is blink rapidly, change your location, do something else, something that engages your brain, whether it's a hobby or talking to someone else, giving your brain another kind of stimulation.
Interviewer: If somebody believes if they or a loved one has Charles Bonnet Syndrome, what should they do at that point? Should they go see an eye doctor? Do you go see somebody else?
Lisa: Well, they can go see an eye doctor. They can see their primary care, but not being afraid to mention that, "I have vision loss and I am also seeing these interesting or not so interesting visions." That doesn't necessarily mean you're crazy. And providers, even though they may have learned about this once in medical school, they don't think to ask people. So if you are a provider that works with elderly people, remembering if they have vision loss to ask, "Do you see things that aren't there?"
Interviewer: Yeah. And frame it.
Lisa: And frame it.
Interviewer: And frame it that this is . . . yeah.
Lisa: We have patients who see things that aren't there and they know that. Is that happening to you?
Interviewer: What about if you have somebody that has lost vision in your life. Is this a conversation you should have with them, just to make it safe for them to talk about it?
Lisa: Yes. I think just opening up that conversation saying, "I heard about this the other day, and I was wondering if that's ever happened to you."
Lisa: It's totally normal.
Interviewer: And I bet a conversation like that could take just a load of stress off of somebody that thinks that they're going crazy, right?
Interviewer: Yeah. What do you think that the ultimate takeaway that you would like somebody to have as a result of the conversation we had about Charles Bonnet Syndrome?
Lisa: I think the ultimate takeaway is that it is not as rare as we once thought. We find that about one in four of our patients with vision loss have experienced this. So talk to somebody about it. You're not going crazy.
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 is a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.
Interviewer: It's well-known that the sun can damage our skin, but it can also have lasting negative effects on our eyes as well. Ophthalmologist Dr. Jeff Pettey, what are some of those concerns?
Dr. Pettey: Yeah, the same way that the sun damages the skin, it can also damage the eye. Things like skin cancer can occur in the eye. Also, the eye can have things such as cataracts and scarring on the surface of the eye from sun damage.
Interviewer: So how can we protect our eyes from UV damage? I assume sunglasses, probably, play a big role?
Dr. Pettey: Yeah, the best protection is sunglasses, sunglasses with 100% UVA and UVB protection. Large sunglasses to provide more protection. And interestingly enough, you don't have to spend $500 to get that protection. A $5 pair will protect your eyes just as well as a $500 pair.
updated: January 14, 2021
originally published: May 24, 2019
Wearing sunglasses prevents UV rays from damaging your eyes.
Interviewer: It might be surprising, but one of the most common injuries of winter sports is actually eye injuries. Dr. Jeff Pettey, what do we need to look out for when it comes to protecting our eyes when we ski or snowboard?
Dr. Pettey: Yeah, the two things we need to protect ourselves from during snow sports are UV damage and then also physical injury. The way that we can protect our eyes from UV damage is by wearing sunglasses or goggles with 100% UVA and UVB protection. While sunglasses will afford some protection, goggles will afford more protection because they're larger. Goggles will also afford protection from physical injury better. Things like a ski pole, things like branches coming into contact with our face, those are things that we need to be protected from, and goggles will give us the best protection.
updated: December 14, 2020
originally published: November 27, 2017
Why skiers should be concerned with UV damage and physical injury to the eyes, as well as the best ways to keep your eyes safe while enjoying winter sports.
Interviewer: Floaters, you know those little squiggles in your vision? Ophthalmologist, Dr. Brian Zaugg from the Moran Eye Center, what are those things anyway?
Dr. Zaugg: Yes, floaters can be very annoying. They're little condensations of the vitreous, generally speaking, in the back of the eye that move around as you move your eye.
Interviewer: All right. And should they worry me or is it pretty normal?
Dr. Zaugg: Generally speaking, they're common and not causing any problems but occasionally, they can cause issues, especially if they're associated with other symptoms such as flashing lights or dark curtains in your vision.
Interviewer: All right. And if they're just annoying without those other symptoms, can I make them go away?
Dr. Zaugg: Not really. You can make the symptoms a little bit less by wearing sunglasses when you're in bright environments outside. You can also adjust your computer screens to decrease the contrast on them to help. But if you do get new floaters or they're accompanied by any of those other symptoms, those are worrisome things and you should get a full eye exam from your eye doctor.
updated: February 19, 2021
originally published: February 15, 2019
What are eye floaters and can they cause problems with my vision?
Interviewer: Those little squiggles that move around in your eyes, I'm talking about floaters, is that something you should be concerned about, and is there anything that can be done about them? We'll find out next on The Scope.
Dr. Brian Zaugg is an ophthalmologist at the Moran Eye Institute. I know I have them, and I know some other people that have them. Floaters, you know, those things where you close your eyes and you see little squigglies moving around, or sometimes if you're looking into a bright light, you might see them? What's going on there and should I worry about them? First of all, what are they?
What Are Floaters?
Dr. Zaugg: Yeah. Floaters are a big annoyance. I see a lot of patients who complain of floaters every day in my clinics. Generally speaking, what they are is they're condensations of a part of the eye called the vitreous. So the vitreous is a gel-like substance in the back of the eye. When you're younger, it'll liquefy a little bit and collapse on itself, and you'll get little floaters of proteins floating around in the surface inside the eye. As those floaters move around, they create a little shadowing on the retina, so the light can't get to the retina and it creates a floater-like symptom for you.
As you get older, that vitreous continues to liquefy and as it liquefies, it actually shrinks. When it shrinks, it pulls away from the retina. It's kind of adherent to the retina in a few places. Where it's more tightly adherent as it pulls away from there, it creates larger floaters. So they generally get more annoying the older you get if you get floaters.
Interviewer: You might see more the older you get, as well?
Dr. Zaugg: Correct.
Interviewer: All right. So it's not going to get any better on its own for me?
Dr. Zaugg: Well, it usually gets better after the initial onset of the floaters.
Dr. Zaugg: So when you get the new floaters coming in, they're very annoying, they're large, there's many of them, and then over time they usually do settle down.
Interviewer: All right. Is it something that I should really be worried about, beyond just an annoyance?
Potential Ailments Associated with Floaters
Dr. Zaugg: So when you get new floaters, you should always be thinking about anything else that's going on with the eye. There are definitely associated symptoms that you should pay attention to. A new floater can be a sign of, what we most commonly fear is a retinal detachment. If you have a retinal detachment or a tear in the retina, those can be, not life threatening, but vision threatening symptoms. So if you have flashing lights, that can mean that there's some tugging or mechanical motion that's happening to the retina. The retina only knows light. So if something stimulates it, it sends a message back to the brain that you saw light.
The other thing that's really bad with floaters is if you have a dark curtain blocking part of your peripheral vision. That could mean that the retina has folded over on itself and it's detaching, and that can mean that you're having a more serious complication from floaters.
Interviewer: So if I understand correctly, floaters on their own without other symptoms just are part of life.
Dr. Zaugg: Correct.
Interviewer: But with some of those other symptoms you mentioned, then that can be an indication of a more serious issue?
Dr. Zaugg: Correct.
Interviewer: Okay. How often does it get into that serious world, generally?
Dr. Zaugg: It's more common the older you get.
Floaters Increasing with Age
Dr. Zaugg: So if you're over the age of 50 and you're getting a lot of new floaters, then you're a little bit more worried about it, because you're getting the complete collapse or separation of the vitreous from the retina, and it can pull the retina with it. So those are times when you really want to get an eye exam to really determine, because you're not going to know for sure if you're having a retinal tear or detachment. Sometimes you have no symptoms other than the floater. So getting a complete eye exam by an ophthalmologist or an optometrist can help to distinguish if it's a more serious eye condition.
Interviewer: That sounds terrifying. But generally, as long as the floaters are the same old floaters, I'm fine?
Dr. Zaugg: Correct.
Interviewer:And is there anything that you can do about, first of all, the annoying floaters?
Dr. Zaugg: Well, generally speaking, they do decrease with time. Again like I said . . .
Interviewer: Understood. Okay.
Dr. Zaugg: . . . if you get a new floater, it usually goes away with time. Either your brain will start to filter out the floater or gravity will actually bring it down in the eye, so it's not in your visual axis. Usually, they'll come up when you're looking at bright backgrounds. So a lot of times when you're looking at a computer, when you're reading, when you're driving on bright, sunny days.
Methods to Filter Floaters
So outside, something that you can do is wear sunglasses. It filters out the floater a little bit. Inside, if you're working at a computer, it's a little bit more tricky. You can get displays that cover the computer screen that kind of filter it a little bit, use a little bit less contrast in your screen. Sometimes that will diminish the floaters as it bothers you.
Interviewer: So it's about decreasing the glare . . .
Dr. Zaugg: Correct.
Interviewer: . . . in those situations?
Dr. Zaugg: Yes.
Interviewer: That's also the gravity thing, is why when I close my eyes, I'll see them float up sometimes, and then I open my eyes and they go away?
Dr. Zaugg: Well, that's usually a little bit of just the eye movement.
Interviewer: Oh, okay.
Dr. Zaugg: Because when your eye closes, your eye actually moves underneath your eyelid and it'll move the floater.
Interviewer: All right. Is there anything else that I should be aware of floaters? My kind of takeaway is they're a part of life for a lot of people. There are some things you can do to minimize seeing them if they're bothersome. If you start getting some new floaters with other symptoms, I should go see someone like you.
Floaters and Diabetes
Dr. Zaugg: There's a couple other medical conditions that you should be thinking about other things. So if you're diabetic, sometimes floaters can be a sign of bleeding inside the eye. Diabetics have a lot of eye problems when they're uncontrolled. So they usually have an eye doctor that they've been with, and that would be a reason to get an eye exam more quickly than others. Other things that can happen, if you've had a recent eye surgery, that's a warning sign that something could be going wrong. So have your eyes examined.
There's other rare inflammatory conditions of the eye, in a category called "uveitis," where the floaters can actually be conglomerations of inflammatory cells that could be signs of other serious eye conditions. So the bottom line is if you get a new floater, get an eye exam so that they can determine what's causing it. If it is one of these benign floaters, then that's great. You move on with your life. But we have to make sure that there's not something more serious going on.
Interviewer: How often do you recommend somebody get an eye exam, anyway?
Dr. Zaugg: Well, that kind of depends on how old you are, and if you wear glasses, if you don't wear glasses.
Dr. Zaugg: If you're doing well and there's no issues with your eyes when you're younger, getting an eye exam every 10 years is probably fine.
Interviewer: Oh, okay.
Dr. Zaugg: As you get into your 40s and 50s, maybe every five years. As you get into your 60s, every year or two.
updated: September 30, 2020
originally published: May 17, 2017
What are floaters in my eye and why are they there?
Interviewer: It's kind of hard to believe, but that headache, neck ache, or even that backache that you get at work could be caused by your eyes. Ophthalmologist, Dr. Brian Zaugg, from the Moran Eye Center, how could that be?
Dr. Zaugg: A lot of what we do at work now is staring at computer screens. A couple of things are going on. Your eyes aren't blinking very much, so the surface is drying out. And when we're staring at computer screens, our eyes can get fatigued, and some of that fatigue will make us change our posture and affect our neck and cause headaches.
Interviewer: And what can I do about that?
Dr. Zaugg: A lot of things are trying to minimize the amount of time that you're staring at the screen. There's a good rule of thumb called a 20-20-20 rule. What that is telling you is that every 20 minutes, you should look at something 20 feet away for 20 seconds. This will reduce the strain on your eyes, and a lot of times reduce some of those other symptoms that you're having of headache and backache.
updated: March 31, 2021
originally published: March 1, 2019
The average American looks at some sort of screen for an upwards of ten hours a day. How screens can affect your health and the simple '20-20-20 rule' for managing screen strain.
Interviewer: You know, contact lenses are great but they can also be dangerous. Ophthalmologist Dr. Amy Lin is from the Moran Eye Center. What do you tell your patients to watch out for?
Dr. Lin: My main concern with contact lens use is infections from misuse. The worst case scenario is you can actually lose your eyesight from a bad infection. The symptoms of an infection include redness, pain and blurry vision. Some common ways that people actually misuse their contact lenses are sleeping in their contact lenses, swimming or showering with your contact lenses in, not cleaning them properly.
You do need to change that solution every day and to change the contact lens case every three to six months. You also don't want to extend the use of a contact lens beyond what is recommended for your lenses. And if your eye hurts, don't put your contact lenses in. Go see your eye doctor about it and make sure there's no infection.
updated: August 6, 2021
originally published: April 4, 2017
Sometimes sleeping with contact lens—or not cleaning them properly—can result in an eye infection. Learn about the infections from contact lens misuse, the symptoms of eye infections and what you can do to keep your eyes healthy.