Imagine looking in the mirror each day and seeing your eyes slowly getting bigger and bigger, beginning to bulge out of their sockets and change your face. Not only do you not look like yourself, but the world has become blurry, watery, and disorienting. You struggle to manage daily activities with double vision, severe pain, and discomfort. In many cases, you can no longer drive, work or read, all of which can lead to social isolation and loss of independence. This is the experience of many people living with a thyroid eye disease (TED).
TED is a rare disease in which the immune system attacks the muscle and fat tissue behind the eye causing inflammation, swelling, and eye bulging. Unfortunately, getting a firm diagnosis is sometimes delayed as many people with TED are juggled from doctor to doctor for months, sometimes years.
To complicate things further, the terminology is confusing. Hyperthyroidism, also known as Graves’ disease, is a condition in which patients have an overactive thyroid. TED is most common in people with Graves’ disease.1 In fact, up to 50% of people with Graves’ disease will develop TED.2
However, TED can also occur with hypothyroidism, Hashimoto’s disease, and even in those with a normally functioning thyroid gland. While related to those conditions, TED itself requires separate specialists and separate management, monitoring, and treatment plan.
According to a new study, the prevalence of TED is highest among African Americans (23%) and white Americans (18%).3
Since most people who have TED also have hyperthyroidism (Graves’ disease), it is important to understand the difference in symptoms between the two conditions. Hyperthyroidism is an autoimmune disorder where your thyroid becomes overactive and produces more thyroid hormone than the body needs.6 This can result in fast or irregular heartbeat, anxiety, weight loss, insomnia, and heat sensitivity.7
If you have hyperthyroidism or Graves’ disease, you may also notice changes in your eyes, but these are most likely signs of TED. Common symptoms of TED include:5
The primary issue with TED is the inflammation of fat or muscle tissue or both around or within the orbit. Due to this increase in the size of the surrounding tissues, the eye is pushed forward (proptosis), giving the appearance of larger than normal eyes. This can also lead to a “staring” or asymmetrical appearance.2,8
In advanced cases, the excessive fat and muscle tissue growth behind the eyeball can place a great deal of pressure on the optic nerve. This compression of the nerve can lead to decreased vision, and in rare cases, blindness or vision loss.9
If you have hyperthyroidism or Graves’ disease, your thyroid level is most likely being managed by an endocrinologist who cares for people with thyroid conditions. An endocrinologist may discuss the risks for developing TED. However, at the first sign of any changes in the eyes, it is important to see an experienced TED Specialist, like an oculoplastic surgeon or neuro-ophthalmologist.
A team approach is key. The TED Specialist and endocrinologist should work in partnership to co-manage the TED and underlying thyroid condition.
When you first meet with a TED Specialist, they will perform a series of exams to set a baseline or starting point to measure symptoms against going forward. At your baseline eye exam or the first comprehensive eye exam, your doctor will want to know all about your history with both the thyroid condition as well as when the eye symptoms started. From there, tests will be run to assess many factors, including:
All these tests will determine where you are in the course of the disease and the best path of treatment.
It is important to understand that this process will often require several visits and time to review the analysis of the laboratory and diagnostic testing with both the patient and other care providers involved.
Eye exams at subsequent visits will determine how or if the TED is changing. In between exams, patients will also be asked to carefully track their symptoms, so doctors have the history of any changes or “flare-ups.”
At the onset of TED, people may make lifestyle changes including using non-prescription or prescription lubricating eye drops, wearing sunglasses to help with light sensitivity, and elevating the head of the bed to help relieve pressure and swelling at night.
Treatment options vary based on the severity and duration of the disease. For some patients with minor signs and symptoms of TED, simple lifestyle changes combined with over-the-counter treatments can be impactful.
For others, more sophisticated treatment regimens are required. Some people are prescribed oral steroids to reduce the inflammation, while other people are candidates for surgery, like orbital decompression. There is also an IGF-1R inhibitor therapy that is given through IV infusion.
TED is a progressive condition that worsens over time if left untreated. The longer TED goes untreated, the more likely serious eye damage will occur. As soon as any changes in the eyes are noticed, especially if you have Graves’ disease or another thyroid condition, contact a TED Specialist immediately for an appointment.
While many in-person care facilities are following strict safety guidelines, many doctors are also offering telehealth visits. To participate in a telehealth visit, all patients need is access to a smartphone or computer with a camera. Patients must be in a well-lit environment and hold or position their device still for an optimal experience.
Despite the virtual circumstances, TED Specialists, such as oculoplastic surgeons, can still conduct a thorough exam simulating an in-office experience. This will include a review of medical history and assessment of visual acuity. By positioning the phone or computer camera close to a person’s eyes, TED Specialists can also assess eyelid measurements and determine an accurate clinical activity score. Not wanting to leave your house is understandable during these times, but it is important to embrace telehealth to ensure consistent management and monitoring of TED.
People living with Graves’ disease and TED can find advice, connection, and resources through the following organizations and communities:
Though a rare disease can feel isolating and lonely, you are not alone. Acting quickly and finding the right TED Specialist can help avoid the confusion, misinformation, and delayed care leading up to diagnosis and accelerate the attention you need.
More than ever, seniors need to be vigilant about their vision. Not only is it an essential sense, but poor vision presents another risk: preventable falls. Unfortunately, we live in the age of COVID which makes it harder for older adults to maintain their health, including their eye health. This article reviews the reasons why it is more important than ever that seniors get regular vision care
There are millions of older adults living alone, a grim fact amplified by the COVID-19 pandemic. Family members are visiting older relatives less. And when they do, they may keep their distance to limit virus exposure and spread.
Seniors are also frequenting their doctors less, to maintain distance and safety during this time.
Although social distancing measures are necessary, older adults living alone face challenges to their health and well-being. In fact, self-isolation increases feelings of loneliness, a risk factor for other medical conditions.
It may also increase the risk and consequences of falls in this population. Isolated elders may be unable to get up after a fall leading to prolonged time on the floor and a delay in getting medical care. As a consequence, they can develop preventable complications, including the following:
Deteriorating vision, reduced muscle mass (known as sarcopenia), and problems with balance often accompany aging. All of these factors contribute to the risk of falls in the elderly. In fact, falls are the leading cause of injuries for older people.
According to the National Council on Aging:
In addition to the physical cost, injuries caused by falls can come at a steep economic price. Each year, about $50 billion is spent on non-fatal fall injuries and $754 million is spent on fatal falls. Further, as the population continues to age, this cost is expected to increase substantially.
According to a widely-cited Pennsylvania State University College of Medicine study, by the age of 65, one in three individuals has some form of a vision-reducing eye condition. These include
All of these changes increase the probability of a fall.
While vision problems related to aging cannot be completely avoided, there are some measures that older adults can take to reduce their risk of eye disease and maintain eye health as they age:
Both quitting smoking and maintaining a healthy weight can reduce the risk of developing eye diseases. This is because smoking increases the risk of certain eye diseases, including cataracts, AMD, and diabetic retinopathy. And, being overweight is associated with cataracts and increases in intraocular pressure.
Eating nutritious foods, maintaining a healthy weight, and increasing physical activity are all essential for vascular health and, therefore, support good eye health.
Wearing sunglasses while outside protects eyes from the negative effects of UV light and can also benefit one’s eyesight, particularly if started early and used consistently.
Vision screening and early intervention are essential for improved clinical outcomes. Because of this, comprehensive routine eye exams are one of the most important steps for the early diagnosis of associated vision problems.
A comprehensive eye exam should include the following:
The good news is that many of the chronic conditions that adversely affect eyesight can be detected through routine eye exams, often before patients exhibit symptoms.
Many people think managed vision care is comprised of annual eye exams to ensure one’s eyeglass prescriptions are correct. However, it is so much more. While seeing clearly is tremendously important, comprehensive vision care goes way beyond prescriptions for glasses. It is essential to both getting ahead of eye conditions and mitigating their impact on vision.
Eye exams allow eye care professionals to take a non-invasive look at the body’s blood vessels. This helps them catch serious systemic diseases early.
Additionally, eye exams help ensure people have access to the right eyesight corrections, such as:
Regular eye exams allow eye care professionals to directly address specific eyesight problems and ensure patients can properly see their surroundings unobstructed or blurred.
With many eye care providers moving towards telemedicine, seniors should explore all the eye care services available to them. Comprehensive eye exams must be done in-person. However, starting the conversation and prioritizing eye health can be a great first step for seniors as we navigate through this pandemic.
It is a reality that as people age, their eyesight will decline. Although some vision deterioration is normal as one gets older, there are conditions that if untreated, can affect seniors’ lifestyles. Serious vision conditions like AMD, cataracts, diabetic retinopathy, and glaucoma can alter how seniors go about their lives including their ability to drive, cook, and exercise.
Managing one’s vision is key, especially now, as seniors navigate the pandemic and rely on their independence to meet their daily needs.
Older adults with impaired vision are also likely to suffer from other chronic illnesses that increase the risk of falling. This includes conditions such as stroke, diabetes, and heart disease. Further, management of these conditions often involves the use of prescription medications that themselves have side effects, including dizziness and muscle weakness that make falls more likely.
Compounding the issue, seniors living alone may be taking on additional physical tasks that present a risk of falls. Here are some examples:
Together, these and other types of issues lead seniors to be the age demographic most likely to fall and to sustain injuries.
Further, the reality of elders falling becomes graver when family members and friends are less likely to be able to support seniors in their day-to-day lives.
All seniors should reflect on the impact their vision has on overall health, fall risk, and their ability to maintain independence and safety. Now is the time to make lifestyle and health decisions that can prevent or delay the onset or progression of degenerative vision problems, such as diabetic retinopathy and age-related macular degeneration. Regular eye examinations are an important step.
I took a pass on keeping the regular follow-up visit with my retinal specialist in April. I said to myself (and anyone else who would listen), there’s no sense keeping the appointment for my rare eye disease because I was not going to accept the recommended treatment. You see, my left eye is afflicted with a progressive, most likely auto-inflammatory process, known as chorioretinitis. It is slowly getting worse.
According to my specialist at Stanford, the next step in my care is big-time immunosuppression with IV methylprednisolone (a steroid) plus IV cyclophosphamide (a chemotherapeutic and immunosuppressive drug). This scared me.
I felt like being immunosuppressed in the middle of the COVID-19 pandemic would be suicide. I also told anyone who would listen, “I would rather be blind than dead.” But the truth is I prefer neither.
Remember, we didn’t know much about the virus at that time except that it was very infectious. And, it makes some people (older folks and those with chronic medical conditions) very, very sick. Some die. And from what I was reading at the time, it is a pretty horrible way to exit this earth.
By June, it looked like the pandemic was slowing down in Northern California. So when my next appointment popped up on my calendar, I decided I would go. This was a big leap for me as I only rarely left the house at that time.
I was nervous, of course, going to a medical setting where people could possibly be exposed to the virus and transmit it. But, I had one N95 mask that one of my sons, a nurse, gave me at the start of the pandemic. (This was way before we knew anything about shortages of these types of masks.)
My husband drove me from Marin County where we live to the Byers Eye Institute, a part of Stanford Healthcare.
The COVID-19 precautions at Byers seemed well thought out. They made everyone enter the building through a single entrance that was guarded by a man with hand-sanitizer and a box of masks. We had to line up six feet apart and enter one-by-one.
We were required to put their mask over the N95s we were already wearing. Our temperature was checked just inside the door. And, only I could enter the patient care area. My husband was relegated to the outer waiting area.
I had to get the usual panel of advanced eye-imaging studies. But I relaxed when I saw that the tech was double-masked and was wearing a face shield. Gradually, I grew confident that Byers was doing everything they should be doing to keep us safe from getting COVID in their clinic.
By the time I got the bad news that my eye disease had indeed progressed, I was able to rationally think about my choices. We initially thought that the inflammation of my eye was due to taking alendronate (Fosamax) for osteoporosis. This is because the timing of me starting the drug and developing the disease was highly suggestive that it could have been the trigger.
It was made more likely because I had tested negative for every known cause of the condition. That made me something you never want to be: an interesting case. I am even the subject of a detailed case study in the Journal of Ophthalmology.
Now, the problem is that the only way to know for sure that the drug was the culprit would be to take it again and see what happens to the disease. This, of course, would be a foolish thing to do.
But there was one other course of action that could be taken before subjecting myself to immunosuppression therapy, however. That was to take a sample of my vitreous (the jelly-like substance in front of the retina that gives the eye its shape) and analyze it for rare or unusual infectious organisms that are not currently known to cause a condition such as mine.
This didn’t seem far-fetched to me as I have traveled in the developing world for years. I once fell in the mud in the jungles of Peru. Who knows what I was exposed to over the years.
Therefore having some sort of exotic infection was not, in my mind, out of the question. Further, I hoped it would be the case as then we would 1) know the cause and 2) be able to take a treatment targeted specifically to that cause.
Aperiomics is a laboratory that specializes in identifying pathogens in various body fluids. They have developed a database of every known, sequenced bacteria, virus, fungus, and parasite in the world.
Then, using something called “deep shotgun metagenomic sequencing”, an advanced technology that can find even small amounts of genetic material in the sample. Using sophisticated algorithms, the sequences of that genetic material is then matched to the database. This can lead to the identification of the causal organism in many cases that had previously gone undiagnosed.
I had interviewed Crystal Icenhour, the founder and CEO about a half a year ago. So I gave her a call to see if this testing could be done in a vitreous sample. They had not done this before but she said she believed it was possible.
I put my ophthalmologist in touch with her so the specimen collection and transfer could be done properly. I wasn’t going to leave this to chance.
Other stories by the same author: COVID-19: The Impact of Our Early Failure to Respond
So, I opted for surgery, a procedure known as a diagnostic vitrectomy. Yes, they remove all or almost all of the vitreous. The surgeon assured me, however, that the body would replace the missing gel with aqueous humor – the liquid in the front part of the eye. He said it wasn’t a risky surgery and, in fact, it only takes about a half-hour to perform.
I arrived at Byers a little nervous but confident I made the right decision. If Aperiomics found some weird infection, that would be a good thing. It could be treated and I would be done with my rare disease.
Again, Byers’s attention to detail with respect to the virus made me feel comfortable. If I am going to get COVID eventually, it was not going to be because of my eye surgery.
I was escorted into the outpatient surgery center and, once again, my husband was relegated to an outside waiting room.
Many different nurses worked on getting me ready for surgery. All were fully PPE’d up.
The nurse anesthetist explained that I was not going to be asleep for the operation. Rather, they were going to use drugs to put me into a twilight state.
And, indeed, I could hear everything that was going on during the surgery, but I pretty much didn’t care. It was pretty strange. I heard the surgeon and his assistant say that I needed to have laser treatment to firm up a weak spot in my retina. I didn’t care about that either.
Later, I could hear my surgeon telling pathology that he was going to take care of mailing the vitreous sample to Aperiomics. I did care about that. After all, why let someone remove your vitreous and then mess up by not ensuring that it arrives at the lab in good shape.
The morning after surgery, I noticed a big bubble with a black rim floating around in my eye. The vision was ok if I positioned my head in a way that allowed the bubble to float out of the field of vision. I also had a huge pupil because I was prescribed dilating drops.
My follow-up visit was uneventful. The surgeon assured me the bubble would be resorbed in time – and it was.
The white of my eye was deep red from pooling of blood below the conjunctiva (the outer lining of the eyeball). I had seen subconjunctival hemorrhages many times when I worked as an emergency physician. So this did not alarm me.
My eye stayed dilated for almost 11 days after I stopped the atropine. But, just like the doctor said, it eventually returned to normal.
Lab tests that had been sent to the Stanford lab started rolling in shortly after the surgery. Everything was negative.
Aperiomics, the outside lab, kept me in the loop on the status of processing my precious specimen. I thought it was a nice touch:
In the end, almost everything was negative: no parasites, no fungi, no viruses. There were small amounts of bacteria, but they likely were contaminants. The report did point out that several of them, however, were known to cause disease in some circumstances. So, I didn’t get the definitive answer I was hoping for.
Obviously, I was disappointed. As I said, I had hoped for a treatable infection even though the ophthalmologist kept telling me an infection was very unlikely because of my clinical course. And, because I never had cells or other signs of infection on my detailed and meticulous eye exams.
One of the choices, the dreaded combo of intravenous (IV) cyclophosphamide (a drug used as chemotherapy and to suppress the immune system) and IV methylprednisolone (a steroid) was still on the table. But this time, new options were offered:
And finally, the doctor suggested trying a course of antibiotics (Septra DS) telling me that sometimes it works in cases like mine. Of course, I opted for that fully aware that I am rolling the dice as the relentless disease keeps on killing off my retinal cells. Luckily, the growth of the inflammatory process is heading away from the macula, the most important area of the eye with respect to vision.
So far, so good.
As you know, in the months after my surgery, the COVID virus went wild again scaring the bejesus out of folks like me worried about having a high risk of a bad outcome. So not being on immunosuppressants right now seems like a good thing. My doctor, however, assured me that other patients are taking those drugs right now and doing just fine.
I will have been on the antibiotics for about a month by the time I go to Byers again. My vision is stable (as always) and I feel great.
I am hoping against hope that we will find that the Septra will miraculously stop the process in its track. If not, this time I may have to bite the bullet and go for the big guns. Fingers crossed.
The bottom line for me is that I was able to actively participate in the decision-making for my eyes. Obviously, I am not a chorioretinitis specialist but I have one of those after all.
I am, however, a specialist in myself. I knew that I had to do everything possible to avoid immunosuppression in the age of COVID. If I end up having to get the dreaded drugs now, at least I know that I did everything within my power to avoid it when I felt it was too big a risk for me.
For me, it was the right plan of action and that is what patient-centered centered care is all about.
How many doctors do you see on a regular basis? Many of us probably go to the doctor for an annual physical. We also see specialists regularly as well. But what about an eye doctor? When was the last time you had an eye exam?
If you haven’t seen an eye care professional in the few years, perhaps you should put it on your “to do” list. Not only is a comprehensive eye exam essential to catch eye problems early, but it is also a good way to get a glimpse of your overall health. An eye doctor can look into your eyes and see the signs of chronic diseases. It’s not just about making sure you can see. It’s how you see and how you want to keep seeing.
Acknowledging that your eyes truly are a window to your overall health, adults should get a thorough eye exam every 1-2 years. During a routine exam, eye care professionals don’t just check to see if glasses or contact lenses are needed. They also check for eye diseases.
And, they are often the first ones to spot a number of other chronic diseases, including
A regular eye exam is especially important if you’re considered at risk for eye and vision problems.
At-risk people are usually those with diabetes and high blood pressure, or who have a family history of eye disease like glaucoma or macular degeneration. But you might be surprised to know that “at-risk” also includes contact lens wearers and people whose jobs are highly demanding visually. If you stare at a computer screen all day, you may also be considered at risk so you’ll want to be sure to get a thorough eye exam every year.
So how do you know if you’re experiencing an eye issue? You may not. Many eye diseases have no symptoms until the disease process is well advanced. Typically, vision issues manifest with blurred vision while driving or reading.
You may also find yourself squinting at the television, feeling visual fatigue by the end of the day, or getting frequent headaches. If it’s been more than 1-2 years since your last visit to your eye doctor, it’s possible your prescription may be out of date.
You may come across websites or smartphone apps that offer online eye exams. These services are definitely tempting. You can get your eyes checked from the comfort of your home instead of making an appointment with your eye care professional. However, you shouldn’t rely on an online test to give you a complete picture of your eye health. Here’s why:
A comprehensive eye exam should include several different tests—many of which, today, have to be done face-to-face with the proper equipment.
-Do You Know the 3 Main Causes of Blindness in the U.S.?
-Vision Correction: Risks and Benefit
-Dealing with a Rare Eye Disease in the Midst of COVID
-Thyroid Eye Disease: Who’s at Risk and Who’s on Call
In addition to the routine eye pressure test, a comprehensive eye exam should include several different tests—many of which must be done face-to-face with the appropriate equipment. These include a slit lamp exam, which uses a unique microscope to review the structures of your eye. It often also includes pupil dilation, which can help detect conditions like retinal detachment, age-related macular degeneration (AMD), and glaucoma.
During your comprehensive exam, your doctor will also review your medical history to identify any risk factors for eye disease. He or she will then determine the appropriate tests for you. For instance, glaucoma, a group of eye diseases where damage to the optic nerve can cause blindness, is hereditary. So if you have a family member with glaucoma, chances are good your doctor will test you for it as well. If fact, many eye doctors include this test in all routine eye examinations.
Patients living with diabetes may develop retinopathy, a complication of diabetes that is a result of leakage from blood vessels. It can cause blindness. Diabetics may also be at higher risk of developing cataracts, a gradual clouding of the eye’s lens.
Older individuals may be at risk of experiencing AMD, an eye disease that causes damage to the macula, which is a tiny spot near the center of the eye that is responsible for seeing objects straight ahead.
During your exam, your eye doctor may test you for one or more of the following:
All of these tests are helpful in diagnosing potential vision issues and determining the best method to address them. Based on your results, your doctor might also suggest additional testing.
While you’re making your eye exam appointment, don’t forget about your kids. The American Academy of Ophthalmology and the American Association for Pediatric Ophthalmology and Strabismus recommend that children receive at least 3 eye exams by age 6:
These exams can be done by an ophthalmologist or by other doctors with proper training.
Children’s eyes should also be screened for visual acuity at the time they enter school. because problems with visions can affect learning. After that, they should be examined every 1 to 2 years, depending on whether they need vision correction.
Triggers for a comprehensive eye exam include the following:
Another reason to ensure your kids get regular eye exams is that nearly 80% of a child’s learning happens visually. Too often, a child who can’t see well is misdiagnosed with a totally unrelated behavioral problem like ADHD when they may only need a pair of glasses.
Just like any other doctor’s appointment, an eye exam should include a robust dialogue with your doctor. It should include any current or past visual symptoms. There should be full transparency about the amount of time you spend staring at screens and tablets. It should also include a discussion of whether you follow guidelines for the proper use and cleaning of contact lenses and whether or not you sleep with your contact lenses in.
Sharing your lifestyle and habits with your eye doctor will allow him or her to provide guidance on optimal eye health for you. Some questions you may want to ask your eye doctor include:
If it’s been a while since you or your kids had an eye exam, don’t put it off any longer. Make an appointment with an eye care professional today to help ensure good vision for life.
Related content: Do You Know the 3 Main Causes of Blindness in the U.S.?
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This article was first published on 8/26/2016. It was reviewed and updated on 5/24/20 for republication.
Getting older is inevitable and aging is often accompanied by changes in vision. As people get older, many of them struggle with cataracts:
This is because the clear lens in our eyes can become cloudy (referred to as a cataract).
Cataracts blur our vision as we age. Seniors with cataracts are more likely to suffer from trips, falls, and even motor vehicle accidents.
If not treated properly, cataracts can be blinding. In fact, cataracts are one of the leading causes of blindness worldwide,[mfn]https://www.who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment.[/mfn]. [mfn ][PubMed][/mfn] My mom, Susan (73), was one of them.
She found that not only was it difficult to read her computer or her phone, but objects in the distance appeared fuzzy and indistinct. Like many, she first tried to fix it by wearing bifocal glasses. However, as an ophthalmologist, I knew this wouldn’t fix the root of the problem.
In fact, bifocal, trifocal, and progressive glasses can actually increase the risk of trips and falls because they reduct depth perception. They also impair edge-contrast sensitivity (the ability to distinguish subtle differences in shading) when looking down to walk. This can cause a person to misjudge their foot placement or fail to negotiate steps or raised surfaces well.[mfn] [PubMed] [Cross Ref][/mfn], [mfn][PubMed][/mfn], [mfn] [PubMed] [Cross Ref][/mfn]
Falling related to bifocal glasses is a significant danger to seniors. In fact, falls are the leading cause of injury for older people. [mfn] https://www.ncoa.org/news/resources-for-reporters/get-the-facts/falls-prevention-facts/[/mfn] They lead to more deaths in seniors than diabetes. [mfn]Kochanek KD, Murphy SL, Xu JQ, Tejada-Vera B. Deaths: Final data for 2014. National vital statistics reports; vol 65 no 4. Hyattsville, MD: National Center for Health Statistics. 2016[/mfn] I was, therefore, worried about my mother falling.
Needless to say, quality of vision is also vital for safe driving, among many other necessary day-to-day activities.
For these reasons, I encouraged my mom to consider cataract surgery. During this outpatient procedure, an ophthalmologist (eye surgeon) removes the cloudy lens and replaces it with a clear artificial intraocular lens (IOL). This helps patients see more clearly and with greater contrast. This procedure is quite routine and is one of the most commonly performed surgeries in the United States [mfn]https://nei.nih.gov/health/cataract/cataract_facts[/mfn]
We’ve seen big advances in cataract surgery in recent years, particularly in the types of IOLs available. Today, we can use the procedure to correct not only the cataract, but also presbyopia (losing the ability to see at near ranges) and astigmatism (an oblong eye shape that distorts images). Following cataract surgery, many patients achieve 20/20 vision without glasses, even after needing glasses or contacts for most of their lives.
Ultimately, my mom decided to undergo cataract surgery, and it was my honor to perform the procedure myself. She and I felt confident this route would not only be best for her overall health but that it would also improve her quality of life.
During surgery, I elected to insert the TECNIS Symfony® IOL (Johnson & Johnson Vision).* It had been available for about two years at the time of her surgery.
This is the first in a new class of advanced lenses called extended-depth-of-focus IOLs. They offer a seamless, continuous range of quality vision. In my professional assessment, this was the right choice for her, but every person considering surgery needs to speak with their physician to determine what is best for them.
Following surgery, my mom was amazed by how clearly she could see and how vibrant colors now appeared. She no longer needs her glasses for most activities. She feels it has given her more independence to do the things she loves, like traveling, playing with her grandchildren, and just performing the tasks of daily life.
As her son, I take comfort in knowing that she’s seeing clearly and is safer from fall risks. I see patients like my mom every day and encourage children of older adults to talk with their parents and their ophthalmologists to address vision issues.
As you age, it is important to have your vision checked annually so that a doctor can monitor your visual acuity and check for the development of diseases such as cataracts, glaucoma, and macular degeneration.
Impaired vision can make driving, moving around, and reading more difficult, so please consult your optometrist or ophthalmologist who can help answer any vision questions you may have.
In-between appointments, it’s important to be aware of the following symptoms that might warrant an earlier return visit [mfn] https://www.aoa.org/patients-and-public/good-vision-throughout-life/adult-vision-19-to-40-years-of-age/adult-vision-41-to-60-years-of-age[/mfn]:
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If you’d like to learn more about vision, here are some important resources
*Financial disclosure: Dr. Chang works with Johnson & Johnson Vision to educate people on cataracts and healthy vision. TDWI did not receive payment for publishing this article.
First published 6/19/18, it has been medically reviewed and updated for republication on 5/2/20.
Study after study has shown that people fear vision loss more than they fear cancer, stroke, heart disease, and other serious health problems. But a new study shows that Americans are scared about an issue they know very little about. And what they don’t know is putting them at risk of vision loss, including blindness.
A survey[mfn]This survey was conducted online within the U.S. by The Harris Poll on behalf of the American Academy of Ophthalmology among 3,512 U.S. adults ages 18 and over between August 8 and 27, 2019. Data by race/ethnicity were weighted where necessary by gender, age, region, income, education, household size, marital status, employment, and specific eye conditions of interest to bring them into line with their actual proportions in the population. The data for each race/ethnicity group was then combined into a grand total to reflect the proportions of each race/ethnicity within the U.S. adult population. Propensity score weighting was also used to adjust for respondents’ propensity to be online.[/mfn] conducted by The Harris Poll shows that while 81% of adults say they are knowledgeable about eye/vision health, less than 1 in 5 (19%) were able to correctly identify the three main causes of blindness in the U.S., which are glaucoma, age-related macular degeneration (AMD) and diabetic eye disease.
Why does this matter? Because most people are also unaware of key facts that could protect them from vision loss, according to the survey. For example, only around one-third of adults (37%) know you do not always experience symptoms before you lose vision to eye diseases. And less than half (47%) are aware your brain can make it difficult to know if you are losing your vision by adapting to vision loss.
Ophthalmologists, physicians who specialize in medical and surgical eye care, have more tools than ever before to diagnose these eye diseases earlier and to treat them better. But these advances cannot help patients whose disease is undiagnosed.
Further, ophthalmologists cannot adequately care for patients who are unaware of the seriousness of their disease. Far too often, ophthalmologists witness the consequences of patients entering our office too late to avoid severe vision loss.
In 2020, we want all Americans to have a clear vision when it comes to eye health. That starts with educating yourself about eye diseases.
The consequences of failing to increase awareness about eye health can be dire. Right now, the number of Americans affected by these potentially blinding eye diseases is expected to double within the next 30 years, due mainly to the aging of the population.[mfn]The Future of Vision: Forecasting the Prevalence and Cost of Vision Problems. Prevent Blindness. Retrieved December 3, 2019, from https://www.preventblindness.org/sites/default/files/national/documents/Future_of_Vision_final_0.pdf[/mfn]
It’s important to note that vision loss affects more than the eyes. Vision loss is also associated with the following:
All of these complications of vision loss can worsen other chronic illnesses.
Another key finding from the Harris poll is that less than half (47%) of respondents were aware that vision loss and blindness does not affect all people equally. But your risk of developing an eye disease varies significantly by your age, ethnicity, family history, and whether you smoke. Here are some relevant facts:
The Harris poll also found that only around one-third of adults surveyed (37%) know that vision loss is not inevitable as you age. Many people think vision loss is just a normal part of aging but it doesn’t have to be. You can take many steps to reduce your risk of vision loss, including
Just because you can see well, doesn’t mean all is well. That’s why the American Academy of Ophthalmology recommends that healthy adults see an ophthalmologist or an eye care professional for a comprehensive, baseline eye exam by age 40 and have their eyes checked every year or two at age 65 or older.
People who have other risk factors will need to be seen more frequently. People with diabetes should have a dilated eye exam every year. African Americans, age 40 and older, and people with a family history of glaucoma should have a dilated eye exam every 2 years.
If you are concerned about the cost of the exam, the Academy’s EyeCare America® program may be able to help. This program provides eye care through volunteer ophthalmologists for eligible seniors 65 and older and those at increased risk for eye disease. See if you’re eligible, visit www.aao.org/eyecareamerica.
Medicare provides an annual dilated eye exam for Medicare beneficiaries over 65 at high risk for glaucoma. Those eligible for this service are people with diabetes, family history of glaucoma, or African Americans over 50. To learn more, call 800-633-4227.
2020 is the year to get smart about eye health. For ophthalmologist-reviewed information about eye diseases and treatments, eye health news, and tools to locate an ophthalmologist, visit AAO.org/EyeSmart.
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There can be a lot of nervousness around addressing eye protection and eye health. Maybe your fears are social—you’re nervous people will mock you with glasses. Maybe your fears are health-related—you’re afraid contacts will hurt your eyes or that eye surgeries like LASIK will go wrong. And maybe you’re just nervous about change—you’ve stuck with one form of vision correction your whole life and don’t want to try something new!
All of these reasons for nervousness are normal and completely understandable. No matter what it is, we’re here to help you make your next vision correcting decision based on facts and information. After all, you want to be informed before making a big decision such as this one!
First and foremost, however, you will want to understand how eyes change over time and with age. A good background on the topic will give you a foundation to stand on while trying to decide on the best move for you.
The fact that eyes change with the rest of your body as you age should not come as any surprise to you. Many of us have had grandparents and elderly people in our life whose visions begin to decline. Past the age of 40 is typically when presbyopia sets in, the hardening of your eyes’ lenses that makes it harder to focus.
In general, eyes change over time—they even change color. As humans settle into their senior years, pupils shrink, eyes get dryer, peripheral vision gets weaker, and you may experience vitreous detachment. So consider that your eyes will keep changing, eye correction does not reverse the effects of age, and the natural course your body will take.
Regardless, you may simply need eye correction. It is wise to start with glasses before moving to other forms of treatment, especially permanent treatment. Contacts aren’t for everyone but they might be worth a shot if you strongly prefer how you look without glasses or don’t like the feel of glasses on your nose.
However, be aware that some people’s eyes get irritated by contacts, and even softer options don’t feel right. Sometimes, the amount of help you need to correct your astigmatism makes the contact lens too thick for comfort, so the softest option doesn’t do too much to make it comfortable.
If you do like contacts though, it’s highly recommended and practically essential to have a pair of glasses as well. The reasons for this are fairly straightforward: eye injuries, allergies, resting your eyes, and some people aren’t approved to sleep in their contacts and may need glasses at night.
LASIK, which stands for Laser-Assisted In Situ Keratomileusis, is a laser-based surgery that permanently fixes your astigmatism, nearsightedness, or farsightedness. It does this by using a laser to reshape the cornea.
Again, this does not mean that the natural course of life will not take place. You will still be subject to the way your eyes age if you choose to get this done. Additionally, it’s a very expensive surgery. However, if you have the money and see fit, it may be worth your while, especially considering you may not have to wear glasses or contacts once it’s done. Even financially, depending on your situation, this permanent eye care may be cheaper in the long run than years of eye care.
Now, there are alternatives to LASIK, and whether or not you choose to take advantage of them should depend on your circumstance. One such option is Advanced Surface Ablation (ASA). What the ASA does differently than LASIK is eliminate the fine layer around the cornea before the surgery, which will regenerate as your eye heals afterward. LASIK, on the other hand, creates a thin flap on the cornea to reach the treatment area.
Another such option is Refractive Lens Exchange (RLE), particularly for those who are struggling with cataracts. A cataract, common in people over 40, is where one’s eye lens becomes cloudy. Vision becomes blurry, colors are less distinguishable, eyes become more sensitive to light, and eventually, you may start seeing double if you have cataracts.
What RLE does is rather than going in and altering the cornea, it replaces the eye lens. The existing natural lens—the one suffering from cataract—is switched through RLE with an artificial lens, called an intraocular lens implant (IOL). RLE serves to fix other vision problems such as near- and farsightedness and presbyopia in the process of defeating cataracts as well.
Make sure to consult your eye doctor or your ophthalmic nurse about whether or not LASIK, ASA, RLE, or a different alternative might be best for you. While you can do your own homework and research things endlessly, you probably do not have the day-to-day experience they do when it comes to such options.
Related Content: Why Cataract Surgery Can Reduce Falls in Seniors
Of course, eye problems can develop over time if you don’t treat your eyes correctly. Not staring at bright lights or screens for too long, for instance, can prevent eye damage and the need for things like vision correction.
Being aware of eye health in general, for fear of other problems that have less to do with vision correction, is good, too. Wearing protective goggles during certain sports, sunglasses when necessary, strengthening your eyes with certain foods (not just carrots), and even staying away from smoking are all active steps you can take to keep your eyes healthy. And keeping up with eye-health knowledge is important. For instance, you don’t want to mistake itchy eyes caused by allergies for an actual vision problem or make it worse by trying to treat the itchiness incorrectly. Similarly, you wouldn’t want to mistake pink eye for a stye and leave it untreated for too long. Without keeping your eye clean or knowing how it reacts when it isn’t kept clean, bad things can happen!
What is your experience with vision correction and healthy oculars? We would love to hear about it. Let us know in the comment section below!
Home runs, goals, slip-n-slides—oh my! After months of anticipation, summer sports and activities have finally arrived. While outdoor fun is a summer essential, these activities can also offer dangers to children’s eyes. August has been named Children’s Eye Health & Safety Month to raise awareness of the eye health issues and injuries susceptible to children.
For a child, hitting a home run is exhilarating. Getting dirt in their eyes while sliding through home base is not. The National Eye Institute claims that baseball is responsible for the largest number of eye injuries among children 14 and under.1
These injuries often occur when dust is kicked up from the field and could lead to watery eyes, redness and irritation, and long-term pain if not handled correctly.2 No matter what sport your child plays, these symptoms can make it difficult to continue the game and are easily preventable with protective eyewear.
Summer is in full swing and, in addition to your favorite summer sports, that means trips to the beach, barbecues, and a lot of time outdoors. While so much fun happens in the summer sun, it is important to remember the effects of harmful UV rays and what you can do to protect your eyes from the sun this summer and year round. Spending hours in the sun without protection is just as bad for your eyes as it is for your skin.
Related Content: Common Summer Health Risks and How to Avoid Them
There are two types of light to keep in mind when protecting your eyes from the sun—Ultraviolet (UV) and High Energy Visible (HEV) light. Both can cause long-term damage to your eyes and the sensitive tissues surrounding them.
Leaving the eyes unprotected from UV rays can lead to a variety of eye diseases and injuries, including “photokeratitis”. This condition occurs from prolonged sun exposure and is like sunburn on the front surface of your eye.
UV light increases the risks of developing cataracts, growths, and cancer. UV light is a causative agent in the development of skin cancer, and approximately 5-10% of all skin cancers occur on the eyelids and the delicate tissues surrounding the eyes. Diseases such as cataracts and eye cancers can take years to develop, but every moment of sun exposure without proper protection could be adding solar damage that increases the risks for serious eye health issues.3
HEV light, most commonly known as “blue light”, is a highly damaging light from the sun that is a major contributor to the development of macular degeneration. Macular degeneration is the breakdown of the macula or the central point of focus on the retina. Symptoms include loss of color vision, a dark area in the center of the visual field, or blurred vision. Macular degeneration is also the leading cause of vision loss among people age 60 or older.
While eye injuries are not always avoidable, there are preventative measures that can decrease the chance they will occur. The same advice for protecting your skin from the sun rings true for your eyes. Limit sun exposure and be sure to wear protective layers, like broad-brimmed hats and sunglasses, to deflect light from your eyes.
Wearing glasses can protect your eyes from debris and drastically decrease the likelihood of eye irritation during fun summer activities. Reports show that approximately 90% of eye injuries could be avoided with protective eyewear.4 Opting for impact resistant lenses for you or your child’s glasses could make all of the difference.
Cheering on your little athlete or enjoying the summer sun is much easier without having to shield your eyes from the sun’s harmful UV rays. Most people assume that simply wearing a pair of sunglasses mitigates the problem; however, that is not always the case. Regular sunglasses do not provide suitable protection from the sun’s damaging rays. Polarized lenses work like sunscreen for your eyes as they contain a special filter that blocks intense reflected light, reducing glare—especially on the water.5 Choosing sunglasses with polarized lenses will protect you from the sun’s rays and could decrease the likelihood of skin cancer. When layering on the SPF before the big game, be sure to grab you and your child’s polarized sunglasses to protect your eyes from the sun.
Coppertone is a known leader in sunscreen for our skin and now for eyes as well. These lenses offer the most advanced protection from UV/HEV rays and allow for the sharpest vision outdoors. Additionally, the Skin Cancer Foundation recommends Coppertone lenses as an effective UV filter for the eyes and the surrounding skin.
Having your child’s eyes and vision examined by an optometrist or ophthalmologist early in their visual development is the best way to assess possible health issues before they become more serious. This is why parents shouldn’t wait until their children report a vision problem to see a vision specialist. Visual skills continue to develop throughout childhood but are more easily treated the earlier they are detected. With some visual skills reaching full development at about 5 years of age, correction after this point can become more difficult. Therefore, it is vital for parents to schedule regular eye examinations as recommended by their pediatrician, their eye care professional, and the American Optometric Association.
As we age, it is common for our vision to deteriorate. The Australian Institute of Health and Welfare reports that 95% of Australians aged over 55 will experience eye problems or eye disease. But just because we’ve come to expect that our eye health will suffer over time, it does not mean it is something we should become complacent about. Understanding what happens to your eyes as you age will help you protect your vision, as well as give insight into what else your eyes might be telling you.
The leading cause of vision loss in people over 60 years old is age-related macular degeneration, where the cells of the macular die with age and are not regenerated. The macula is a small part of the retina, an area at the back of the eye which is responsible for color and our central vision—what we see directly in front of us.
“Dry” macular degeneration is the most common form of the condition, with 10-15% of sufferers going on to develop “wet” macular degeneration. For sufferers of “wet” macular degeneration, the process is faster as abnormal vessels leak blood and other fluids into the macula, causing significant damage.
Other common causes of vision loss include cataracts (clouding of the eye’s natural lens), glaucoma (changes to the optic nerve), and diabetes-related eye complications.
While we are all at risk of developing poor eye health as we age, for some of us, lifestyle factors or other health conditions will exacerbate this risk.
If you suffer from a chronic systemic problem such as high blood pressure or diabetes, or have a family history of eye disease such as macular degeneration or glaucoma, your chances of developing significant problems in your eye health will be greater. Even the medication for seemingly unrelated illnesses, such as arthritis, depression, anxiety, or thyroid problems, can have side effects that affect your vision and eye health.
Similarly, jobs and workplaces hazardous for eye health can also contribute to vision loss, whether through welding glare or prolonged exposure to computer screens.
If you experience any of the following, you should have your eyes tested:
There are a number of steps you can take to prevent the development of eye disease and protect your vision.
Diet: Studies have shown that regularly eating foods high in lutein and omega-3 fatty acids can prolong good eye health by protecting against macular degeneration. Incorporating foods such as salmon, spinach, kale, and collard greens in your diet can slow the process of eye deterioration that comes with aging.
Exercise: Regular exercise has been shown to reduce the risk of macular degeneration by up to 70%.
Don’t smoke: Smoking increases your chances of developing numerous health problems, including cataracts and macular degeneration. Smoking has also been linked to uveitis (inflammation of the eye’s middle layer), a condition which can cause complete and irreversible vision loss. Don’t speed up the aging process. Don’t smoke.
Protect: Just like the rest of your body, your eyes need protection from the sun’s harmful UV rays. If you are out in the sun or experiencing glare, make sure you are wearing good quality sunglasses. If your workplace presents a threat to your eye health, wear the necessary personal protective equipment. If you are working with computers, try reducing the display brightness—your screen should not seem like a light source in its surrounds, otherwise prolonged staring at it may cause strain.
Eye tests are also useful for assessing brain health and cognitive functioning, two areas of health that may also deteriorate with age. Eye problems, such as cataracts, thinning of the nerves in the retina, and unusually high sensitivity to pupil dilation drugs, are common warning signs of dementia. Regular eye tests measure the rate of cell death in our eyes, which if occurring rapidly is considered another warning sign for decreased cognitive ability. Seniors with poor vision are five times more likely to experience a decline in cognitive ability, and those who leave it untreated are 10 times more likely to develop Alzheimer’s disease, the most common form of dementia. Eye tests can help with early detection, treatment, and minimization of these cognitive illnesses.
Early intervention in eye disease can significantly reduce the level of vision loss experienced. Eye tests can also provide doctors with information about your brain health and cognitive functioning. So, it is important to maintain regular eye tests as you grow older. The Glaucoma Research Foundation says people aged 55 and over should be having their eyes tested every 1-2 years, while people over 65 should increase regularity to every 6-12 months.
If you know your risk of developing eye disease is higher than average due to systemic illness or lifestyle factors, take it upon yourself to begin having your eyes tested more regularly and at a younger age. Early detection could save your vision.
Take responsibility for protecting and monitoring your eye health, and enjoy your vision for longer.