Save Your Sight!

by Marc R. Rose

  • Lens color may vary. The most popular is grey because it doesn’t affect color perception. Yellow lenses may help reduce night glare for those with cataracts. Orange-brown lenses are best for those with macular degeneration because UV and blue-light rays are filtered out, offering the best retinal protection. Blues and violets look grey through orange-brown lenses, which bothers some people. Green lenses are popular and give the wearer a natural view, because there isn’t much distortion of color as there can be with other lens tints.

  • Scratch-protected lenses resist scratching that often occurs during sunglass cleaning.

  • Mirrored lenses may increase comfort but don’t filter UV rays.

  • In addition to your sunglasses, it’s a good idea to wear a hat with at least a three-inch brim. This will shade your face and give you added eye protection.

  • Blue light, which is part of the visible spectrum, reacts with pigment deposits on the retina to make free radicals. This causes retinal damage that can, over the years, result in macular degeneration and loss of central vision. Wear sunglasses that filter out at least some blue light. When you wear them outside, a blue sky will look grey.

  * * *

  FACTS ABOUT ULTRAVIOLET RADIATION

  • UV radiation doesn’t cause you to feel pain in your eyes like the pain of sunburned skin.

  • The UV-B and UV-A rays don’t feel hot on the skin, as do other, less dangerous kinds of solar radiation.

  • UV rays are just as hazardous on a cloudy day as on a sunny day. There is some added risk because people are unaware of the need for protection on cloudy days.

  • UV-B rays, strongest between 10 A.M. and 2 P.M., are considered the most harmful. This form of radiation is the one responsible for the manufacture of vitamin D in your skin. Only a few minutes of exposure a day is necessary for this conversion.

  * * *

  Eye Drops

  Using eye drops can be very challenging as we age. Shaky hands, poor aim, arthritis that makes it difficult to squeeze tiny bottles, uncontrolled blinking, and problems reading labels affect up to half of older patients given eye drops. To make matters even worse, few doctors give adequate instructions to their patients when prescribing these medications.

  The best way to use eye drops is to (1) pull down the lower lid with one hand and (2) squeeze the drops into the space between the lower lid and the eyeball. Look upward just before applying the drop. Do your best to avoid touching the tip of the dropper to any part of the eye or eyelid. Keep your eyes closed and shift your eyeballs so that it feels like you’re looking down for a few minutes after the drops are in. Closing your eyes (not tightly) seals tear drains shut so that the medicine doesn’t drain immediately off the eye. Don’t rub or squeeze the eyelid. You also can gently pinch the inside corners of your eyes—this also helps keep tear drains closed so that medicine isn’t wasted.

  If the above method doesn’t work, try the closed-eye technique, which is often recommended for administration of eye drops to children. This may require help from another person. Lie down and place the prescribed number of drops onto the inner corner of the eyelid, then open the eye so that the drops fall in. Close the eye again once the drops have entered it, and follow the instructions given for the open-eye method from that point on.

  To protect your eyes from bacteria, always wash your hands before instilling eye drops. Don’t rinse the dropper, and keep it out of contact with the eye. Take care not to touch the dropper to fingers or countertops.

  If your eye drops sting, keep them refrigerated. The cold is soothing and briefly numbs the eyes so that discomfort is minimized.

  If you are using any ointments, which commonly are prescribed after surgery to help the eye heal, use them after other eye medications in drop form because they will keep fluids from absorbing into the eyes if used initially. For effective administration of ointments, first warm the tube in your hand for a few minutes. The first time you use the medication, squeeze out the first half-inch or so because it may have dried out. Tilt your head back and gaze upward. Pull out the lower lid to form a pouch, and then place ¼–½ inch of ointment along the lower lid, being careful to squeeze the tube gently. Then, slowly release the eyelid and keep it closed for one to two minutes, rolling the eyeball in all directions. Keep in mind that temporary blurring will occur, so you may want to delay activities like driving for a while. Use a tissue to remove excess ointment from around the eye. If there is another ointment you need to use after the first one, wait at least ten minutes before applying it.

  Avoid Preservatives in Eye Drops

  Preservatives used in eye drops actually may worsen the problem for which you use the drops in the first place. Benzalkonium chloride, often used in “artificial tears” for dry eyes, temporarily relieves symptoms but makes dry eyes worse over time. This preservative also is found in eye drops for glaucoma and causes the eyes to dry out more quickly than drops that don’t contain it. While prescription glaucoma drops without benzalkonium chloride are not available, you do have a choice when it comes to the use of “artificial tears.” Look for those that are preservative-free. Some examples of brand names are Refresh, Refresh Plus and Relief by Allergan, Tears Naturale and BION by Alcon, Aquasite by CIBA Vision Care, and a Vitamin A drop by Vision called VIVA Drops.

  Treating Dry Eyes

  Millions of adults suffer from dry, itchy, red, burning eyes. Artificial tears sold over-the-counter offer only temporary relief. As you might have already guessed, dry eyes are usually symptoms of problems affecting the entire body. An exception to this rule might exist in some older people who have droopy lower eyelids, so that too much of the eye’s surface area is exposed and eye fluids evaporate more easily.

  Medications such as diuretics and anti-glaucoma eye drops (because they contain harmful preservatives) often promote dry eye problems. Diabetics, arthritics, and those with cancer commonly complain of dry eyes. The use of the artificial sweetener aspartame has been linked to dry eyes.

  Poor nutrition and hormone imbalances are probably the major culprits in causing dry eyes: Lack of essential fatty acids, vitamin A, vitamin C, riboflavin, and vitamin B6 affect the workings of the eyes’ lubrication systems. Since dry eyes are most common in menopausal women, it’s probably safe to assume the hormonal imbalance has to do with low estrogen or progesterone. Our guess is that it’s probably caused by estrogen dominance: Even when estrogen is low, if there’s no progesterone to balance it, there are symptoms of excess estrogen. We have noticed that women who begin using natural progesterone cream often report that their dry eyes have cleared up.

  Dry eyes also can be caused by allergies, often to some ingredient in cosmetics. If you suddenly start suffering from dry eyes, take a careful inventory of any new skin care products, shampoos, conditioners, makeup, and other products you recently have started using. If you stop using the product and the dry eyes clear up, you’ve found the culprit.

  How Tears Protect Your Eyes

  Tears aren’t just for crying. A film of tears made of three layers protects your eyes. One is a lipid (fat) layer, the interface between the inner two layers and the environment. Because of the fat, water can’t evaporate through it. The middle layer is mostly water, and the inner layer contains mucin, which helps to spread tears across the surface of the eyeball when you blink. Human tears also contain a special bacteria-killing enzyme to zap airborne bacteria.

  Blockage of the lacrimal glands or ducts of the eyes can cause dry eyes and irritation.

  Glands that secrete these oils, enzymes, and mucins are located in your eyelids. Blinking stimulates secretion from these glands. The lacrimal gland, located just below the brow, is responsible for the production of watery tears. Irritation from smoke, dust, wind, fumes, or smog triggers release of extra tears to moisten the eyes; strong emotions have the same effect (crying).

  In people who suffer from autoimmune diseases such as rheumatoid arthritis, lupus, and childhood-onset diabetes, the lacrimal gl
and may shrivel and stop functioning. If the eyes lack oils and mucin, the lacrimal gland may work overtime to try to keep the eyes wet. People with this condition are surprised to find that the problem is actually dry eyes. Oversecretion of water dilutes the oils and mucin further.

  If you have dry eyes, there are simple ways to restore the integrity of the tear film that keeps water against the eyeball rather than allowing it to evaporate. Omega-6 fatty acids help to restore the lipid layer. Use borage, black currant seed, or evening primrose oil. Omega-3 fatty acids from fish oil are also helpful. To improve the utilization of these fats in the body, take 50 mg of vitamin B6 with them.

  Vitamin A is an integral part of the mucin layer. Carrots, yams, sweet potatoes, and cantaloupes contain plentiful beta-carotene, which can be converted into vitamin A. Fish liver oil contains both omega-3 fatty acids and vitamin A, so eat plenty of fish. I also recommend preservative-free vitamin A drops. We recommend VIVA eyedrops, which you can ask for at your pharmacy.

  Vitamin C also helps improve dry eye problems. There’s a very high concentration of vitamin C in the natural tear film on the eyes, and eye irritants that cause the eyes to water dilute this antioxidant on the eyes’ surface.

  Drink plenty of pure water to improve the aqueous (watery) layer of the tear film. Avoid drinking too much coffee because its diuretic effect can worsen dry eye problems.

  The following medications can cause eye dryness:

  Antihistamines (Benadryl, Coricidin)

  Atropine (a heart medication)

  Any kind of diuretic (for high blood pressure)

  Decongestants

  Decongestant eye drops (Visine, Murine, ClearEyes, Prefrin)

  Diazepam, Valium, Elavil (anti-anxiety drugs)

  Methotrexate and other cancer drugs (chemotherapeutic agents)

  Morphine

  Niacin (used to treat high cholesterol)

  Glaucoma eye drops (Betagan, Ocupress)

  In stubborn cases of dry eyes or cases that involve damage to the cornea, you can take supplemental glucosamine sulfate. This natural substance, part of your body’s pathway for building connective tissue, helps to build the collagen matrix of the cornea. Follow the directions on the bottle or take 500 mg three times a day.

  Please don’t try to instill herbal remedies or homemade eye drops into dry eyes. Eye drops should closely match the pH of the eye fluid. Anything too acidic will burn the eye. Be careful to keep eye drops separated from other similar-looking bottles, such as those containing glue or other household chemicals. Patients can put all kinds of things into their eyes, intentionally or unintentionally, and it can take some medical heroics to fix them up afterwards.

  You can conserve moisture on the eyes by blinking more frequently, avoiding smog and fumes, and avoiding eye makeup (or reducing the amount you use). Check the nose pads of your glasses to be sure they don’t pull the lower eyelids off the eyeballs. If you use a computer, set the monitor lower and tilt the screen up so that you can look down slightly, keeping the eyes narrowed. Humidifiers can be helpful for those with dry eyes.

  There is a procedure called punctal occlusion that can help those with dry eyes who don’t respond to nutritional changes. A tiny silicone plug is inserted into the tear drain at the inside lower corner of the eye. This prevents fluid from draining too quickly off the eye’s surface and keeps the eyes moist. Your eye doctor may try temporary plugs that dissolve after a few days. If these work well, permanent plugs can be inserted. Laser surgery or cauterization also can be used to close the fluid drains. Plugging of the tear drains can help make contact lens wear more comfortable, reduce side effects from glaucoma eye drops (by keeping them in the eye rather than allowing them to drain), and even relieve postnasal drip or sinus problems.

  Artificial tear inserts can also be used. These are small pellets of hydroxypropyl cellulose (sold under the trade name Lacrisert), which are inserted into the lower eyelid. They absorb fluid, swell up, and then release a nonmedicated moistening agent into the eye for twenty-four hours. These, like the tear drain plugs, are only for cases of dry eye that don’t get better with the nutritional changes we’ve suggested.

  During sleep, your eyes don’t secrete tears. Blinking is your body’s stimulus for tear secretion. When you stop blinking, tear-producing glands take a rest. Those people whose eyes don’t close completely during sleep have a condition known as lagophthalmos. Proteins build up over the exposed part of the eye during sleep, protecting it from drying out. Most people have small bits of this dried protein in the corners of their eyes when they wake up. If you have very stringy strands of mucus between your eyelids in the morning or if you often have trouble opening your eyes when you wake because the lids are stuck shut by these caked proteins, mention this to your eye doctor. He or she may recommend you tape your eyes closed when you go to sleep.

  Treating Eye Allergies

  An allergy is the body’s overreaction to a substance it labels as harmful. For example: What harm could the droppings of dust mites that live in furniture, bedding, clothing, and carpets do to the human body? The mites themselves are microscopic. Yet their tiny droppings are one of the most potent allergenic substances we know. People who are allergic to dust mites, pollen, animal dander, and other irritants suffer from sneezing, wheezing, itchy, watering eyes, and overproduction of mucus. Eyes swell, noses run continuously, and the skin may break out in itchy welts (hives). These reactions are caused by the release of inflammatory substances in the body in response to allergens.

  Allergic eyes are itchy, watery, and often swollen. The overflow of water from the lacrimal glands dilutes the other components necessary to keep your eyes moist, and so allergic eyes are usually also dry at times. Eye doctors can distinguish simple dry eye from eye allergy because of a distinctive “cobblestone” pattern seen inside the eyelids in those with allergies. Contact lens wearers are particularly vulnerable to eye allergy.

  Drops prescribed to treat allergic eyes contain antihistamines, decongestants, or cortisone. They reduce inflammation but treat only the symptom, not the source of the problem, and they can make dry eyes worse. Continual use of any of them can damage the eyes. To better control allergies at their source, have yourself tested so that you know which allergens to avoid most carefully. If you are most allergic to dust mite droppings, you can buy mite-proof pillow and bed casings, an air filtration system, and a top-quality vacuum cleaner. Getting rid of carpeting and extra dust-collecting objects is also important if you have a dust mite allergy. If you are allergic to pollens, keep your windows closed and use an air-conditioner during the allergy season. Know the hours during which the pollens and molds you are most sensitive to are heaviest in outdoor air. Stay indoors during those hours. Usually the worst times are between the hours of 5 and 10 A.M. If you do go out, wear wraparound sun goggles to keep out dust and pollen.

  To control allergic reactions, try the bioflavonoid quercetin, 500 mg twice a day. It’s a natural histamine blocker, so it works much like those antihistamine drugs but without the side effects. Take it with vitamin C, one of nature’s most potent anti-inflammatory agents. We recommend that you take 2–3 g (2,000–3,000 mg) of vitamin C daily anyway, but you may want to try taking 1,000 mg four times a day if you have allergies. Some companies make products that combine quercetin with vitamin C. Echinacea, an herb that fortifies the immune system, is available in a tincture (liquid) form. This can be added to your allergy control regimen.

  * * *

  IN SHORT…

  1. Choose sunglasses carefully. Make sure they cut out 100 percent of the sun’s ultraviolet radiation. Remember that the label’s claims may not be accurate.

  2. Eye drops are used daily by many people with eye problems, particularly those with glaucoma, dry eye, or eye allergies. It’s important to use eye drops correctly. If you use artificial tears, find a brand that doesn’t contain benzalkonium chloride or other harmful preservatives. Wash hands before putting in eye drops and keep the bot
tle in a place where it’s least likely to become contaminated with bacteria. Refrigerated eye drops can be soothing to the eyes.

  3. Dry eyes can be caused by a variety of medications, by preservatives used in some eye drops, or by nutritional deficiencies. Try the following supplements for dry eyes:

  Omega-6 fatty acids from evening primrose, borage, or black currant seed oil

  Omega-3 fatty acids from fish

  Vitamin B6 to improve utilization of essential fatty acids (50 mg)

  Preservative-free vitamin A drops (VIVA Drops by Vision Pharmaceuticals)

  Plenty of vitamin A and beta-carotene-rich foods in the diet

  Vitamin C (1,000-4,000 mg a day in divided doses)

  Clean water—lots of it

  Glucosamine sulfate (500 mg twice a day)

  4. Also try your best to avoid using medications or artificial sweeteners that dry the eyes out. Plugging the tear drains may be an effective way to remedy dry eyes that don’t respond to nutritional changes.

  5. Your first step in treating an eye allergy is to try to eliminate allergenic substances from the surroundings and from the diet. Vitamin C, quercetin (500 mg twice a day), and echinacea can be helpful in reducing inflammation that causes allergy symptoms.

  * * *

  15

  Coping with Vision Loss

  Loss of vision can be emotionally devastating. For older people, it often means loss of independence. Check writing, grocery shopping, the use of a computer, reading, watching television, and other daily tasks and recreations that once were so easy become difficult or impossible. It’s not unusual for the loss of vision to bring about bouts of deep depression. Having to depend upon others makes many still strong, vital people with low vision (due to macular degeneration, glaucoma, cataracts, diabetic eye disease, or retinitis pigmentosa) feel much more helpless than they actually are.