February is AMD/Low Vision Awareness Month

Low vision affects millions of Americans — including many older adults. People with low vision aren’t blind, but because of their vision loss, they may not be able to do everyday tasks like driving or reading even with glasses.

What is Low Vision?

When your eyesight is impaired to the degree that you struggle with daily tasks like reading or cooking – or that you have difficulty recognizing faces, you may have a medical condition referred to as low vision. Someone with low vision can’t simply put on a pair of glasses or contacts and see well; this condition is beyond the typical loss of vision that occurs with aging.

Individuals experiencing low vision can struggle with maintaining independence; hobbies, reading and even socializing may become challenging as vision loss progresses. Because of the impact low vision can have on your life, it is important to have your eyes checked by a low vision specialist if you have any concerns. Since it is unusual to be able to restore vision once it is lost, screenings can help preserve the vision you have and help you access adaptive lenses and devices if you need them. While there is not a cure for low vision, a low vision specialist can help you adapt and if needed, create a vision rehabilitation program designed to meet your specific needs.

If you are experiencing trouble seeing even with prescription eye glasses, ask your optometrist or ophthalmologist for a low vision evaluation. If your practitioner does not perform this evaluation, request a referral to a low vision specialist in a private practice, at a Braille Institute or a University Eye Care Institute.

Low vision is often caused by one of these conditions:

Age-related macular degeneration (AMD) –AMD is a progressive eye condition affecting as many as 15 million Americans. The disease attacks the macula of the eye, where our sharpest central vision occurs, affecting reading, driving, identifying faces, watching television, safely navigating stairs and performing other daily tasks. Although it rarely results in complete blindness, it robs the individual of all but the outermost, peripheral vision, leaving only dim images or black holes at the center of vision. Read more

Diabetes– Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults caused by changes in the blood vessels of the retina.

In some people with diabetic retinopathy, blood vessels may swell and leak fluid or blood inside the eye. In other people, abnormal new blood vessels grow on the surface of the retina. The retina is the light-sensitive tissue at the back of the eye. A healthy retina is necessary for good vision. Read More

Glaucoma– Glaucoma is a disease that causes damage to the major nerve of the eye called the optic nerve, a part of the central nervous system that carries visual information from the eye to the brain

The eye experiences a gradual increase of intraocular pressure (IOP) due to an imbalance of the fluid produced in the eye and the amount of fluid drained. Over time, elevated IOP can cause vision loss. The most common form of glaucoma is primary open angle glaucoma which affects about 3 million Americans. However, there are other types including narrow angle, congenital, normal tension, and secondary glaucoma. Read more

Reducing your risk for Low Vision

Practicing healthy daily lifestyle habits can reduce your risk for low vision. A healthy diet, not smoking and maintaining healthy blood pressure are important first steps. Other healthy habits that can lower the risk include:

Eat a diet with plenty of green, leafy vegetables such as kale, spinach, and collard greens, and fresh fruit.
Fish that is high in omega-3 fatty acids is good for eye health. Try to include it in your diet at least once or twice a week. Types of fish that are high in omega-3 fatty acids include salmon, sardines, mackerel, herring, and albacore tuna.
It’s important to keep your body healthy. Maintain a healthy weight, exercise regularly, maintain healthy blood pressure and cholesterol levels. The healthier your body, the more it can foster good eye health. Visit our website for eye healthy recipes Eye Cook.
Protect your eyes. Wear sunglasses and a hat with a visor in bright sunlight to protect your eyes from potentially harmful ultra-violet (UV) light and blue light.

Low Vision Reading Apps on Your Smartphone

Reading often is one of the most difficult challenges for visually impaired people. Many people with low vision give up reading altogether, because what used to be an enjoyable, effortless activity now requires thought, preparation and a lot of adjustment. In short, reading is just no fun anymore.

The American Academy of Ophthalmology (AAO) has listed some of the top apps, devices and resources for people with low vision, below are a few listed for reading app, for more apps visit American Academy of Ophthalmology.

Reading

KNFB Reader (Android and iOS, $99.99) – This voice-to-text tool lets you take a picture of any text—books, recipes, product labels—and have it read back to you or converted to braille.
Audible (Android and iOS, $14.95 per month plus downloads) – Provides downloadable audiobooks, periodicals, newspapers and more. Their collection currently includes 200,000+ books.
Kindle app (Android, iOS, PC and Mac, free) – An e-reader app that allows you to download books. Books can be purchased and directly downloaded from Amazon, or downloaded from your library app into the Kindle app. The free Kindle app can be downloaded onto many iOS and Android devices.
Bookshare (Android and iOS, $50 per year) – An online library for people with low vision. Currently, the Bookshare collection contains nearly 850,000 titles, downloadable in a choice of formats including ebooks, audio, braille, and large font. Membership requires verification of your print disability, and includes free downloads.
BARD Mobile (Android and iOS, free) – A talking book library that offers access to tens of thousands of titles. You must first enroll in the National Library Service (NLS) for the Blind and Print Disabled at the Library of Congress. Note that this program may only be available in the United States.

Regular eye exams are essential for all adults; it is recommended that adults over the age of 60 have eye exams each year. If your vision can not be improved to the point that you are able to see the things you need to see or read, your eye care professional can refer you to a low vision specialist. This specialist differs from a conventional optometrist and is trained to evaluate your low vision problem and offer solutions to help you retain or regain independence and the ability to do things you enjoy again.

More Low Vision resources

Tips To Protect Children From Digital Eye Strain

With COVID-19 and a shift to online learning by many schools, children are spending even more time looking at screens. Staring at digital screens for a long period of time can cause hazy, blurred vision and can make eyes burn and feel dry, itchy and irritated. This condition is known as digital eye strain or computer vision syndrome. Other symptoms of digital eye strain can include:

Neck and shoulder pain
Headaches
Fatigue
Words moving on the screen (due to underlying eye alignment issues)

What Parents Can Do:

Monitor screen time. Find some balance between the digital and real world. Two especially important aspects of this are making sure screens don’t cut into:
- Sleep. Not getting enough shut-eye leads to tired, sore eyes. Avoid exposure to screens for 1 hour before going to bed. Using devices past bedtime, especially for violent video games or shows, can interfere with sleep.

Putting down the device or stepping away from the computer or TV can help avoid eye and vision problems from too much screen time. Children age 6 years and older should be getting at least 60 minutes of physical activity each day. Active play is the best exercise for young children. Outside play can also be a great “workout” for children’s vision—giving them a chance to focus at different distances and getting exposure to natural sunlight.

Take frequent breaks. Children frequently get so absorbed in what they’re doing that they don’t notice symptoms of eye strain. Remind them to take breaks. Use the 20/20/20 rule: look away from the screen every 20 minutes, focus on an object at least 20 feet away, for at least 20 seconds. In addition, children should walk away from the screen for at least 10 minutes every hour. A simple timer can help your child remember, and there are even software programs that can help by turning off the screen in regular intervals.

Remember to blink. Staring at a computer can cut blinking rates by half and cause dry eyes. Encourage your child to try to blink extra, especially when they take breaks. Your pediatrician or eye doctor may recommend moisturizing eye drops or a room humidifier if your child continues to be bothered by dry eyes.
Screen positioning. Make sure the screen on your child’s desktop or laptop computer is slightly below eye level. Looking up at a screen opens eyes wider and dries them out quicker. Some experts suggest positioning device screens based on the 1/2/10 rule: mobile phones ideally at one foot, desktop devices and laptops at two feet, and roughly 10 feet for TV screens (depending on how big the screen is). Adjusting the font size—especially on smaller screens—so it’s twice as big as your child can comfortably read may also help reduce eye fatigue.
Spotlight on lighting. To cut down on glare and eye fatigue, consider the level of lighting in a room when using a computer or other screen. Ideally, it should be roughly half what it would be for other activities such as writing on paper or working on crafts. Try to position computers so that light from uncovered windows, lamps and overhead light fixtures aren’t shining directly on screens. Decrease the brightness of the screen to a more comfortable level for viewing. Some optometrists recommend special computer glasses with orange lenses that may also help reduce glare. Children who wear prescription eyeglasses may have an anti-reflective coating added, as well.
Get regular vision screenings. If your child is having blurry vision or similar eye problems, he or she may not speak up. That’s why regular vision screenings are important. The American Academy of Ophthalmology recommend children have their eyes checked by a pediatrician at well-child visits beginning at birth. If a problem is found during one of these routine eye exams, your pediatrician may refer you to a pediatric ophthalmologist.

Children, especially younger ones, will likely need help and reminders to use digital screen devices in an eye-friendly way. If you have any questions about keeping your child’s eyes and vision healthy, talk with your pediatrician.

How to Prevent Eye Strain While Working From Home

Working from home has become the new normal for many Americans during this pandemic. Most are happy without the commute, although working outside the office and in all sorts of strange places, such as bedrooms, backyards, living rooms, has become common place. We’ve had to learn how to work remotely, which in turn means spending a lot more time using computers and smartphones.

Moving out of properly-lit classrooms and offices – and away from ergonomically correct desks – can have long-term effects on our eyes. Excessive time at a computer screen under the best conditions can lead to symptoms of eye strain.

Eye Strain Symptoms include:

Headaches
Blurred vision
Uncomfortable dry eyes
Neck and shoulder pain

To help avoid eye strain, here are few tips for working from home:

Record time spent on screens – Most adults age 18 and older spend at least 13 hours each day using digital devices. Extended screen time can cause discomfort and vision difficulties. When working from home, you may lose track of how much time you’re on your computer or smartphone. So keep track of the hours you use devices. That way, you’ll be aware of the demand you’re placing on your eyes.

Rest and blink your eyes – Researchers found that over 30% of people using digital devices rarely take time to rest their eyes. Just over 10% say they never take a break, even when working from home. The eye muscles get overworked and don’t get a chance to relax and recover. Experts suggest the 20-20-20 rule; every 20 minutes, focus your eyes and attention on something 20 feet away for 20 seconds. You can also get up and walk around for a few minutes.

Reduce exposure to blue light – In the spectrum of light, blue is more high energy and close to ultraviolet light. So, if you use screens throughout the day, ask your eye doctor about the value of computer glasses that block blue light. Reducing exposure to blue light may help lessen vision problems. At home, using digital devices until bedtime can overstimulate your brain and make it more difficult to fall asleep. Eye doctors recommend no screen time at least one to two hours before going to sleep.

Sit up straight – Proper posture is important. Your back should be straight and your feet on the floor while you work. Elevate your wrists slightly instead of resting them on the keyboard.

Proper lighting – A setting that’s too bright (sunny backyard) or too dim (cavernous basement) can cause eye strain and headaches. Your screen should be bright enough that you don’t need to squint. A screen shield can help reduce glare.

Set up monitor properly – Make sure your computer screen is about 25 inches, or an arm’s length, away from your face. The center of the screen should be about 10-15 degrees below eye level. Cut glare by using a matte screen filter. You can find them for all types of computers, phones, and tablets. Increase font size or set the magnification of the documents you are reading to a comfortable size.

Consider computer glasses –For the greatest comfort at your computer, you might benefit from having your eye doctor modify your eyeglasses prescription to create customized computer glasses. This is especially true if you normally wear distance contact lenses, which may also become dry and uncomfortable during extended screen time. Computer glasses also are a good choice if you wear bifocals or progressive lenses, because these lenses generally are not optimal for the distance to your computer screen.

Create Technology-Free Zones – These tips can help reduce eye strain when you’re forced to look at screens all day, creating technology-free zones in certain areas of your home, like the bedroom or bathroom. If you spend the entire day working on the computer, getting in bed and scrolling through social media until you fall asleep won’t do your eyes any favors.

Once you’re done for the day, truly unplug. Read a book or spend some quality time with family members without your phone.

Get an Eye Exam – If you have tried all these tips and eye strain is still an issue, it might be time to see an eye care professional to schedule an eye exam. The exam may even detect underlying issues before they becomes worse.

Blinking – Why is it so important?

Blinking is something we all do every minute, whether we think about it or not. The average person blinks 15-20 times per minute, or about 1,200 times per hour.

So why do we unconsciously move our eyelids over our eyeballs so many times? Because it’s extremely important for your eyes and vision.

Although you may not think of blinking as a major component of your health care routine, if you didn’t blink for extended periods you’d be at higher risk of eye infection. You would also have uncomfortable, dry eyes and would have decreased clarity of vision. The most important benefit of blinking is that it cleans the surface of your eye of any debris and washes it away with fresh tears. The thin coating of tears helps sharpen your vision, clearing and brightening the image your retina receives. Blinking also nourishes your eye with oxygen and nutrients, keeping your eyes healthy and comfortable.

Blinking wipes and renews your tear film, the smooth, moist layer covering our eyeballs.

The tears have 3 important layers. The inner most is the mucous layer that contains ‘mucins’ to keep the tears attached to the surface cells of the cornea. This material is produced by ‘goblet cells’ in the conjunctiva. The next layer is aqueous or ‘water-like’ that is produced by the lacrimal gland located in the upper-outer quadrant of the eye region. Finally, the outer layer is lipid or ‘oil-like’ that prevents the other layers from evaporating. These lipids are produced by tiny glands along the lid margins, next to the eyelashes. If any of these layers are absent or abnormal, then the cornea becomes vulnerable to damage.

The tears contain many protein components such as lysozyme, which function like natural antibiotics. The tear film also contains many nutrients and amino acids to nourish the cells of the cornea, which is the clear, dome-like structure on the front of the eye.

Besides keeping your eyes lubricated, the tear film also:

Helps form an almost perfectly smooth front optical surface on the cornea helping light to focus properly.
Washes away debris.
Transfers oxygen from the atmosphere to the cornea, since the cornea lacks blood vessels to deliver it directly.
Provides a pathway for white blood cells when there is an injury to the eye’s surface.
Prevents infection due to presence of lysozyme and other antibacterial enzymes.

Your eyelids also play a significant role, aside from protecting your eye and keeping things dark while you sleep. There is also a slight horizontal movement of the eyelid that pushes debris toward the tear ducts, which are the small openings at the inner corners of the eyes through which tears drain into your nose. That is why your nose runs when you cry.

Blinking exercises are a great way to keep your eyes moist. Blinking stimulates tear production and gives our eyes a chance to wash away any debris that has accumulated on the surface of the eye. Individuals who spend a lot of time on the computer or reading a lot tend to blink less often than they should. Therefore, if your eyes feel dry and irritated when using the computer or reading, then look away and do the following blinking exercises.

Blinking Exercises for Dry and Irritated Eyes:

Close your eyes quickly and tightly. Squeeze your facial muscles around your eyes for three to five seconds. Open your eyes slowly and relax your facial muscles. Keep your eyes open for another three to five seconds and repeat the squeezing process five to seven times.
Use the 10-10 rule and every 10 minutes look at away from your computer and intentionally blink 10 times. Then resume your activities.

LUTEIN AND ZEAXANTHIN

Why Lutein & Zeaxanthin are vital for healthy vision.

Good nutrition is important to keep your eyes healthy. Researchers have linked two very important eye nutrients that play a key role in healthy vision. Lutein (LOO-teen) and Zeaxanthin (zee-ah-ZAN-thin), both are potent antioxidants and are best known for protecting your eyes and may reduce your risk for macular degeneration and cataracts.

Lutein and zeaxanthin are two types of carotenoids (kuh-RAH-teh-noids), which are yellow to red pigments found widely in vegetables and other plants and lutein is a yellow pigment, in high concentrations it appears orange-red.

Both lutein and zeaxanthin can also be found in high concentrations in the macula of the human eye. The macula is essential for vision. Lutein and zeaxanthin work as important antioxidants in this area by protecting your eyes from harmful free radicals. It’s thought that a reduction of these antioxidants over time can impair eye health. Along with other natural antioxidants, including vitamin C, beta-carotene (vitamin A) and vitamin E, these important pigments guard the body from damaging effects of free radicals, which are reactive molecules that can destroy cells and play a role in many diseases. It is also believed that lutein and zeaxanthin in the macula block blue light from reaching the underlying structures in the retina, thereby reducing the risk of light-induced oxidative damage that could lead to macular degeneration (AMD).

Unfortunately, the human body does not naturally make the lutein and zeaxanthin it needs. This is why getting daily amounts of lutein and zeaxanthin through your diet or nutritional supplements can help maintain good eye health.

Foods that Contain Lutein and Zeaxanthin

Diets rich in these two nutrients may help hold off age-related eye diseases. The best natural food sources of lutein and zeaxanthin are green leafy vegetables and other green or yellow vegetables. Among these, cooked kale and cooked spinach top the list.

Key sources of these carotenoids include kale, parsley, spinach, broccoli and peas. Orange juice, honeydew melon, kiwis, red peppers, squash and grapes are also good sources of lutein and zeaxanthin.

In addition, egg yolk may be an important source of lutein and zeaxanthin, as the high fat content of the yolk may improve the absorption of these nutrients.

For eye healthy recipes visit Eye Cook

Lutein and Zeaxanthin Supplements

Because of the benefits of lutein and zeaxanthin, many nutritional companies have added these carotenoids to their multiple vitamin formulas. Others have introduced special eye vitamins that are predominantly lutein and zeaxanthin supplements.

Some popular lutein and zeaxanthin supplements include:

MacuHealth with LMZ3 (MacuHealth LLC)
EyePromise Zeaxanthin (Zeavision)
ICaps Eye Vitamin Lutein & Zeaxanthin Formula (Alcon)
Macula Complete (Biosyntrx)
MacularProtect Complete (ScienceBased Health)
MaxiVision Ocular Formula (MedOp)
OcuGuard Plus (TwinLab)
Ocuvite (Bausch + Lomb

The source of lutein in many lutein supplements is marigold flowers, while for zeaxanthin it is often red peppers. If you choose a lutein and zeaxanthin supplement, make sure it’s a high quality product from a reputable dietary supplement company.

Be sure to keep in mind that individuals sometimes react differently to certain supplements, which can have unintended effects such as adverse reactions with medications. Consult with your physician or eye doctor before trying any vision supplements.

Remember that taking dietary supplements does not replace a healthy diet. Eating a well-balanced diet that includes plenty of fruits and vegetables usually is the best way to get the important eye nutrients you need.

Too Much Screen Time: Is it bad for kids?

Children and their phones, iPads and gaming devices are inseparable today. Most are growing up with a wide selection of electronic devices at their fingertips. They can’t imagine a world without the internet, smartphones and tablets. Although, all that reading and playing games on their handheld devices may be harmful. But it’s not just kids who are getting too much screen time. Many parents struggle with over use of screen time themselves. So it’s important to understand how too much screen time could be harming everyone in the family.

Children can experience at least one of the following symptoms after being exposed to more than two hours of screen time per day:

Headaches
Neck/shoulder pain
Eye strain, dry or irritated eyes
Reduced attention span
Poor behavior
Irritability

Any of these symptoms could potentially affect academic performance and social interactions.

The worldwide rapid rise of nearsightedness has been linked to increased use of and exposure to electronic devices. However, spending more time outdoors, especially in early childhood, can decrease the progression of nearsightedness.

Blue Light can be harmful

The LED screens of computers and portable digital devices emit a broad spectrum of visible light. Most of these light rays are harmless, but a portion of the light emitted by these screens is relatively high-energy visible light called “blue light.”

Blue light has shorter wavelengths and higher energy than other visible light rays. Some laboratory research suggests certain bands of blue light may be harmful to the light-sensitive retina of the eye over time.

Blue light also plays an important role in regulating our body’s circadian rhythm. This basically is an internal clock that’s running in our brain and cycles between alertness and sleepiness at regular intervals over a 24-hour period.

Too much exposure to blue light at the wrong time of day can disrupt a person’s normal sleep/wake cycle, which can have serious health consequences. Sleep disruption can be especially problematic for children, leading to daytime drowsiness and poor performance in school. Some authorities feel that disruption of the sleep/wake cycle also can eventually lead to weight gain and obesity-related health problems.

Research has shown that people who experience disrupted 24-hour cycles of sleep and activity also are more likely to have mood disorders, lower levels of happiness and greater feelings of loneliness.

How to cut back on screen time

Set a limit on daily screen time. Make it clear to your kids and stick to it.
Encourage your child to spend some of that screen-free time outdoors while it is still light.
Establish screen-free zones: For example, no smartphone use for anyone in the family in the car, at restaurants, or at the dinner table.
No screens in the bedroom when it is time for bed. No exceptions.
As parents you can be a model for moderate screen use. Show your children, with your own behavior, how to live a rich, varied and healthy life where all habits are practiced in moderation.

It is also very important to teach your child good eye habits, below are few tips from experts:

You can set a kitchen timer or a smart device timer to remind them.
Alternate reading an e-book with a real book and encourage kids to look up and out the window every two chapters.
After completing a level in a video game, look out the window for 20 seconds.
Pre-mark books with a paperclip every few chapters to remind your child to look up. On an e-book, use the “bookmark” function for the same effect.
Avoid using a computer outside or in brightly lit areas, as the glare on the screen can create eye strain.
Adjust the brightness and contrast of your computer screen so that it feels comfortable to you.
Use good posture when using a computer and when reading.
Encourage your child to hold digital media farther away, 18 to 24 inches is ideal.
Create a distraction that causes your child to look up every now and then.
Remind them to blink when watching a screen.

Finally, it is very important to make sure your child gets a regular eye exam by a pediatric ophthalmologist or optometrist. This will help monitor your child’s vision and eye health.

Mitochondrial Revolution: New Hope for AMD and Aging Diseases

How many times have we heard: “This field has been thoroughly studied, and we know all there is to know; there is no reason to continue investigating, because there is nothing more to find out on the subject”? This has been the attitude of some researchers with respect to the importance of mitochondria and diseases. For more than 50 years, we have known that mitochondria, which are the “batteries” of the cell, are critical for energy production. But many believed they did not have other major roles in the health of the cell, so when it came to developing drugs against diseases, mitochondria were overlooked.

That idea has now been turned on its head.

Led by Discovery Eye Foundation (DEF) Research Director Dr. Cristina Kenney, the Mitochondria Research Group believed that, to really discover something new, you have to look in novel areas. This group has done just that. Using the transmitochondrial cybrid model, which are cell lines with identical nuclei, but with each line containing mitochondria from a different person, they have shown that the mitochondria have major regulation powers over cell behavior and expression of disease-related pathways. This is significant, because the mitochondria then become a target for therapies to combat diseases.

Kenney’s group is investigating various drugs and substances that will keep the mitochondria healthy and, ultimately, improve the health of the retinal cells in age-related macular degeneration (AMD). But it does not stop there. This same approach to developing mitochondria-targeting drugs is being pursued for drugs to treat Parkinson’s disease, Alzheimer’s disease, leukemia, various cancers, heart failure, thrombosis, stroke, diabetic retinopathy, Leber hereditary optic neuropathy, and even liver toxicity from acetaminophen.

The continued support from DEF, especially in the early stages of the mitochondria research, has fostered a new area to be opened up, specifically for AMD and diabetic retinopathy. In turn, this has allowed new collaborations among Kenney and researchers from the eye field, and laboratories studying the brain and neurodegeneration, cardiology, cancer therapies and methods to reduce side effects from cancer drugs. Kenney’s discoveries using cybrids have revolutionized the field of mitochondrial research, showing that mitochondria have wide-ranging biological effects never imagined and opening up the field of mitochondrial therapy to careful investigation.

You can help make a difference by supporting DEF’s sight saving research. Help our researchers advance AMD research by donating today!

Lauren Hauptman
Lauren Hauptman Ink

The Brain and the Eye – How They Work Together

The Brain and the Eye

The eye works like a camera. The iris and the pupil control how much light to let into the back of the eye, much like the shutter of a camera. When it is very dark, our pupils get bigger, letting in more light; when it is very bright our irises constrict, letting in very little light.

The lens of the eye, like the lens of a camera, helps us to focus. But just as a camera uses mirrors and other mechanical devices to focus, we rely on eyeglasses and contact lenses to help us to see more clearly.

The focus light rays are then directed to the back of the eye, on to the retina, which acts like the film in a camera. The cells in the retina absorb and convert the light to electrochemical impulses which are transferred along the optic nerve to the brain. The brain is instrumental in helping us see as it translates the image into something we can understand.

The eye may be small, but it is one of the most amazing parts of your body. To better understand it, it helps to understand the different parts and what they do.

Choroid
A layer with blood vessels that lines the back of the eye and is between the retina (the inner light-sensitive layer that acts like film) and the sclera (the outer white part of the eyeball).

Ciliary Body
The muscle structure behind the iris, which focuses the lens.

Cornea
The very front of the eye that is clear to help focus light into the eye. Corrective laser surgery reshapes the cornea, changing the focus to increase sharpness and/or clarity.

Fovea
The center of the macula which provides the sharp vision.

Iris
The colored part of the eye used to regulate the amount of light entering the eye. Lens focuses light rays onto the retina at the back of the eye. The lens is transparent, and can deteriorate as we age, resulting in the need for reading glasses. Intraocular lenses are used to replace lenses clouded by cataracts.

Macula
The area in the center of retina that contains special light-sensitive cells, allowing us to see fine details clearly in the center of our visual field. The deterioration of the macula can be common as we age, resulting in age related macular degeneration.

Optic Nerve
A bundle of more than a million nerve fibers carrying visual messages from the retina to the brain. Your brain actually controls what you see, since it combines images. Also the images focused on the retina are upside down, so the brain turns images right side up. This reversal of the images Is a lot like what a mirror does in a camera. Glaucoma can result when increase pressure in the eye restricts the flow of impulses to the brain, causing optic nerve damage and makes it difficult to see.

Pupil
The dark center opening in the middle of the iris changes size to adjust for the amount of light available to focus on the retina.

Retina
The nerve layer lining the back of the eye that senses light and creates electrical impulses that are sent through the optic nerve to the brain.

Sclera
The white outer coating of the eyeball.

Vitreous Humor
The clear, gelatinous substance filling the central cavity of the eye.

3/3/16

Susan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Posterior Vitreous Detachment

10/30/14

Have you ever noticed floaters in your vision? Perhaps they looked like a bunch of small dots or maybe a cobweb swaying back and forth in your visual field. Were the floaters associated with flashing lights that made you think there was a lightning storm coming your way? These are typical symptoms of a posterior vitreous detachment (PVD), and if you have had these symptoms you are far from alone.

PVD is a natural process that occurs in the majority of people usually over the age of 50. The vitreous is a jelly-like substance that occupies the back portion of the eye. The vitreous is comprised primarily of water, which accounts for 99% of its volume, and the remaining 1% includes proteinaceous substances such as collagen fibers as well as hyaluronic and ascorbic acids. The collagen fibers act as a scaffold to allow the vitreous to maintain a formed shape as well as provide a means for the vitreous to attach to the retina, which is the light-sensitive tissue that lines the inner back wall of the eye and is critical for vision. As we age, changes in these fibers cause the vitreous to lose its shape and eventually pull away from the retina. When the vitreous separates from the retina, this is called a PVD.

As we age, the collagen components of the vitreous can clump together and are free to float in the eye. When the vitreous separates from the retina during the development of a PVD, the floaters may become more noticeable or numerous. It is common for patients to describe floaters of different shapes and sizes, and patients may notice just one or in some cases many. In many people, a PVD develops slowly and there may be no symptoms or just a few annoying floaters. In others, a PVD may occur abruptly and cause more dramatic symptoms that can be very anxiety provoking.

Since the normal process of PVD development involves the vitreous tugging on the retina until it can fully separate, this tugging can result in flashing lights that can commonly appear in the peripheral, or side, vision. These flashing lights are sometimes described as lightning streaks, and patients may notice them more readily in settings with low ambient light. The flashes of light typically resolve once the vitreous has fully separated from the retina and the tugging has ceased.

The good news is that PVD is usually harmless in the vast majority of cases, and the annoying floaters will become less bothersome over time. In approximately 5-10% of cases, the vitreous can tug too hard on the retina as it tries to separate and it may pull a hole or tear in the retina. Tears in the retina can predispose to retinal detachment, which is a serious condition that can lead to permanent vision loss.
It is important to recognize that the typical symptoms of a regular PVD are often similar to a PVD with an associated tear. For this reason, it is recommended that all patients with the new onset of floaters or flashes have a dilated eye exam. If a retinal tear or detachment is discovered, early treatment can help prevent loss of vision.

Treatment for PVD usually involves simple observation. With time, the flashes will go away, and the floaters will become less noticeable. More recently, few providers have claimed that floaters can be treated with a laser in order to make them less noticeable. I would caution that this is not mainstream therapy at the current time, and I do not advise my patients to pursue this option. Another treatment possibility is vitrectomy surgery, where the vitreous gel is removed as part of a surgical procedure. Due to safety advances in vitrectomy surgery, this is now a potential option for the rare patient who has floaters that are so numerous and bothersome that they are negatively impacting their activities of daily living. For the vast majority of patients this is not necessary.

When I see a patient with a PVD, I often recommend one follow-up visit in 4-6 weeks to make sure there are no retinal holes or tears that have developed in the interim. If the other eye has not had a PVD yet, I will counsel them that a PVD will most likely develop in that eye within the next few years, and when it does they need to be examined. I will also discuss the retinal detachment warning signs. Patients with retinal detachment will not only have symptoms similar to PVD, including flashes and floaters, but in addition they may also notice what looks like a black shade or curtain that starts in the peripheral vision and extends towards the central vision. My patients are taught that this symptom requires an immediate examination.

In conclusion, PVD is a natural process that the majority of people will experience in their lives. The symptoms can range from having no symptoms at all to many floaters with associated lightning flashes. In the majority of patients, there is no damage to the eye or threat to the vision. A dilated exam is recommended to look for possible holes or tears in the retina, and if these are uncovered, prompt treatment can prevent vision loss.

Daniel D. Esmaili, MD
Retina Vitreous Associates Medical Group

The Way Eyes Work

9/16/14

Eyes are an amazing part of your body and not just because of what they do helping you see. The are also fascinating be because of the way eyes work. Here are 20 facts about how your eyes function.

1. The pupil dilates 45% when looking at something pleasant.

2. An eye’s lens is quicker than a camera’s.

3. Each eye contains 107 million cells that are light sensitive.

4. The light sensitivity of rod cells is about 1,000 times that of cone cells.

5. While it takes some time for most parts of your body to warm up their full potential, your eyes are always active.

6. Each of your eyes has a small blind spot in the back of the retina where the optic nerve attaches. You don’t notice the hole in your vision because your eyes work together to fill in each other’s blind spot.

7. The human eye can only make smooth motions if it’s actually tracking a moving object.

8. People generally read 25% slower from a computer screen compared to paper.

9. The eyes can process about 36,000 bits of information each hour.

10. Your eye will focus on about 50 things per second.

11. Eyes use about 65% or your brainpower – more than any other part of your body.

12. Images that are sent to your brain are actually backwards and upside down.

13. Your brain has to interpret the signals your eyes send in order for you to see. Optical illusions occur when your eyes and brain can’t agree.

14. Your pupils can change in diameter from 1 to 8 millimeters, about the size of a chickpea.

15. You see with your brain, not your eyes. Our eyes function like a camera, capturing light and sending data back to the brain.

16. We have two eyeballs in order to give us depth perception – comparing two images allows us to determine how far away an object is from us.

17. It is reported that men can read fine print better than women can.

18. The muscles in the eye are 100 times stronger than they need to be to perform their function.

19. Everyone has one eye that is slightly stronger than the other.

20. In the right conditions and lighting, humans can see the light of a candle from 14 miles away.

Susan DeRemer. CFRE
Vice President of Development
Discovery Eye Foundation

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