tag:theconversation.com,2011:/us/topics/eye-health-30661/articlesEye health – The Conversation2024-03-21T12:23:26Ztag:theconversation.com,2011:article/2228722024-03-21T12:23:26Z2024-03-21T12:23:26ZHow safe are your solar eclipse glasses? Cheap fakes from online marketplaces pose a threat, supply-chain experts say<figure><img src="https://images.theconversation.com/files/582258/original/file-20240315-20-z9c7t4.jpg?ixlib=rb-1.1.0&rect=59%2C7%2C4923%2C3287&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Don't trust. Verify.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-with-solar-glasses-looking-at-sun-royalty-free-image/82714690">Andrew Holt/The Image Bank via Getty Images</a></span></figcaption></figure><p>Americans from Maine to Texas are set for a rare treat on April 8, 2024, when a <a href="https://science.nasa.gov/eclipses/future-eclipses/eclipse-2024/where-when/">total solar eclipse</a> will be visible across much of the U.S. </p>
<p>In ancient times, eclipse-viewers thought they were watching the Sun be eaten by <a href="https://www.exploratorium.edu/eclipse/eclipse-stories-from-around-the-world">wolves</a>, a <a href="https://www.vox.com/culture/2017/8/18/16078886/total-solar-eclipse-folklore">dragon</a> or a <a href="https://www.livescience.com/53961-solar-eclipse-myths-and-superstitions.html">demon</a>.</p>
<p>Of course, we now know that the Sun isn’t really eaten during an eclipse. Instead, it does what it always does: rain ultraviolet rays on everything in its path. That’s why you should never look at a solar eclipse without protective eyewear. </p>
<p>But not just any eyewear will do. To make sure that you enjoy the total solar eclipse safely, the American Astronomical Society has specifically <a href="https://eclipse.aas.org/eye-safety/viewers-filters">warned against</a> buying eclipse glasses at the lowest price from online marketplaces like Amazon or eBay.</p>
<p>What gives? Why not save a buck on something you’ll use possibly just once for a few minutes?</p>
<p>It turns out there’s a very good reason: Deceptive counterfeit products have infiltrated retail supply chains. And some of them can pose a threat to your health.</p>
<h2>Invasion of the bogus products</h2>
<p><a href="https://scholar.google.com/citations?user=JMgbELkAAAAJ&hl=en">As experts in</a> <a href="https://scholar.google.com/citations?user=fbARgoUAAAAJ">supply-chain management</a>, we know that counterfeit products have become a growing problem in recent years.</p>
<p>While counterfeit products can be found at brick-and-mortar shops, they’re an especially big problem at online marketplaces. <a href="https://economictimes.indiatimes.com/tech/technology/amazon-removes-6-million-counterfeit-items-from-supply-chains/articleshow/99247317.cms?from=mdr">Amazon removed more than 6 million counterfeit items</a> from its supply chain in 2022 alone.</p>
<p>There are several reasons for this. First, our recent research shows that <a href="https://doi.org/10.1111/poms.13833">consumers often consider the reputation of an online retailer</a> while judging a product’s quality. Unscrupulous third-party sellers can take advantage of this fact by selling their wares through a reputable online marketplace. </p>
<p>Another complication arises from the fulfillment services offered by some marketplaces, such as Amazon, where third-party sellers directly send their merchandise to the online retailer’s warehouse for shipping and handling. These sorts of fulfillment services offer a little-known benefit to retailers: If a product is running out of stock, <a href="https://www.amazonsellers.attorney/blog/amazons-commingled-inventory-policy-risks-and-recommendations">they can “borrow” from a third-party seller’s inventory</a>. </p>
<p>Unfortunately, this also means that a consumer who agrees to buy from one retailer may actually receive merchandise – perhaps counterfeit – from a third-party seller. While there aren’t statistics showing how frequently this happens, <a href="https://www.ft.com/content/f6d85b96-359e-384d-a255-f60bf152e992">there’s evidence</a> it’s a significant problem. </p>
<p>Thankfully, customers are becoming more aware of counterfeit products and have increasingly pushed online retailers to separate inventories of authorized sellers of merchandise from those that aren’t. For instance, Amazon maintains a list of “<a href="https://www.thesellingguys.com/identifying-amazon-gated-restricted-brands-avoid-suspension/">gated</a>” brands, such as Asics and Under Armour, that require authorization before they can be sold. </p>
<p>But these protections don’t apply across the board. In fact, some counterfeit-prone brands, such as <a href="https://www.retaildive.com/news/birkenstock-pulls-products-from-amazon-over-counterfeiting-concerns/423027/#:%7E:text=Citing%2520concerns%2520over%2520counterfeiting%2520and,%252Dparty%2520Marketplace%252C%2520CNBC%2520reports.">Birkenstock</a>, refuse to sell their products through some online retailers entirely. That leaves an opening for counterfeiters, who tend to offer the lowest prices. </p>
<p>That’s why the American Astronomical Society recommends eclipse-watchers avoid buying protective glasses from the lowest-price sellers on online marketplaces. And we completely agree. After all, counterfeit sunglasses can be returned, but damage to your eyes is permanent. In 2017, one California man wearing counterfeit eclipse glasses was <a href="https://www.indystar.com/story/news/2017/08/29/eclipse-eyes-only-few-people-have-lasting-effects-staring-sun/609367001/">left with retina damage</a>.</p>
<h2>How to find safe solar eclipse glasses</h2>
<p>If you’re in the market for eclipse glasses, it’s not hard to get a safe pair. First, buying directly from one of the American Astronomical Society’s <a href="https://eclipse.aas.org/eye-safety/viewers-filters">approved list of brands and manufacturers</a> is the most reliable way. Unfortunately, many of them only sell cheaper, disposable solar eclipse viewers in bulk.</p>
<p>If you need a single pair, your next best option is to purchase one from a major brick-and-mortar chain retailer in person. Many organizations are also <a href="https://www.forbes.com/sites/jamiecartereurope/2024/03/01/where-to-get-free-solar-eclipse-glasses-for-aprils-event/?sh=3f3051ce102b">handing out free viewers</a>. If you take one, you should make sure it was made by a manufacturer on the American Astronomical Society’s list.</p>
<p>If you must buy from an online marketplace, look for evidence of manufacturer authorization. For instance, American Paper Optics – an American Astronomical Society-approved brand – maintains <a href="https://www.eclipseglasses.com/pages/amazon-approved-vendors">a list of Amazon sellers</a> approved for reselling their viewers. </p>
<p>What if you’ve already bought something from a no-name seller on Amazon? Let’s say you bought a pair of sunglasses, or eclipse glasses, with UV protection. It’s hard to verify UV protection properties. Sure, there are standards and certifications such as UV400 and <a href="https://www.iso.org/standard/59289.html">ISO 12312-2</a>, but as you have probably guessed, even those can be faked. For instance, you can easily buy entire rolls of UV400 stickers online. </p>
<p>Thankfully, most local opticians can <a href="https://www.allaboutvision.com/sunglasses/how-to-tell-if-have-uv-protection/">test your sunglasses’ UV protection properties in seconds</a>. In other words, when in doubt, verify.</p><img src="https://counter.theconversation.com/content/222872/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Don’t skimp on your eye safety.Yao "Henry" Jin, Associate Professor of Supply Chain Management, Miami UniversitySimone Peinkofer, Assistant Professor of Supply Chain Management, Michigan State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2150432024-03-20T12:20:42Z2024-03-20T12:20:42ZAre you one of the millions about to have cataract surgery? Here’s what ophthalmologists say you need to know<figure><img src="https://images.theconversation.com/files/557920/original/file-20231107-25-sofdb9.jpg?ixlib=rb-1.1.0&rect=60%2C0%2C6720%2C4406&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Cataract surgery removes the clouded lens of the eye and replaces it with a new, clear lens.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/laser-correction-vision-concept-royalty-free-image/1279156312?phrase=cataract%2Bsurgery">Ivan-balvan/iStock via Getty Images Plus</a></span></figcaption></figure><p>Cataract surgery is one of the most popular and commonly performed procedures in the world. The vast majority of patients have excellent outcomes with few complications.</p>
<p>Here are the numbers: </p>
<ul>
<li><p>By age 80, <a href="https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts">over half of all Americans have cataracts</a>.</p></li>
<li><p>Close to 4 million cataract surgeries are <a href="https://doi.org/10.1136/bmjophth-2020-000464">performed in the U.S. every year</a>.</p></li>
<li><p>Over 90% of patients have <a href="https://doi.org/10.4103/ijo.IJO_1073_22">20/20 vision with glasses after surgery</a>, although those with other eye conditions may not do as well, including those with <a href="https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma">glaucoma</a>, a progressive disease typically associated with elevated pressure within the eye; <a href="https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/diabetic-retinopathy">diabetic retinopathy</a>, which ultimately can cause leakage in the retinal tissues; and <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/agerelated-macular-degeneration-amd#">macular degeneration</a>, a disease that is typically related to age.</p></li>
<li><p>The <a href="https://www.ncbi.nlm.nih.gov/books/NBK559079/#">rate of post-surgery infection from endophthalmitis</a> is less than 0.1%.</p></li>
</ul>
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<p><a href="https://eye.ufl.edu/profile/steigleman-walter/">As ophthalmologists who have</a> <a href="https://integrity-eye.com/elizabeth-hofmeister/">performed thousands of these procedures</a>, we know that many patients have misconceptions about both cataracts and the surgery. For example, some think a cataract is a growth on the eye’s surface. </p>
<p>We like to compare a cataract with the frosted glass of a bathroom window, where light can be transmitted but details cannot. Or when turbulence from a storm causes normally clear water in the ocean to become murky. In much the same way, the eye’s once transparent lens becomes cloudy. </p>
<figure>
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<figcaption><span class="caption">After surgery, there’s no bending, inversions, lifting or straining, high-impact activities or eye makeup for one to two weeks or until the doctor says it’s OK.</span></figcaption>
</figure>
<h2>About the surgery</h2>
<p>Cataract surgery removes the clouded lens of the eye and replaces it with a new, clear lens to restore your vision. Most patients report the procedure is painless. </p>
<p>It’s <a href="https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts/cataract-surgery#">typically an elective surgery</a> that is performed on an outpatient basis. The patient is often awake, under local anesthesia, with sedation similar to that used for dental procedures. We like to say patients receive the equivalent of three margaritas in their IV. </p>
<p>Numbing drops are then applied to the eye’s surface, along with an anesthetic inside the eye. Patients with claustrophobia, or movement disorders such as Parkinson’s disease, may not be suitable candidates for awake surgeries and require general anesthesia.</p>
<p>Before surgery, patients receive dilating drops to make the pupil as large as possible. The surgeon makes a tiny incision, usually with a small pointed scalpel, between the clear and white part of the eye to gain access to the <a href="https://www.aao.org/eye-health/anatomy/lens-capsule-definition">lens capsule</a>, a thin membrane similar in thickness to a plastic produce bag at the grocery store. </p>
<p>This capsule is <a href="https://webvision.med.utah.edu/2020/09/ciliary-zonules/#">suspended by small fibers called zonules</a>, which are arranged like the springs that suspend a trampoline from a frame. The surgeon then creates a small opening in the capsule, called a capsulotomy, to gain access to the cataract. The cataract is then broken into smaller parts so they are removable through the small incision. </p>
<p>This is similar to a tiny jackhammer, breaking the large lens into smaller pieces for removal. That sounds scary, but it’s painless. Ultrasound emulsifies the lens and vacuum power then aspirates it from the eye. </p>
<p>Laser-assisted cataract surgery <a href="https://doi.org/10.3310/hta25060">has been found to have similar outcomes</a> to traditional cataract surgery. </p>
<h2>Complications are rare</h2>
<p>Serious complications, such as postoperative infection, bleeding in the eye or a postoperative retinal detachment are rare; they occur in approximately 1 in 1,000 cases. But even in many of these situations, appropriate management <a href="https://doi.org/10.1038/eye.2015.3">can salvage useful vision</a>. </p>
<p>Capsular complications deserve additional discussion. According to some studies, they occur <a href="https://doi.org/10.1159/000528657">in up to 2% of cases</a>. If a hole or tear of the posterior capsule is encountered during cataract surgery, the clear gel in <a href="https://www.aao.org/eye-health/anatomy/vitreous">the vitreous</a> – the back chamber of the eye – may be displaced into the front chamber of the eye. </p>
<p>If that happens, the gel must be removed at the time of the cataract surgery. This will reduce the likelihood of additional postoperative complications, but those who have the procedure, <a href="https://www.aao.org/eye-health/treatments/what-is-vitrectomy">known as a vitrectomy</a>, have an increased risk for additional complications, including postoperative infections and postoperative swelling. </p>
<h2>After the surgery</h2>
<p>Patients usually go home right after the procedure. Most surgery centers require that the patient have someone drive them home, more for the anesthesia rather than the surgery. Patients begin applying postoperative drops that same day and must wear an eye shield at bedtime for a few weeks after surgery. </p>
<p>Patients should keep the eye clean and avoid exposure to dust, debris and water. They should try not to bend over and should avoid heavy lifting or straining in the first week or so after surgery. Lifting or straining can cause a surge of blood pressure to the face and eye. <a href="https://doi.org/10.1159/000533937">Known as a choroidal hemorrhage</a>, it can lead to bleeding into the wall of the eye and be devastating to vision. </p>
<p>Things that cause only moderate increases in heart rate such as walking are OK. Routine postoperative examinations are usually completed the day after surgery, about a week after surgery and about a month after surgery. </p>
<figure>
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<figcaption><span class="caption">Light and UV exposure, coupled with time, causes the lens of the eye to become increasingly cloudy.</span></figcaption>
</figure>
<h2>A choice of lens</h2>
<p>The plastic lens used to replace the cataract, or <a href="https://www.aao.org/eye-health/diseases/cataracts-iol-implants">intraocular lens</a>, requires careful sizing for optimal results and a nuanced discussion between patient and surgeon. </p>
<p>Early intraocular lens technologies <a href="https://www.ncbi.nlm.nih.gov/books/NBK580484/">were monofocal</a>, and most patients with these lenses chose distance correction and used reading glasses for near tasks. This is <a href="https://www.aao.org/eye-health/diseases/cataracts-iol-implants#">still the preferred approach</a> for approximately 90% of patients having cataract surgery today. </p>
<p>Recent advances have led to <a href="https://www.verywellhealth.com/intraocular-contact-lenses-3421653">intraocular lenses that offer multifocality</a> – the opportunity to have near as well as distance vision, without glasses. Some multifocal lenses are even in the trifocal category, which includes distance, near, and intermediate vision, the latter of which in recent years has become very important for computer and phone use. </p>
<p>Most patients with these advanced technology multifocal lenses <a href="https://doi.org/10.2147/OPTH.S347382">are happy with them</a>. However, a small percentage of patients with multifocal lenses can be so bothered by visual disturbances – notably night glare and halos around light sources in the dark – that they request removal of the multifocal lens to exchange it for a standard intraocular lens. These exchanges are a reasonable option for such situations and offer relief for most affected patients. </p>
<p>Determining who’s an ideal candidate for a multifocal intraocular lens is an area of active research. Most clinicians would recommend against such a lens for a patient with a detail-oriented personality. Such patients tend to <a href="https://doi.org/10.1177/11206721231176313">fixate on the shortcomings of these lenses</a> despite their potential advantages.</p>
<p>As with many technologies, current generation advanced technology intraocular lenses are much better than their predecessors. Future offerings are likely to offer improved vision and fewer side effects than those available today.</p>
<p>But these newer lenses are often not reimbursed by insurance companies and often entail <a href="https://www.bettervisionguide.com/multifocal-iols/">substantial out-of-pocket costs</a> for patients. </p>
<p>Deciding on what type of lens is best for you can be complicated. Fortunately, except in unusual circumstances, such as when a cataract develops after trauma to the eye, there is seldom a hurry for adult cataract surgery.</p><img src="https://counter.theconversation.com/content/215043/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Typically, cataract surgeries are painless and significantly restore vision.Allan Steigleman, Associate Professor of Ophthalmology, University of FloridaElizabeth M. Hofmeister, Associate Professor of Surgery, Uniformed Services University of the Health SciencesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2213812024-03-12T17:44:46Z2024-03-12T17:44:46ZTotal solar eclipses, while stunning, can damage your eyes if viewed without the right protection<figure><img src="https://images.theconversation.com/files/580528/original/file-20240307-30-bxdz7t.jpg?ixlib=rb-1.1.0&rect=47%2C6%2C4468%2C2383&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Solar eclipses don't come around often, but make sure to view these rare events with eclipse glasses to protect your vision. </span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/USEclipseSchools/0f2e25e7620440c0be042b6516d1acde/photo?Query=eclipse%20viewing&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=524&digitizationType=Digitized&currentItemNo=18&vs=true&vs=true">AP Photo/Charlie Riedel</a></span></figcaption></figure><p>On April 8, 2024, and for the second time in the past decade, people in the U.S. will have an opportunity to <a href="https://science.nasa.gov/eclipses/future-eclipses/eclipse-2024/">view a total solar eclipse</a>. But to do so safely, you’ll need to <a href="https://preventblindness.org/get-ready-for-the-next-eclipse/">wear proper protection</a>, or risk eye damage.</p>
<p>Earth is the only planet in our solar system where <a href="https://theconversation.com/when-the-sun-goes-dark-5-questions-answered-about-the-solar-eclipse-81308">solar eclipses can occur</a>. During these celestial events, the Moon passes between our planet and the Sun, blocking the Sun and casting a shadow over the Earth. Total eclipses rarely happen multiple times in the same region of a country during one’s lifetime. </p>
<p>The path of totality for <a href="https://science.nasa.gov/eclipses/">this spring’s eclipse</a>, where you can view the total eclipse, will extend over a 100-mile path that crosses through Mexico, Texas, New England and eastern Canada.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/fmtGqOxxmEU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Those in the path of totality will have the opportunity to see a total solar eclipse this April.</span></figcaption>
</figure>
<p>As excitement for the celestial show grows across the country, <a href="https://www.forbes.com/sites/jamiecartereurope/2024/03/09/11-ways-to-find-your-last-minute-hotel-for-the-total-solar-eclipse---but-be-quick/?sh=415b5585f4e2">hotels in the path of totality</a> have been booked up by eclipse enthusiasts. Museums and schools have <a href="https://solarsystem.nasa.gov/embeddable-eclipse-events/">planned viewing events</a>, and researchers have developed technology for the <a href="https://astrolab.fas.harvard.edu/LightSound.html">visually impaired and those with hearing loss</a> so more people have the opportunity to experience the eclipse.</p>
<p>Seeing an eclipse is a rare and special opportunity, but <a href="https://directory.hsc.wvu.edu/Profile/28506">as an ophthalmologist</a>, I know that looking directly at the Sun, even for a few moments, can severely damage your eyes. With a few easy precautions, eclipse viewers can protect themselves from severe and irreparable eye damage and vision loss.</p>
<h2>Safe eclipse viewing</h2>
<p>This year’s eclipse will unfold over a 75-minute period, from the moment the Moon starts to partially block the Sun until it completely moves away from it again. </p>
<p>During the partial eclipse period, when the Moon is partly blocking the Sun, you should never look directly at the Sun nor through binoculars, <a href="https://www.masterclass.com/articles/how-to-photograph-a-solar-eclipse">cameras</a> or <a href="https://www.space.com/how-to-photograph-a-solar-eclipse-with-a-smartphone">cellphones</a>. Sunglasses, photographic filters, exposed color film and welding glasses will dim the sunlight, but these items do not prevent <a href="https://www.aao.org/eye-health/tips-prevention/solar-eclipse-eye-safety">eye damage from the Sun’s very intense light rays</a>. </p>
<p>Only <a href="https://preventblindness.org/solar-eclipse-glasses/">solar eclipse glasses</a> with filters designed specifically for observing the partial eclipse are safe to use. They are easily available <a href="https://www.cnn.com/cnn-underscored/outdoors/best-solar-eclipse-glasses?cid=ios_app">from a variety of sources</a>, and you can wear them by themselves or over your glasses or contact lenses. </p>
<p>Keep in mind that these safety filters will permit you to view only the eclipse, as they blacken out everything around you but the Sun itself. Before purchasing a pair, make sure your eclipse glasses are approved by the <a href="https://eclipse.aas.org/eye-safety/iso-certification">ISO 12312-2 international standard</a>.</p>
<p>Only during its <a href="https://eclipse.gsfc.nasa.gov/SEhelp/SEglossary.html">period of totality</a>, the time when the Sun is fully behind the Moon, is it safe to remove your filtered glasses – and then only with caution.</p>
<p>This year, totality will last an unusually long <a href="https://science.nasa.gov/eclipses/future-eclipses/eclipse-2024/">four and a half minutes</a>. If you leave your eclipse glasses on, you will miss seeing the Sun’s bright ring, or corona, behind the Moon. But then, as the Moon moves on, the sky will brighten and you’ll need to put the eclipse glasses back on.</p>
<h2>Eyes and light</h2>
<p>While the pupils of our eyes naturally constrict to limit bright light, and our eyes have pigments to absorb light, direct sunlight overwhelms these functions. Even viewing the Sun for a few brief moments <a href="https://theconversation.com/turn-around-bright-eyes-heres-how-to-see-the-eclipse-and-protect-your-vision-203571">can cause permanent vision loss</a>. </p>
<p>The Sun emits intense <a href="https://www.britannica.com/science/sunlight-solar-radiation">ultraviolet and infrared light</a>, which, while not visible to the human eye, can burn sensitive ocular tissues, such as the cornea and retina.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/581353/original/file-20240312-24-e55u1i.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A diagram of an eye as viewed from the side." src="https://images.theconversation.com/files/581353/original/file-20240312-24-e55u1i.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/581353/original/file-20240312-24-e55u1i.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=486&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581353/original/file-20240312-24-e55u1i.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=486&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581353/original/file-20240312-24-e55u1i.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=486&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581353/original/file-20240312-24-e55u1i.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=611&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581353/original/file-20240312-24-e55u1i.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=611&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581353/original/file-20240312-24-e55u1i.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=611&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The cornea is the clear front surface of the eye, which lets light in. The retina is the inner lining of the back part of the eye, which sends signals to your brain, allowing you to see.</span>
<span class="attribution"><a class="source" href="https://aapos.org/glossary/how-to-safely-view-a-solar-eclipse">American Association for Pediatric Ophthalmology and Strabismus</a></span>
</figcaption>
</figure>
<p>Corneal damage from sunlight, called <a href="https://www.mayoclinic.org/diseases-conditions/actinic-keratosis/symptoms-causes/syc-20354969">solar keratosis</a>, can blur vision and be quite painful. While the cornea can heal itself, it may require several days to get better and lead to lost time at work or school. </p>
<p>Retinal damage, called <a href="https://www.health.wa.gov.au/Articles/S_T/Solar-retinopathy">solar retinopathy</a>, occurs inside the eye. While it isn’t painful, it can be more severe than corneal damage and can dramatically impair vision. Solar retinopathy symptoms include a blind spot in one’s central vision, visual distortions and altered color vision. </p>
<p>In mild cases, these symptoms may go away, but in more severe cases, and even with treatment, <a href="https://aapos.org/glossary/how-to-safely-view-a-solar-eclipse">they may become permanent</a>. </p>
<p>To both enjoy the eclipse and prevent eye damage, make sure you and your loved ones all view the event with strict proper precautions.</p><img src="https://counter.theconversation.com/content/221381/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Geoffrey Bradford does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Now’s the time to get your hands on a pair of eclipse glasses in preparation for April’s display of celestial wonder.Geoffrey Bradford, Professor of Pediatrics and Ophthalmology, West Virginia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2194412023-12-28T09:20:09Z2023-12-28T09:20:09ZSix ways to look after your eyes in 2024<figure><img src="https://images.theconversation.com/files/564923/original/file-20231211-27-7cymn4.jpg?ixlib=rb-1.1.0&rect=0%2C9%2C6523%2C4342&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-mature-man-fitting-o-1832804689">Inside Creative House/Shutterstock</a></span></figcaption></figure><p>The World Health Organization estimates that <a href="https://www.who.int/news/item/09-10-2003-up-to-45-million-blind-people-globally---and-growing">over 80%</a> of all vision impairment around the world can be prevented and even cured. Reducing the risk of eye diseases involves adopting a combination of lifestyle changes, protective measures, and regular eye care. Here are six ways to look after your eyes in 2024. </p>
<h2>1. Have regular eye tests</h2>
<p>Many eye diseases don’t have symptoms – at least, initially. <a href="https://www.nhs.uk/conditions/glaucoma/#:%7E:text=Glaucoma%20is%20a%20common%20eye,not%20diagnosed%20and%20treated%20early.">Glaucoma</a>, for example, will cause irreversible damage to the eye if not picked up early enough as it damages the peripheral visual field to start with. People tend not to notice and merely compensate for this loss of peripheral vision by moving their heads more. </p>
<p>Eye disease linked to diabetes also causes irreversible damage to the eyes without much noticeable vision loss as it damages the <a href="https://www.nhs.uk/conditions/diabetic-retinopathy/#:%7E:text=Diabetic%20retinopathy%20is%20a%20complication,it%20could%20threaten%20your%20sight.">small blood vessels</a> in the eye. </p>
<p>Going for an eye test with a qualified optometrist will enable them to detect eye diseases and refer you to a specialist if needed. Early detection of changes in the eye due to diabetes will reduce the <a href="https://diabetesjournals.org/clinical/article/27/4/140/1721/Diabetic-Retinopathy-Screening-Updatelink">risk of blindness by 60-90%</a>. </p>
<p>And a visit to the optometrist does not necessarily mean you have to fork out for expensive new glasses if your vision hasn’t changed. People in the UK qualify for <a href="https://www.nhs.uk/nhs-services/opticians/free-nhs-eye-tests-and-optical-vouchers/">free NHS eye tests</a> if they are over 60 or under 18 years, have a family history of glaucoma, or receive certain state benefits. </p>
<h2>2. Check your eyes at home</h2>
<p>As most of us use both eyes at the same time, it can be difficult to know if one is not seeing so well. Try covering each eye every week and look at a number plate in the distance to make sure both eyes are seeing well. </p>
<p>Differences between the two eyes will affect your depth perception, which then ends up with you not being able to judge how far a person is when driving. </p>
<p><a href="https://www.nhs.uk/conditions/age-related-macular-degeneration-amd/">Age-related macular degeneration</a> usually affects one eye earlier than the other. And the “wet” type – caused by tiny blood vessels at the back of the eye leaking fluid – needs to be treated as soon as possible to avoid any further damage. </p>
<p>Use graph paper held at a near distance, wearing near glasses if you need them, and if lines appear to be wavy or missing, seek an appointment with your optometrist. </p>
<h2>3. Protect your eyes from mechanical and UV damage</h2>
<p>Ultraviolet light can damage the macula, the most central and important part of the eye. Make sure you wear good quality sunglasses that block 100% of UVA and UVB rays to protect your eyes from harmful ultraviolet radiation. </p>
<p>If you are a DIY enthusiast, it’s really important to wear safety goggles. In the summer, gardening accidents, such as getting caught in the eye with a twig when pruning are quite frequent and can cause permanent damage.</p>
<p>Playing squash and other sports without adequate protection can also cause permanent damage. A squash ball is just a bit smaller than the orbit of the eye and this can cause a lot of damage to the soft tissues within the eye as the orbital wall cannot stop the ball’s entry into the eye. </p>
<figure class="align-center ">
<img alt="Woman wearing sunglasses" src="https://images.theconversation.com/files/564933/original/file-20231211-15-nslvhc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564933/original/file-20231211-15-nslvhc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564933/original/file-20231211-15-nslvhc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564933/original/file-20231211-15-nslvhc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564933/original/file-20231211-15-nslvhc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=425&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564933/original/file-20231211-15-nslvhc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=425&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564933/original/file-20231211-15-nslvhc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=425&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Wear good-quality sunglasses.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-shot-stylish-young-woman-sunglasses-459775861">Jacob Lund/Shutterstock</a></span>
</figcaption>
</figure>
<h2>4. Reduce digital eye strain</h2>
<p>Excessive exposure to computers and smartphones can lead to eyestrain. While eyestrain does not normally cause permanent damage or affect your glasses prescription, it can be very uncomfortable. </p>
<p>Most people forget to blink when they are working on screens, and this leads to dry eyes. To reduce this discomfort, try consciously blinking more often during screen time. </p>
<p>It helps keep your eyes moist and reduces that tired, dry feeling. You can set a reminder on your phone for blinking exercises where you forcibly blink at least ten times every hour. </p>
<p>Regular breaks will not only give your eyes a rest but will also give your back a rest, too. Remember the <a href="https://www.rnib.org.uk/your-eyes/how-to-keep-your-eyes-healthy/eye-safety/#:%7E:text=Taking%20frequent%20breaks%20from%20the,cause%20you%20to%20need%20spectacles.">20-20-20 rule</a>: every 20 minutes, take a 20-second break, and look at something 20 feet away.</p>
<h2>5. Have a good diet</h2>
<p>While many of us know that vitamin A from carrots is good for the eyes, our eyes need <a href="https://www.medicalnewstoday.com/articles/326758">more than vitamin A</a> to function healthily. </p>
<p>Vitamin C found in citrus fruits, strawberries, bell peppers and broccoli helps protect the eyes from oxidative damage as does vitamin E found in nuts, seeds, spinach and fortified cereals. </p>
<p>Green leafy vegetables have been shown to reduce the risk of macular damage, which is the <a href="https://www.cdc.gov/visionhealth/resources/features/macular-degeneration.html#:%7E:text=AMD%20is%20a%20major%20cause,to%2088%20million%20in%202050.">leading cause of blindness</a> in the elderly. </p>
<p>A healthy diet is also linked to good control of diabetes, and poor control of diabetes will lead to a much higher risk of blindness from diabetic-related eye disease. </p>
<h2>6. Quit smoking and be more active</h2>
<p>Smoking is a significant risk factor for most systemic diseases in the body <a href="https://www.fda.gov/tobacco-products/health-effects-tobacco-use/how-smoking-can-contribute-vision-loss-and-blindness">including the eyes</a>. Smoking increases the risk of macular degeneration and cataracts. Quitting can be tough, but your eyes will appreciate it in the long run. </p>
<p>Exercise is not only important for the rest of the body but also for the eyes. Outdoor activity is a <a href="https://www.sciencedirect.com/science/article/pii/S0161642007013644?via%3Dihub">significant protective factor</a> against the progression of myopia (shortsightedness) in children. </p>
<p>Physical activity increases blood circulation to the eyes, which is essential for delivering oxygen and nutrients to the eyes and removing waste products. It has also been linked to reducing the risk of <a href="https://www.sciencedirect.com/science/article/pii/S0002939417302180?via%3Dihub">age-related macular degeneration</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/29610523/">diabetic retinopathy and glaucoma</a>. </p>
<p>Physical activity is also essential for controlling diabetes, which reduces the risk of blindness in patients with this condition. It is important to note that physical activity is not just about joining a gym. It can involve free activities, including brisk walking, which would be a wonderful opportunity to spend time with family and reduce the progression of myopia in our children.</p><img src="https://counter.theconversation.com/content/219441/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span><a href="mailto:shahina.pardhan@aru.ac.uk">shahina.pardhan@aru.ac.uk</a> receives funding from various NHS bodies, Charities and EU. </span></em></p>Your eyes are your windows on the world. Here’s how to stop them getting smudgy.Shahina Pardhan, Professor of Optometry, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2173322023-11-10T16:34:37Z2023-11-10T16:34:37ZAll the Light We Cannot See: how progressive congenital cataracts can lead to blindness<p>In the new Netflix series <a href="https://www.imdb.com/title/tt15320362/">All the Light We Cannot See</a>, a blind French girl called Marie-Laure LeBlanc makes illicit radio broadcasts from her uncle’s house in Nazi-occupied France. We are told that Marie-Laure has congenital cataracts in both eyes. But what is this condition?</p>
<p>The word “cataract” comes from the Latin word for waterfall and describes a condition where the usually transparent lens of the eye is cloudy or opaque. This prevents a clear image being projected onto the back of the eye and causes poor vision. </p>
<p>Many people will have heard of cataracts in the context of older adults because the lens becomes cloudier throughout life, slowly causing blurry vision. Surgery to remove the cloudy lens and replace it with a clear plastic one is commonplace and quite routine nowadays. In fact, cataract surgery in adults is one of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7812090/">most common operations</a> performed in healthcare systems across the world.</p>
<p>However, around three in 10,000 children are <a href="https://www.moorfields.nhs.uk/content/childrens-cataracts#:%7E:text=In%20the%20UK%203%20in,Cataracts%20may%20not%20require%20treatment.">born with cataracts</a> (congenital cataracts) and this poses a much more urgent problem. During very early childhood, the brain learns to see and so anything causing poor vision must be dealt with rapidly to allow the brain time to adjust. </p>
<p>In modern healthcare systems, most babies with cataracts have surgery before the age of ten weeks to avoid very poor lifelong vision. Some children are born with milder cataracts and then they progress (become cloudier), as we can assume was the case for the fictional character Marie-Laure. Nowadays, these children are watched closely because their cataracts can <a href="https://www.rnib.org.uk/your-eyes/eye-conditions-az/congenital-cataracts/">progress slowly, or very quickly</a>, depending on their cause.</p>
<p>Surgery is offered when the potential benefits outweigh the risks. Marie-Laure’s story is quite different. In the 1940s, surgery was far riskier and a far cry from modern micro-surgery under general anaesthetic. Most children had no treatment at all.</p>
<figure class="align-center ">
<img alt="An intraocular lens." src="https://images.theconversation.com/files/558675/original/file-20231109-29-pvi0kl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/558675/original/file-20231109-29-pvi0kl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/558675/original/file-20231109-29-pvi0kl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/558675/original/file-20231109-29-pvi0kl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/558675/original/file-20231109-29-pvi0kl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/558675/original/file-20231109-29-pvi0kl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/558675/original/file-20231109-29-pvi0kl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In cataract surgery, the cloudy lens is replaced.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/iol-intraocular-lens-cataract-ophthalmology-2057263202">Simpotich Photography/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Treatment is very different today</h2>
<p>In most developed healthcare systems in 2023, newborns are examined routinely after birth and one part of this is to look for eye problems, including cataract. This was not the case in the 1940s, and so how Marie-Laure’s cataracts developed and at what age, is probably unclear. This is important, because there are many different underlying causes of congenital cataract, including conditions affecting just the eyes, conditions affecting other parts of the body such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6975004/#:%7E:text=Nance%E2%80%93Horan%20syndrome%20(NHS),%2C%20congenital%20cataract%2C%20and%20strabismus.">Nance-Horan syndrome</a>, and even life-limiting metabolic diseases. </p>
<p>Nowadays, when a cataract is found in newborns or children, doctors seek these conditions using genetic testing and other blood tests.</p>
<p>Importantly, congenital cataracts which do get worse in childhood (as is the story for Marie-Laure) are more likely to be due to conditions that affect other parts of the body, and so it is possible that Marie-Laure also had other medical problems related to an underlying condition.</p>
<p>One critic <a href="https://www.stylist.co.uk/entertainment/tv/all-the-light-we-cannot-see-netflix/568157">praised</a> All the Light We Cannot See for being “a significant leap forward for disability inclusion, rights and representation on screen and beyond”. Marie-Laure’s teenage character is played by <a href="https://www.imdb.com/name/nm13200978/">Aria Mia Loberti</a>, an American actor who has a congenital eye condition called <a href="https://www.moorfields.nhs.uk/condition/achromatopsia">achromatopsia</a>. And the young Marie-Laure is played by <a href="https://www.imdb.com/name/nm15346843/">Nell Sutton</a>, who has another rare condition called <a href="https://www.moorfields.nhs.uk/content/childrens-glaucoma">congenital glaucoma</a>. </p>
<p>Achromatopsia causes low vision, moving eyes and no colour vision at all, and congenital glaucoma causes the pressure inside the eye to be very high and when untreated, causes loss of vision and the eyeball to enlarge way beyond its normal size. In the 1940s little would have been known about any of these conditions or indeed, how to treat them.</p>
<p>Medical treatment, surgery and support have changed vastly since the 1940s, but the challenges faced by young people living with low vision, despite the cause, are still very real.</p><img src="https://counter.theconversation.com/content/217332/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jay E. Self does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Cataracts aren’t just something people develop in older age. Some people are born with them.Jay E. Self, Associate Professor and Consultant Ophthalmologist, University of SouthamptonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2056112023-06-29T17:01:34Z2023-06-29T17:01:34ZCan you really ‘address’ annoying eye floaters with a supplement?<figure><img src="https://images.theconversation.com/files/526821/original/file-20230517-21-e9af07.jpg?ixlib=rb-1.1.0&rect=25%2C344%2C5725%2C3414&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-image-old-womans-eye-looking-1078840871">triocean/Shutterstock</a></span></figcaption></figure><p>If you look up at the sky on a clear day, you might notice little cobweb-like structures drifting across your field of vision. They are known as floaters or, more formally, muscae volitantes – Latin for flying flies.</p>
<p>Like regular flies, muscae volitantes are rather pesky, so it’s not surprising that people want to banish them. A recent article in the Mirror, <a href="https://www.mirror.co.uk/news/health/eye-floaters-what-causes-how-29880076">Eye floaters: What causes them and how to get rid of them naturally</a>, claims to have a solution.</p>
<p>Sarah Brewer, a GP, is quoted in the article as saying that a supplement called Clearer, made by Theia Bio, is “a natural but effective solution to address annoying floaters”. Despite the promise in the headline, Dr Brewer does not talk about getting rid of floaters. </p>
<p>The Theia Bio <a href="https://www.clearereyes.com/">website</a> uses more precise language. It says: “Clearer contains a blend of antioxidants and antiglycation micronutrients that has been scientifically proven to reduce eye floater size and visual discomfort in around 70% of test subjects over six months.” </p>
<p>Before we look at the feasibility of a supplement to “address” annoying floaters or reduce their size, let’s look at what floaters are and why they occur.</p>
<p>The main reason floaters occur is age. With age, the vitreous – a clear, gel-like substance inside the eye – starts to thicken and shrink. Vitreous consists mostly of water, collagens and an acid called hyaluronan. Over time, the vitreous degenerates slightly and little clumps of collagen begin to form. Floaters are the shadows these clumps cast on the retina. </p>
<p>With age, it’s normal for the vitreous to pull away from the back of the eye, a process called <a href="https://www.rnib.org.uk/your-eyes/eye-conditions-az/posterior-vitreous-detachment/">posterior vitreous detachment</a>, and this causes more floaters.</p>
<p>Is it possible that vitamin supplements could affect the clumps and strands of collagen, to improve the vitreous? In 2022, <a href="https://doi.org/10.3390/jcm11226710">researchers in Taiwan</a> reported that taking high-dose mixed fruit enzyme supplements could reduce floaters, but it’s not clear how they measured the number of floaters, so it is difficult to judge this study properly without more information. </p>
<p>Theia Bio, the company that Dr Brewer was speaking in partnership with, shares a <a href="https://tvst.arvojournals.org/article.aspx?articleid=2777982">link to a study</a> on its website as scientific proof that the Clearer supplement can “reduce eye floater size and visual discomfort”. But floaters are tricky to measure because the vitreous is mobile. Every time you move your eyes, the vitreous opacities (the floating objects in the vitreous) move, and the floaters - the shadows the vitreous opacities cast - move too.</p>
<p>The vitreous clumps are 3D, not 2D, so catching them from different angles affects the measure you take and floaters appear bigger when they’re closer to the front of your eye. The reduction in opacity size in the study is based on just 26 people who took the formulation, and opacity sizes were reported in a 2D measure (cm²).</p>
<p>This small trial does not convince me that floater size can be reduced with this dietary supplement.</p>
<h2>What about other solutions?</h2>
<p>There are a couple of medical ways to get rid of floaters. The most accepted is a procedure called <a href="https://www.webmd.com/eye-health/what-is-vitrectomy">vitrectomy</a>, which surgically removes the vitreous. But this surgery poses risks to a person’s vision far more significant than the floaters themselves. </p>
<p>Zapping floaters with a laser (known as a YAG laser) is another option, but not all experts agree that this is safe. Worryingly, several private companies offer this treatment as a good solution, even though there are <a href="https://link.springer.com/article/10.1007/s12325-020-01261-w">reports of damage</a> to various eye structures and glaucoma as a result.</p>
<p>Other “solutions” suggested online include <a href="https://www.drberg.com/blog/best-treatment-for-eye-floaters">intermittent fasting</a>, <a href="https://www.youtube.com/watch?v=WqRVDGTTdvM">temple massage and acupressure</a>, as well as <a href="https://www.rebuildyourvision.com/blog/vision-conditions/how-to-get-rid-of-eye-floaters-naturally/#:%7E:text=Rapidly%20moving%20eyes%20up%20and,going%20even%20after%20eyes%20stop.">eye exercises</a>. But there is no credible evidence for these.</p>
<figure class="align-center ">
<img alt="Eye floaters seen against a cloudy sky." src="https://images.theconversation.com/files/526838/original/file-20230517-10717-802ecs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/526838/original/file-20230517-10717-802ecs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526838/original/file-20230517-10717-802ecs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526838/original/file-20230517-10717-802ecs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526838/original/file-20230517-10717-802ecs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=425&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526838/original/file-20230517-10717-802ecs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=425&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526838/original/file-20230517-10717-802ecs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=425&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Flying flies marring a beautiful sky.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/eye-floaters-myodesopsia-blue-sky-656229847">meyerandmeyer</a></span>
</figcaption>
</figure>
<p>There is some evidence that lifestyle factors can accelerate or decelerate ageing in the eye more generally, which might affect the age you first notice floaters, or how large or troublesome they are. For example, eating lots of vegetables rich in carotenoids (spinach, broccoli, watermelon, pink grapefruit) and fatty fish containing omega-3, may <a href="https://doi.org/10.1167/iovs.14-13916">help people</a> at risk of age-related macular degeneration. </p>
<p>Emerging evidence also suggests that excessive exposure to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3693028/">blue light</a> from mobile phones, tablet computers and LCD screens might also accelerate age-related <a href="https://www.sciencedirect.com/science/article/abs/pii/S0306987720303856?via%3Dihub">eye changes</a>. But while slowing ageing in the eye would be great, it’s not proof that it will stop people from getting floaters.</p>
<p>So what should you do if you find yourself troubled by floaters? Mostly, the best thing to do is ignore them. Over time, the brain adapts and we notice them much less. </p>
<p>You’re <a href="https://www.ajo.com/article/S0002-9394(11)00191-7/fulltext">more likely to get floaters</a> if you are shortsighted, had cataract surgery, or if you’ve had eye inflammation (swelling). And you might have more floaters if you <a href="https://www.sciencedirect.com/science/article/pii/S1350946218300892">have diabetes</a>, so glucose and diabetic control are important. </p>
<p>Occasionally, floaters can be signs of a serious condition. If you suddenly notice a lot of new floaters or flashes, or if a shadow or grey curtain comes down over your vision, this could indicate a retinal tear needing urgent surgery.</p>
<h2>The verdict</h2>
<p>Can supplements “address” collagen clumps in the vitreous? There is little evidence to support this at present.</p>
<p>Can supplements and lifestyle changes slow the ageing process in the eye, delaying the onset of these age-related floaters? <a href="https://www.nih.gov/news-events/news-releases/nih-study-confirms-benefit-supplements-slowing-age-related-macular-degeneration">Possibly</a>.</p>
<p>Dr Brewer makes excellent recommendations about nutritious food, hydration and sleep – all great ways to maintain your health. It’s doubtful that it will have a direct impact on floaters, but it’s great health advice generally and might delay the ageing processes in the eye by which they arrive.</p>
<p>Kawa Wong, the founder of Theia Bio, told The Conversation that his company “does not promise a cure for eye floaters; rather, it offers the best nutritional support for eye floater patients based on available scientific evidence”.</p><img src="https://counter.theconversation.com/content/205611/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charlotte Codina does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Eye floaters are annoying, so it’s not surprising that people want to get rid of them.Charlotte Codina, Lecturer, Orthoptics, University of SheffieldLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1967962023-02-01T03:12:36Z2023-02-01T03:12:36ZMacular diseases cause blindness and treatment costs millions. Here is how to look after yours<figure><img src="https://images.theconversation.com/files/505792/original/file-20230123-38684-3kz8jx.jpg?ixlib=rb-1.1.0&rect=29%2C24%2C3245%2C2450&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/macular-degeneration-retina-isolated-600w-192688028.jpg">Shutterstock</a></span></figcaption></figure><p>The single most expensive drug for the Australian government today, costing more than <a href="https://www.pbs.gov.au/info/statistics/expenditure-prescriptions/pbs-expenditure-and-prescriptions-report-30-june-2021">A$400 million per year</a>, is one called <a href="https://www.ncbi.nlm.nih.gov/books/NBK582136/">aflibercept</a>. It stops the growth and “leakiness” of blood vessels, and is given to treat a range of different eye diseases. These diseases have one thing in common: they all affect a piece of tissue inside the eye called the macula.</p>
<p>The macula is a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1270903/">structure</a> that distinguishes us humans, as well as some other primates including apes and monkeys. It is a part of the retina that lets us recognise people’s faces, navigate a car and read the newspaper. Our eye is built to focus images onto the macula to achieve this level of vision.</p>
<p>Like the rest of the retina, the macula consists of cells that detect light – <a href="https://www.aao.org/eye-health/anatomy/photoreceptors#:%7E:text=Special%20cells%20in%20the%20eye's,photoreceptor%20cells%3A%20rods%20and%20cones.">photoreceptors</a> – plus nerve cells and other supporting cells, but they are arranged differently to ensure <a href="https://pubmed.ncbi.nlm.nih.gov/21413391/">images are seen</a> in high resolution. The macula also contains the highest body concentration of yellow <a href="https://www.healthline.com/health/carotenoids#benefits">carotenoid pigments</a> – protective antioxidants which <a href="https://pubmed.ncbi.nlm.nih.gov/27847637/">filter out blue light</a> to hone vision.</p>
<p>Scientists are working to understand why so many diseases and conditions, including diabetes, inflammation and parasitic infection, <a href="https://pubmed.ncbi.nlm.nih.gov/29148528/">affect the macula</a>. This is likely due to a host of factors: from the special anatomy of cells, to blood supply, the need for carotenoid pigments and a high metabolic rate.</p>
<h2>The many causes of macular disease</h2>
<p>When a person’s macula becomes diseased, they often experience changes in vision. However, because the macula is just one part of the retina, even severe macular disease generally does not cause complete loss of sight.</p>
<p>Dame Judi Dench has <a href="https://www.theguardian.com/culture/2021/feb/25/you-find-a-way-judi-dench-on-working-through-sight-loss">talked</a> about her macular disease – macular degeneration – including how friends help her learn lines by repeating them over and over to her, and how fellow performers help her know where to face when she is acting. Having this condition might mean she no longer drives a car, but she continues to live a full life.</p>
<p>Macular degeneration affects about <a href="https://www.mdfoundation.com.au/about-macular-disease/age-related-macular-degeneration/amd-overview/">one in seven people</a> over 50 years of age, and can occur as an overgrowth of blood vessels or as a loss of tissue.</p>
<p>Diabetes causes an accumulation of fluid in the macula, called macular oedema; around one in 15 people with diabetes <a href="https://pubmed.ncbi.nlm.nih.gov/22301125/">develop this condition</a>. Other causes of macular oedema include a blocked blood vessel or inflammation inside the eye. It can also be a <a href="https://www.ncbi.nlm.nih.gov/books/NBK576396/">complication</a> after cataract surgery.</p>
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<a href="https://images.theconversation.com/files/506958/original/file-20230130-25-xxwvw6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="older woman with short hair poses for photo on red carpet" src="https://images.theconversation.com/files/506958/original/file-20230130-25-xxwvw6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/506958/original/file-20230130-25-xxwvw6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/506958/original/file-20230130-25-xxwvw6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/506958/original/file-20230130-25-xxwvw6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/506958/original/file-20230130-25-xxwvw6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/506958/original/file-20230130-25-xxwvw6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/506958/original/file-20230130-25-xxwvw6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Dame Judi Dench has spoken about how macular degeneration has limited her eyesight.</span>
<span class="attribution"><a class="source" href="https://photos-cdn.aap.com.au/Image/20221010001715263070?path=/aap_dev16/device/imagearc/2022/10-10/b2/e9/8f/aapimage-7n46othvj6x1n1ioe97b_layout.jpg">Vianney Le Caer/Invision/AP</a></span>
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<em>
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Read more:
<a href="https://theconversation.com/we-could-be-doing-more-to-prevent-vision-loss-for-people-with-diabetes-132086">We could be doing more to prevent vision loss for people with diabetes</a>
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<p>There are many more macular diseases. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/14700638/">Toxoplasmosis</a> – a parasite infection – often affects the macula. </p>
<p>Macular disease is a side effect of some drugs, such as hydroxychloroquine used to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2926651/">treat inflammatory diseases</a> like lupus, and the <a href="https://pubmed.ncbi.nlm.nih.gov/26043707/">new immunotherapy drugs</a> for cancers including melanoma.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/12431693/">Central serous chorioretinopathy</a> is a macular disease that affects younger adults and is associated with high levels of the stress hormone <a href="https://pubmed.ncbi.nlm.nih.gov/12431693/">cortisol</a>. Rare inherited conditions can affect the macula even <a href="https://pubmed.ncbi.nlm.nih.gov/28941524/">earlier in life</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/505796/original/file-20230123-16-sv3ko5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman shields her eyes from sun on beach" src="https://images.theconversation.com/files/505796/original/file-20230123-16-sv3ko5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/505796/original/file-20230123-16-sv3ko5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/505796/original/file-20230123-16-sv3ko5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/505796/original/file-20230123-16-sv3ko5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/505796/original/file-20230123-16-sv3ko5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/505796/original/file-20230123-16-sv3ko5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/505796/original/file-20230123-16-sv3ko5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Sun protection isn’t just about your skin.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-traveler-wearing-sunglasses-600w-2151827203.jpg">Shutterstock</a></span>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/one-in-three-people-are-infected-with-toxoplasma-parasite-and-the-clue-could-be-in-our-eyes-182418">One in three people are infected with _Toxoplasma_ parasite – and the clue could be in our eyes</a>
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<h2>Treatments and prevention: 5 ways</h2>
<p>Treatments depend on the type of macular disease. Most drugs are given by injection with a fine needle into the back part of the eye, called the <a href="https://www.aao.org/eye-health/anatomy/vitreous">vitreous</a>. This quick procedure may be done in the doctor’s office.</p>
<p>But understanding what the causes of disease have in common points to lifestyle changes that can protect the macula or slow the damage of diseases.</p>
<p><strong>1. Diet</strong></p>
<p>Researchers at the United States National Eye Institute have <a href="https://pubmed.ncbi.nlm.nih.gov/32574780/">shown the benefits</a> of a Mediterranean diet, heavy in legumes and other vegetables, fruits, nuts and whole grains, and favouring fish over red meat, for protection against macular degeneration. A supplement combining vitamin C and E, lutein and zeaxanthin, zinc and copper is also <a href="https://pubmed.ncbi.nlm.nih.gov/32574780/">recommended</a> to limit progression of certain types of degeneration.</p>
<p><strong>2. Avoiding smoking</strong></p>
<p>Not taking up smoking or quitting if you are already a smoker safeguards your macula. <a href="https://pubmed.ncbi.nlm.nih.gov/18321467/">Smoking</a> has been linked to a number of macular diseases, including macular oedema and <a href="https://pubmed.ncbi.nlm.nih.gov/30002072/">central serous chorioretinopathy</a>, as well as <a href="https://pubmed.ncbi.nlm.nih.gov/33958600/">macular degeneration</a>.</p>
<p><strong>3. Sun smarts</strong></p>
<p>Wearing a sunhat and sunglasses from childhood may have benefits beyond skin safety. Some studies suggest sunlight exposure is a risk factor for <a href="https://pubmed.ncbi.nlm.nih.gov/23143904/">macular degeneration</a>. <a href="https://pubmed.ncbi.nlm.nih.gov/29242921/">Physical activity</a> can also protect against this condition, although there is debate about whether vigorous exercise is protective or potentially dangerous.</p>
<p><strong>4. Shut eye</strong></p>
<p>Quality sleep protects the macula. <a href="https://onlinelibrary.wiley.com/doi/10.1111/ceo.14071">Sleep apnoea</a> is associated with several macular diseases, including macular degeneration, macular oedema and central serous chorioretinopathy. Moreover, people with these diseases and untreated sleep apnoea may need <a href="https://pubmed.ncbi.nlm.nih.gov/36054031/">more frequent drug injections</a> for their condition.</p>
<p><strong>5. Busting stress if possible</strong></p>
<p>Limiting stress in life is difficult, but stress is a well-established risk factor for central serous chorioretinopathy. One <a href="https://iovs.arvojournals.org/article.aspx?articleid=2773228">group of US researchers</a> reported an unusually high number of people with the disease at their local health network early in the COVID pandemic, which was a highly stressful time.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/505794/original/file-20230123-20-sv3ko5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman waking up and reaching for glasses" src="https://images.theconversation.com/files/505794/original/file-20230123-20-sv3ko5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/505794/original/file-20230123-20-sv3ko5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/505794/original/file-20230123-20-sv3ko5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/505794/original/file-20230123-20-sv3ko5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/505794/original/file-20230123-20-sv3ko5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/505794/original/file-20230123-20-sv3ko5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/505794/original/file-20230123-20-sv3ko5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Getting enough good quality sleep protects eye health.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/older-mature-woman-holding-taking-600w-1536338495.jpg">Shutterstock</a></span>
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<p>Controlling other aspects of diseases that affect the macula can be important too. For example, the macula benefits from: keeping <a href="https://www.nature.com/articles/s41598-020-61386-4">blood pressure</a> well-controlled, <a href="https://pubmed.ncbi.nlm.nih.gov/32065699/">stabilising blood sugars</a> in people with diabetes, and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6387597/">reducing inflammation</a> in people with uveitis.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/syphilis-is-making-a-come-back-and-causing-some-unusual-health-problems-109658">Syphilis is making a come-back, and causing some unusual health problems</a>
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</em>
</p>
<hr>
<h2>Check it and see</h2>
<p>You can monitor your own macula using a simple test called the <a href="https://www.mdfoundation.com.au/about-macular-disease/age-related-macular-degeneration/detecting-monitoring-amd/">Amsler grid</a>, available for free online. </p>
<p>Testing with an Amsler grid picks up changes in the vision caused by macular diseases. </p>
<p>Self-testing doesn’t take the place of regular checks with your eye health practitioner. They can examine your macula directly, usually after dilating the pupils, and may employ a powerful technology – <a href="https://www.aao.org/eye-health/treatments/what-is-optical-coherence-tomography">optical coherence tomography</a> – to scan through it.</p><img src="https://counter.theconversation.com/content/196796/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Justine R. Smith receives funding from Macular Disease Foundation Australia, Queensland Eye Institute Foundation, Flinders Foundation and the National Health and Medical Research Council of Australia. </span></em></p>Scientists are figuring out why so many diseases and conditions, including diabetes, inflammation and parasitic infection, can affect our eye health. But there are ways to protect your macula.Justine R. Smith, Professor of Eye & Vision Health, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1863292022-07-20T09:32:25Z2022-07-20T09:32:25ZHow your eyes could help diagnose high blood pressure<figure><img src="https://images.theconversation.com/files/473595/original/file-20220712-31542-rqwwk6.jpg?ixlib=rb-1.1.0&rect=7%2C7%2C4888%2C3258&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Signs of high blood pressure may be spotted in your eyes long before you're diagnosed with the condition.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sight-old-woman-verifying-by-apparatus-632890499">Olena Yakobchuk/ Shutterstock</a></span></figcaption></figure><p>Most people over the age of 40 regularly see an optometrist. But while most see their optometrist for an eye exam, many don’t realise just how much our eyes can tell someone about our health. In fact, your eyes may actually be one of the first parts of our body to show signs of high blood pressure – often before most people are even aware they have the condition.</p>
<p>An estimated <a href="https://www.who.int/news-room/fact-sheets/detail/hypertension">1.3 billion people worldwide</a> have hypertension – but only half of these people are aware of it or have been diagnosed. Many people may be unaware they have high blood pressure because it has few warning signs or symptoms. This is also why it’s often called “<a href="https://www.nhs.uk/conditions/high-blood-pressure-hypertension/">the silent killer</a>”.</p>
<p>High blood pressure isn’t something that develops suddenly. It’s often the result of many years of an unhealthy lifestyle with poor diet, lack of physical activity, smoking and excess alcohol consumption. Family history of high blood pressure, alongside other conditions – such as diabetes and kidney disease – are also risk factors. </p>
<p>If left untreated, high blood pressure can increase risk of heart disease (including heart attacks and heart failure), stroke, kidney disease, vascular dementia, as well as causing eye problems. This is why it’s important to catch high blood pressure early – and regular eye exams could be one way to do this. </p>
<h2>Pressure changes</h2>
<p>There are several ways to find out if you have <a href="https://www.nhs.uk/conditions/high-blood-pressure-hypertension/diagnosis/">high blood pressure</a>. You can get it checked by your doctor, at a pharmacy or using a home testing kit. This is usually done with a stethoscope, arm cuff or an automated arm cuff, which can be used at home. The NHS advises people get their blood pressure checked every five years – though this may be yearly if a person is at greater risk of having high blood pressure. </p>
<p>But your optometrist may also be able to spot signs of high blood pressure – possibly even before your GP does. </p>
<p>When viewing inside the eye with a <a href="https://www.medicalnewstoday.com/articles/322267">slit-lamp</a> (a specialised microscope used during an eye exam) or taking a <a href="https://drive.google.com/drive/folders/1j9_0yQt5rqRkPhO-7T4MFZYqaVZAZzgG">retinal photograph</a>, many different parts of the eyes can be seen – including the small blood vessels. </p>
<p>These small blood vessels are very sensitive to changes in blood pressure and may become damaged as a result of high blood pressure – which may lead to blurry vision. High blood pressure may also cause a buildup of fluid beneath our retina, which may also affect the health of the eye. </p>
<figure class="align-center ">
<img alt="An optometrist examines a retinal photograph on a computer screen." src="https://images.theconversation.com/files/473596/original/file-20220712-18-ylyptw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/473596/original/file-20220712-18-ylyptw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/473596/original/file-20220712-18-ylyptw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/473596/original/file-20220712-18-ylyptw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/473596/original/file-20220712-18-ylyptw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/473596/original/file-20220712-18-ylyptw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/473596/original/file-20220712-18-ylyptw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Small blood vessels in the eyes are very sensitive to blood pressure changes.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-ophthalmologist-looking-retina-scan-computer-206471308">Dario Lo Presti/ Shutterstock</a></span>
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<p>During an eye exam, an optometrist may be able to measure the diameter of blood vessels to determine if a person is likely to have high blood pressure. If the optometrist takes a retinal photograph, signs of high blood pressure will be seen in red areas of haemorrhaging in the eyes. </p>
<p>The eye’s circulation is very similar to the brain’s circulation. This is because eyes developed from brain tissue, hence they’re often referred to as <a href="https://theconversation.com/the-eye-is-our-window-to-the-brain-and-theres-a-lot-we-can-tell-from-it-38746">“the window to the brain”</a>. This is also the reason why changes in the eye’s blood vessels can be used as an early warning sign for what is likely to go on in the brain and elsewhere in the body. But because changes in the eye’s blood vessels can also be due to other diseases affecting the eyes (such as diabetes), any changes that your optometrist spots would need to be confirmed by a GP or at-home blood pressure device. </p>
<p>In order to diagnose someone with high blood pressure by <a href="https://reader.elsevier.com/reader/sd/pii/S188842961400065X?token=D51E5DC58E656053DB9F05E23DC1936579A73C5E9215F5E9DA507DF7755034B3080A974B220926490E5AC458E35ED9D5&originRegion=eu-west-1&originCreation=20220706113518">looking at a their eyes</a>, optometrists will <a href="https://reader.elsevier.com/reader/sd/pii/S0161642099905250?token=3FB0B22981594EF2950233E4F5DE58DC121F1AAD028985141744657C3AAC97F52757311A233522A70104E1AA5D4C1C57&originRegion=eu-west-1&originCreation=20220706113258">look for</a> fluid build-up in the eye (which may lead to swelling), inflammation and blood vessel dysfunction. They may also measure the <a href="https://onlinelibrary.wiley.com/doi/10.1111/opo.12967">diameter of blood vessels in the eyes</a> to predict who is at higher risk of developing high blood pressure and cardiovascular disease. </p>
<p>Your optometrist may also ask you questions about your health during an exam – including if you have high blood pressure – to better identify risk factors for certain eye conditions. Someday, AI could even used during regular eye exams to better identify those <a href="https://www.researchgate.net/publication/358109014_Predicting_myocardial_infarction_through_retinal_scans_and_minimal_personal_information">at risk of having a heart attack</a>. </p>
<p>While a regular eye exam doesn’t replace a regular health check up with your doctor, it’s often the first place that high blood pressure is picked up, as patients are often symptom-free. Optometrists may also be able to catch signs of other diseases too – such as diabetes – which can also cause damage to the eyes.</p><img src="https://counter.theconversation.com/content/186329/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span><a href="mailto:c.french5@herts.ac.uk">c.french5@herts.ac.uk</a> received funding from The College of Optometrists Research in Practice Grant. </span></em></p><p class="fine-print"><em><span>Rebekka Heitmar does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Don’t skip your next eye exam – it could be important for your overall health.Rebekka Heitmar, Reader, Optometry and Vision Sciences, University of HuddersfieldChristian French, Senior Lecturer, Optometry, University of HertfordshireLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1824182022-05-11T19:55:43Z2022-05-11T19:55:43ZOne in three people are infected with ‘Toxoplasma’ parasite – and the clue could be in our eyes<figure><img src="https://images.theconversation.com/files/462178/original/file-20220510-20-i2xe1.jpg?ixlib=rb-1.1.0&rect=26%2C8%2C5964%2C3907&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-illustration/parasitic-protozoans-toxoplasma-gondii-causative-600w-2136137853.jpg">Shutterstock</a></span></figcaption></figure><p><em>Toxoplasma gondii</em> is probably the most successful parasite in the world today. This microscopic creature is capable of infecting any mammal or bird, and people across all continents are <a href="https://pubmed.ncbi.nlm.nih.gov/32717377/">infected</a>. Once infected, a person carries <em>Toxoplasma</em> for life. So far, we don’t have a drug that can eradicate the parasite from the body. And there is no vaccine approved for use in humans.</p>
<p>Across the world, it’s estimated <a href="https://pubmed.ncbi.nlm.nih.gov/22491772/">30–50% of people</a> are infected with <em>Toxoplasma</em> – and infections may be increasing in Australia. A survey of studies conducted at blood banks and pregnancy clinics across the country <a href="https://pubmed.ncbi.nlm.nih.gov/470719/">in the 1970s</a> put the infection rate at 30%. However, a recent Western Australian <a href="https://ro.ecu.edu.au/ecuworkspost2013/8534/">community-based study</a> found 66% of people were infected.</p>
<p>The disease caused by this parasite can scar the back of the eye. Our <a href="https://www.ophthalmologyretina.org/article/S2468-6530(22)00215-9/fulltext">new research</a> looked for signs of disease in otherwise healthy people and found a significant number bore the mark of <em>Toxoplasma</em>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cats-carry-diseases-that-can-be-deadly-to-humans-and-its-costing-australia-6-billion-every-year-147910">Cats carry diseases that can be deadly to humans, and it's costing Australia $6 billion every year</a>
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<h2>We don’t just get it from cats</h2>
<p>The cat is the primary host for <em>Toxoplasma</em>. </p>
<p>Cats catch the parasite when they eat infected prey. Then, for a couple of weeks, they pass large numbers of parasites in their faeces in a form that can survive for long periods in the environment, even during extreme weather. </p>
<p>When the faeces are ingested by livestock while grazing, parasites lodge in the muscle and survive there after the animals are slaughtered for meat. Humans can become infected by eating this meat, or by eating fresh produce or drinking water soiled by cats. It is also possible for a woman infected for the first time during pregnancy to pass the infection to her unborn child.</p>
<p>While infection with <em>Toxoplasma</em> is extremely common, the most important health statistic is the rate of the disease caused by the infection, which is called toxoplasmosis. </p>
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<strong>
Read more:
<a href="https://theconversation.com/disease-causing-parasites-can-hitch-a-ride-on-plastics-and-potentially-spread-through-the-sea-new-research-suggests-181824">Disease-causing parasites can hitch a ride on plastics and potentially spread through the sea, new research suggests</a>
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<h2>How it affects the eye</h2>
<p><em>Toxoplasma</em> <a href="https://pubmed.ncbi.nlm.nih.gov/32717377/">really likes the retina</a>, the multi-layered nerve tissue that lines the eye and generates vision. Infection can cause recurring attacks of retinal inflammation and <a href="https://pubmed.ncbi.nlm.nih.gov/22712598/">permanent retinal scarring</a>. This is known as ocular toxoplasmosis.</p>
<p>Contrary to much that is written about ocular toxoplasmosis, medical research shows this condition usually <a href="https://pubmed.ncbi.nlm.nih.gov/16226526/">affects healthy adults</a>. However, in aged persons or people with a weakened immune system, or when contracted during pregnancy, it can be more severe.</p>
<p>An attack of active inflammation causes “floaters” and blurred vision. When the inflammation progresses to scarring, there may be permanent loss of vision. </p>
<p>In a <a href="https://www.nature.com/articles/s41598-021-82830-z">study</a> of patients with ocular toxoplasmosis seen at a large ophthalmology clinic, we measured reduced vision to below driving level in more than 50% of eyes, and 25% of eyes were irreversibly blind.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/462169/original/file-20220510-17-mu0okv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="close up of person's eye" src="https://images.theconversation.com/files/462169/original/file-20220510-17-mu0okv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/462169/original/file-20220510-17-mu0okv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/462169/original/file-20220510-17-mu0okv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/462169/original/file-20220510-17-mu0okv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/462169/original/file-20220510-17-mu0okv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/462169/original/file-20220510-17-mu0okv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/462169/original/file-20220510-17-mu0okv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"><em>Toxoplasma</em> really likes the retina at the back of the eye and can leave a scar.</span>
<span class="attribution"><a class="source" href="https://images.unsplash.com/flagged/photo-1552065172-4f7d73c31fca?ixlib=rb-1.2.1&ixid=MnwxMjA3fDB8MHxzZWFyY2h8MTB8fHJldGluYSUyMGV5ZXxlbnwwfHwwfHw%3D&auto=format&fit=crop&w=800&q=60">Unsplash/Marc Schulte</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>How many eyes?</h2>
<p>Ophthalmologists and optometrists are quite familiar with managing ocular toxoplasmosis. But the extent of the problem is not widely recognised, even by the medical community. The number of Australians with ocular toxoplasmosis had never been measured, until now.</p>
<p>We wanted to investigate the prevalence of ocular toxoplasmosis in Australia, but we knew it would be challenging to get funding for a major survey of this neglected disease. So, we used information collected for a different purpose: as part of the Busselton Healthy Ageing Study, retinal photographs were taken from more than 5,000 baby boomers (born 1946–64) living in Busselton, Western Australia. The photographs <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-13-936">were gathered</a> to look for other eye diseases, macular degeneration and glaucoma.</p>
<p>By screening these retinal photographs, we <a href="https://www.ophthalmologyretina.org/article/S2468-6530(22)00215-9/fulltext">estimated</a> the prevalence of ocular toxoplasmosis at one in 150 Australians. This might seem surprisingly common, but it fits with the way people catch <em>Toxoplasma</em>. </p>
<p>In addition to pet cats, Australia has huge populations of <a href="https://pubmed.ncbi.nlm.nih.gov/32547918/">feral cats</a>. And Australia is home to a lot of farmland, including over 50% of the <a href="https://www.researchgate.net/publication/329231876_Maps_of_Organic_Agriculture_in_Australia">global organic farming area</a>. </p>
<p>Most importantly, many Australians like to eat their <a href="https://bright-r.com.au/how-most-australians-prefer-their-steak-cooked/#:%7E:text=Research%20conducted%20by%20Brighter%20has,Australians%20prefer%20a%20medium%20steak.">red meat rare</a>, putting them at real risk. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/462171/original/file-20220510-24-li5uy5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="cute cat rolls on back" src="https://images.theconversation.com/files/462171/original/file-20220510-24-li5uy5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/462171/original/file-20220510-24-li5uy5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/462171/original/file-20220510-24-li5uy5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/462171/original/file-20220510-24-li5uy5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/462171/original/file-20220510-24-li5uy5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/462171/original/file-20220510-24-li5uy5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/462171/original/file-20220510-24-li5uy5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Yes, cats do spread <em>Toxoplasma</em>. But they’re not solely to blame.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/46TvM-BVrRI">Unsplash/Daria Shatova</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/ive-always-wondered-can-i-flush-cat-poo-down-the-toilet-159340">I've always wondered: can I flush cat poo down the toilet?</a>
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<h2>How the condition is treated</h2>
<p>To diagnose ocular toxoplasmosis, a retina examination is necessary, ideally with the pupils dilated. </p>
<p>The retinal lesion is easy to spot, because of the way <em>Toxoplasma</em> <a href="https://pubmed.ncbi.nlm.nih.gov/31569536/">activates retinal cells</a> to produce certain proteins, and an ophthalmologist or optometrist can immediately recognise the appearance. Often a blood test is also performed to make the diagnosis.</p>
<p>If the condition is mild, the doctor may let the body’s own immune system control the problem, which takes a few months. However, <a href="https://pubmed.ncbi.nlm.nih.gov/35197262/">usually</a> a combination of anti-inflammatory and anti-parasitic drugs is prescribed. </p>
<h2>Stopping the spread</h2>
<p><em>Toxoplasma</em> infection is not curable, but it can be prevented. Meat sold in Australian supermarkets <a href="https://pubmed.ncbi.nlm.nih.gov/31825558/">may harbour</a> <em>Toxoplasma</em>__. Cooking meat to an internal temperature of <a href="https://www.cdc.gov/parasites/toxoplasmosis/prevent.html">66°C</a> or freezing it ahead of cooking are ways to <a href="https://www.taylorfrancis.com/books/mono/10.1201/9781420092370/toxoplasmosis-animals-humans-dubey">kill the parasite</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/462177/original/file-20220510-15-xpot89.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="raw steak on a plate" src="https://images.theconversation.com/files/462177/original/file-20220510-15-xpot89.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/462177/original/file-20220510-15-xpot89.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=359&fit=crop&dpr=1 600w, https://images.theconversation.com/files/462177/original/file-20220510-15-xpot89.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=359&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/462177/original/file-20220510-15-xpot89.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=359&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/462177/original/file-20220510-15-xpot89.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=451&fit=crop&dpr=1 754w, https://images.theconversation.com/files/462177/original/file-20220510-15-xpot89.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=451&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/462177/original/file-20220510-15-xpot89.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=451&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Meat needs to be well-cooked to 66°C to kill the parasite.</span>
<span class="attribution"><a class="source" href="https://images.unsplash.com/photo-1638294133684-b2036f3ecd76?ixlib=rb-1.2.1&ixid=MnwxMjA3fDB8MHxwaG90by1wYWdlfHx8fGVufDB8fHx8&auto=format&fit=crop&w=3371&q=80">Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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</figure>
<p>Fresh fruit and vegetables should be washed before eating, and drinking untreated water (such as straight from rivers or creeks) should be avoided. Gloves should be worn when changing cat litter, and hands washed afterwards.</p>
<p>The World Health Organization and other international and national health bodies are promoting an approach called <a href="https://www.who.int/news-room/questions-and-answers/item/one-health">One Health</a> for diseases that cross humans, animals and their environments. This involves different sectors working together to promote good health. Now we know just how common ocular toxoplasmosis is in Australia, there is real justification to harness One Health to combat <em>Toxoplasma</em> infections in this country.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-dangerous-parasite-could-be-used-to-treat-cancer-new-research-in-mice-171022">A dangerous parasite could be used to treat cancer – new research in mice</a>
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<img src="https://counter.theconversation.com/content/182418/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Justine R. Smith receives funding from NHMRC, Macular Disease Foundation Australia, Australian Department of Industry, Science, Energy and Resources, Flinders Foundation, QEI Foundation and South Bank Day Hospital.</span></em></p><p class="fine-print"><em><span>João M. Furtado does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We looked at eye photos and found one in every 150 Australians might have scarring from a common parasitic disease.Justine R. Smith, Professor of Eye & Vision Health, Flinders UniversityJoão M. Furtado, Associate Professor of Ophthalmology, Universidade de São Paulo (USP)Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1737422021-12-16T20:26:32Z2021-12-16T20:26:32ZFace masks, digital screens and winter weather are a triple threat for dry eyes<figure><img src="https://images.theconversation.com/files/437861/original/file-20211215-17-1nc27z4.jpg?ixlib=rb-1.1.0&rect=41%2C201%2C4877%2C3352&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Eye doctors report that patients are more frequently saying during routine exams that their eyes are irritated, burn and sting.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/face-masks--digital-screens-and-winter-weather-are-a-triple-threat-for-dry-eyes" width="100%" height="400"></iframe>
<p>How do your eyes feel right now? Whether you’re sitting at home or in the office, you’re likely reading this on a digital device, and your eyes may be hot, scratchy, tired and dry. If so, you may be part of a new phenomenon called dry eye triad (DET).</p>
<p>The science of eye dryness has advanced rapidly in recent years, as has general awareness of the condition. Researchers have faced two new variables as the pandemic set in: significant upticks in digital screen use and altered airflow from mask wearing. Colder weather is on the horizon in much of the world, adding a seasonal third punch to a growing problem. </p>
<figure class="align-right ">
<img alt="Close-up of a blue eye" src="https://images.theconversation.com/files/437847/original/file-20211215-23-1y86kpf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/437847/original/file-20211215-23-1y86kpf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/437847/original/file-20211215-23-1y86kpf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/437847/original/file-20211215-23-1y86kpf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/437847/original/file-20211215-23-1y86kpf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/437847/original/file-20211215-23-1y86kpf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/437847/original/file-20211215-23-1y86kpf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Your eyes are subject to the same environmental conditions as the rest of your body.</span>
<span class="attribution"><span class="source">(AP Photo/Patrick Sison)</span></span>
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</figure>
<p>The good news is that people do not need to suffer in silence. Once aware of the causes and steps to counter dryness, everyday comfort is usually within reach.</p>
<h2>What is dry eye disease?</h2>
<p>Eye doctors report seeing more patients with irritated, burning and stinging eyes. These symptoms are very common, and when persistent can be diagnosed as dry eye disease, a condition affecting up to <a href="https://www.tfosdewsreport.org/report-epidemiology_report/71_36/en/">75 per cent of the population</a>. </p>
<p>Severity varies, with most people having minor intermittent symptoms, but for others it can be <a href="https://dx.doi.org/10.1007%2Fs40135-013-0009-1">highly disruptive to work and daily life</a>.</p>
<p>Dry eye disease has many causes, and effectively addressing it requires attention to multiple aspects of ocular health, general health and the environment. </p>
<p>Starting with the eye itself, the role of an eye care practitioner like me has been to ensure the <a href="https://doi.org/10.2147/OPTH.S114674">eyelids and eyelashes are healthy</a>, that the <a href="https://doi.org/10.1016/j.ophtha.2017.05.031">glands in the eyelids are producing oils</a>, that there are <a href="https://doi.org/10.1186/s40662-019-0172-z">sufficient tears to keep eyes feeling moist and ensure that surface inflammation</a> is controlled. It is also important to <a href="https://dx.doi.org/10.1155%2F2012%2F285851">account for health conditions and medications that may contribute to drying the ocular surface</a>. </p>
<p>Then the pandemic arrived, behaviours changed and dry eye triad began to affect millions across the globe.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/438157/original/file-20211217-21-spenrh.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Infographic detailing the elements of the dry eye triad: Digital device use, fall and winter air and mask wear" src="https://images.theconversation.com/files/438157/original/file-20211217-21-spenrh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/438157/original/file-20211217-21-spenrh.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/438157/original/file-20211217-21-spenrh.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/438157/original/file-20211217-21-spenrh.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/438157/original/file-20211217-21-spenrh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/438157/original/file-20211217-21-spenrh.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/438157/original/file-20211217-21-spenrh.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The dry eye triad.</span>
<span class="attribution"><span class="source">(William Ngo)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Factor 1: Impact of fall and winter</h2>
<p>Your eyes are subject to the same environmental conditions as the rest of your body. This is more apparent during the fall and <a href="https://dx.doi.org/10.1016%2Fj.ophtha.2015.02.013">winter</a>. As surrounding air becomes less humid, dry eye symptoms increase. Comfortable levels of humidity typically range between 40 and 70 per cent. During the coldest days of winter, humidity percentages can drop into the single digits. The <a href="https://doi.org/10.1016/j.ajo.2005.10.057">tear film evaporates much more quickly in these conditions</a>, leaving the surface of the eye drier than normal. </p>
<p>Cooler weather comes hand-in-hand with increased use of indoor heating. That commonly dry heat accelerates tear film evaporation even further. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/437862/original/file-20211215-27-1isa0ai.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man sitting in front of a laptop, rubbing his eyes with his glasses in his hand" src="https://images.theconversation.com/files/437862/original/file-20211215-27-1isa0ai.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/437862/original/file-20211215-27-1isa0ai.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/437862/original/file-20211215-27-1isa0ai.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/437862/original/file-20211215-27-1isa0ai.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/437862/original/file-20211215-27-1isa0ai.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/437862/original/file-20211215-27-1isa0ai.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/437862/original/file-20211215-27-1isa0ai.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">When viewing a digital screen, dryness sensations are driven by a change in blinking patterns.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Several steps can help offset these drying situations. Using <a href="https://doi.org/10.1097/opx.0000000000001136">humidifiers</a> increases moisture in the air and <a href="https://dx.doi.org/10.3390%2Fjcm9113740">air purifiers</a> may also help. </p>
<p>Simple management strategies guard against excessive tear film evaporation by improving the oily (lipid) outer layer of the tear film. Using <a href="https://doi.org/10.1097/01.icl.0000060998.20142.8d">warm compresses</a> on the eyelids helps tear film oils spread more easily, and adding <a href="https://dx.doi.org/10.1089%2Fjop.2017.0052">lipid-based artificial tear drops</a> supplements the oil level. </p>
<p>It also helps to <a href="https://doi.org/10.1167/iovs.12-10175">drink more water</a> to maintain adequate levels of hydration. </p>
<h2>Factor 2: Increased digital device use</h2>
<p>The COVID-19 pandemic has forced many people to work and study remotely from home, spending more time on digital devices. When viewing a screen, dryness sensations are driven by a change in blinking patterns. Blinks are <a href="https://doi.org/10.1097/apo.0000000000000328">less frequent and not as full and complete</a>. </p>
<p>The natural mechanism of blinking is important to distribute a fresh layer of tears over the surface of the eye. With a reduced blink rate, the tear film evaporates and is not replaced quickly enough, leading to <a href="https://dx.doi.org/10.1167%2Fiovs.19-27298">increased irritation and discomfort</a>. </p>
<p>The most straightforward advice is to take more frequent breaks. The “<a href="https://opto.ca/health-library/the-20-20-20-rule">20-20-20 rule</a>” (every 20 minutes, look at something 20 feet away for 20 seconds) helps manage eye strain when working on digital devices. There are even <a href="http://eyedoc2020.blogspot.com/2017/03/best-apps-to-remind-you-to-blink-your.html">programs and apps</a> that remind you to blink more frequently and more fully.</p>
<h2>Factor 3: Mask wear continues</h2>
<figure class="align-center ">
<img alt="Close up of a man's irritated eyes, wearing a protective face mask" src="https://images.theconversation.com/files/437865/original/file-20211215-15-17rncy2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/437865/original/file-20211215-15-17rncy2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/437865/original/file-20211215-15-17rncy2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/437865/original/file-20211215-15-17rncy2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/437865/original/file-20211215-15-17rncy2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/437865/original/file-20211215-15-17rncy2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/437865/original/file-20211215-15-17rncy2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Mask-associated dry eye is caused by exhaled air travelling out the top opening of the mask and over the surface of the eyes, making tears evaporate even faster.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>With indoor mask-wearing still being mandated or recommended to reduce the spread of COVID-19, it has also resulted in some people noticing an <a href="https://theconversation.com/why-face-masks-can-make-eyes-feel-dry-and-what-you-can-do-about-it-143261">increase in dry eye sensations</a>. Termed mask-associated dry eye (MADE), it is caused by exhaled air travelling out the top opening of the mask and over the surface of the eyes, making <a href="https://dx.doi.org/10.1007%2Fs40123-020-00282-6">tears evaporate even faster</a>. </p>
<p><a href="https://dx.doi.org/10.1007%2Fs40123-020-00282-6">The remedy</a> is similar to preventing glasses from fogging with mask wear: use medical tape to “seal off” the top part of the mask to prevent airflow there.</p>
<h2>Managing dry eye triad</h2>
<p>With winter drawing closer, plus increased digital device use and mask wearing, the dry eye triad’s triple-layered threat to the stability of your tear film is real. Thankfully, in most cases, that does not have to be debilitating.</p>
<p>Begin by having a conversation with your eye care provider, who can help you implement the steps I’ve mentioned to make sure your eyes are lubricated, well-rested and not subjected to low humidity and evaporative airflow conditions.</p>
<p>More intense eye dryness may well benefit from tailored treatment. Your optometrist or ophthalmologist may recommend a specific regimen or refer you to a dry eye speciality clinic. Several <a href="https://www.aao.org/eye-health/tips-prevention/new-dry-eye-treatments-ocular-surface-disease">new pharmaceuticals and medical devices</a> are putting relief in reach for even severe cases. </p>
<p>The most important advice of all, though, is not to dismiss dry eye altogether. The condition is real, more prevalent than ever and can be addressed with a combination of education, behaviours and therapies. Understanding your options will put you on a path to comfortable, healthy eyes not only during the cold weather months, but year-round.</p><img src="https://counter.theconversation.com/content/173742/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>William Ngo is a consultant with Alcon and Sun Pharma.
William Ngo is an independent contractor (optometrist) at Market Lane Optical.
William Ngo is a volunteer for the American Academy of Optometry.
William Ngo has received awards and research funding from the American Academy of Optometry Foundation.
As an employee at the Centre for Ocular Research & Education (CORE), we have received research funding from the following companies: Alcon, Allergan, Allied Innovations, Aurinia Pharma, Azura Ophthalmics, Bausch Health Canada, Brien Holden Vision Institute, CooperVision, GL Chemtec, i-MED Pharma, Johnson & Johnson Vision, Lubris, Menicon, Nature’s Way, Novartis, Ophtecs, Ote Pharma, PS Therapy, Santen, SightGlass, SightSage, Visioneering Tech Inc. CORE has also received funding from the following funding agencies: American Academy of Optometry Foundation, Natural Sciences and Engineering Research Council of Canada, Canadian Institutes of Health Research, Mitacs, Canadian Association of Optometrists, European Union Funding for Research & Innovation, Canada Foundation for Innovation, Innovation and Technology Commission.
</span></em></p>Increased digital screen use, face masks and winter weather combine to form a triple threat to eye health: The dry eye triad. Here’s how to combat the resulting eye fatigue, irritation and discomfort.William Ngo, Assistant Professor, School of Optometry & Vision Science, University of WaterlooLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1606832021-06-01T16:39:57Z2021-06-01T16:39:57ZMacular degeneration is a leading cause of blindness. Here’s how to prevent it<figure><img src="https://images.theconversation.com/files/399869/original/file-20210510-18-1hk45fb.jpg?ixlib=rb-1.1.0&rect=2%2C0%2C1347%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Macular degeneration can result in blurred or no vision in the center of the visual field. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/">(Shutterstock)</a></span></figcaption></figure><p>Jacques was a very active retiree. That ended one November morning as his life was suddenly turned upside down. When he woke that day, he could not see out of one eye. Panicked, he came to see me right away. </p>
<p>Jacques had been diagnosed with age-related macular degeneration (AMD) a few years earlier. His condition had been stable, but now it suddenly progressed to the most severe form of the disease, “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404137/">wet degeneration</a>.” This stage is characterized by the sudden development of a network of new blood vessels that ooze into the deep layers of the retina, causing a rapid loss of functional vision in the affected eye.</p>
<p>An urgent referral to ophthalmology is made in cases like these because the window of opportunity for treatment is narrow. Immediate treatment usually results in <a href="https://www.aao.org/preferred-practice-pattern/age-related-macular-degeneration-ppp">the best prognosis</a>. Jacques managed to get treatment within a few days.</p>
<p>The ophthalmologist gave him <a href="https://www.cochrane.org/CD005139/EYES_anti-vascular-endothelial-growth-factor-neovascular-age-related-macular-degeneration">intraocular injections</a> of medication, but this only improved his vision slightly. Jacques was depressed and his anxiety was increasing. He felt useless and had lost considerable autonomy.</p>
<p>The loss of an eye is a traumatic event, regardless of the patient’s age. While the significant negative psychological effects are well documented for <a href="https://pubmed.ncbi.nlm.nih.gov/26893539/">older patients</a>, recent publications also report the same adverse consequences in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328297/">younger populations</a>.</p>
<p>For example, the rate of depression is six times greater in those with significant vision loss than in the general population (<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2792986/">25 per cent versus four per cent</a>).</p>
<h2>Hope for patients</h2>
<p>So what can we do to help Jacques? We can’t promise that his vision will be fully restored. Although injection treatments can be effective, the basic degeneration will not go away. The best option for Jacques is to refer him to a visual impairment rehabilitation centre where he will receive help from a variety of professionals.</p>
<p>At this centre, he will be seen by specialists trained to treat visual impairment and its repercussions on the lives of people who suffer from it, and on the people around them. Understanding this reality is the first step toward helping patients address their needs.</p>
<p>The next step, after providing psychological support to Jacques, is to optimize his visual condition. Optometrists who specialize in low vision can prescribe optical aids to help Jacques regain some of his visual function, including magnifiers, vision aids and specialized glasses that can be provided through a government program designed for this purpose.</p>
<p>Specialists in visual impairment rehabilitation (VIR) trained at the school of optometry of the University of Montréal (the only institution in Canada that offers a master’s program in VIR), can then help Jacques learn new strategies to carry out his daily activities. Specialized educators can help him to use a computer and specific software. When needed, orientation and mobility specialists teach people with visual impairments methods how to safely orient themselves and get around whether on the street or in an unfamiliar environment.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/391277/original/file-20210323-18-1nq7b4v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/391277/original/file-20210323-18-1nq7b4v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/391277/original/file-20210323-18-1nq7b4v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/391277/original/file-20210323-18-1nq7b4v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/391277/original/file-20210323-18-1nq7b4v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/391277/original/file-20210323-18-1nq7b4v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/391277/original/file-20210323-18-1nq7b4v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Age-related macular degeneration (AMD) can result in blurred or no vision in the centre of the visual field.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>A social worker, aware that the impacts of a visual handicap go far beyond the person experiencing it, will accompany Jacques during his rehabilitation process and communicate with his family. In short, Jacques will have a good support system and will be able to regain a certain level of autonomy in his life, which, in turn, will have a positive impact on his morale. <a href="http://www.aqdm.org/home.html">Support groups</a> can also help him in his efforts and if, thanks to effective injections, his visual acuity improves, he will be in a win-win situation.</p>
<p>However, Jacques still has other concerns about his disease. He is worried that his children will develop similar conditions, especially one of his sons.</p>
<h2>Several risk factors</h2>
<p>Age-related macular degeneration is aptly named: its prevalence increases with the age of the patients. Nearly one million Canadians — 300,000 in Québec alone — suffer from AMD. Of these, <a href="https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/DMLA/Note_informative_DMLA.pdf">10 to 15 per cent have the wet form</a>, like Jacques. AMD is the leading cause of blindness in people over the age of 65.</p>
<p>In addition to aging, other risk factors associated with the development of the disease include family history, ethnic origin (white people are more affected), gender (women are more affected), atherosclerotic and vascular diseases, obesity and sun exposure (phototoxicity of the retinal cells).</p>
<p>Smoking also plays an important role. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3866712/">Consuming 25 cigarettes per day</a> doubles the risk of severe damage. Exposure to second-hand smoke is also harmful. The chemicals absorbed during exposure to smoke <a href="https://pubmed.ncbi.nlm.nih.gov/30426163/">increase the absorption of harmful sunlight by the retina by 1,000 times</a>.</p>
<p>For Jacques’ son, the risk of developing AMD is clear but so are his options. He will not be able to change his genes, prevent himself from aging or change his ethnicity or chromosomes. However, he can control the modifiable factors: he can quit smoking, control his weight and stay physically active.</p>
<hr>
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<strong>
À lire aussi :
<a href="https://theconversation.com/glaucoma-visions-silent-killer-113878">Glaucoma: Vision's silent killer</a>
</strong>
</em>
</p>
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<p>Diet can play a preventive role. Reducing fat intake in the diet and ensuring adequate omega-3 consumption (forms of triglyceride, 800 mg DHA/EPA per day) <a href="https://pubmed.ncbi.nlm.nih.gov/18779490/">are important</a>. However, adding vitamins formulated for eye health to the mix is not recommended in Jacques’ case. Vitamins are only effective in treating dry AMD in its middle stages, not for preventing it. However, they are one of the few ways Jacques can reduce the risk of having his other eye affected and losing all his functional vision.</p>
<p>It is imperative for both Jacques and his son to follow the doctor’s recommendations on managing vascular problems (hypertension, cholesterol, diabetes). When poorly controlled, these conditions significantly increase the risk of developing wet AMD.</p>
<p>Remember, macular degeneration is first and foremost a vascular disease: the blood vessels are no longer able to nourish the retinal cells and no longer get rid of their metabolic waste efficiently. As a result, the cells die. New blood vessels develop, but they are fragile and, when they break, flood the retina with fluid.</p>
<p>Finally, both father and son will need to protect themselves from the sun’s harmful rays, either with a transparent filter (UV400) in their regular prescription glasses or by wearing good quality sunglasses when they are outdoors. Their eye care professionals will be able to advise them about this.</p>
<p>Jacques’ spirits are not high, but I have given him some hope that better days lie ahead. He knows he can count on a team of professionals to support him and that he will not be dealing with his condition alone. There is hope. And hope is the first thing that makes it possible to overcome the impacts of any disease.</p><img src="https://counter.theconversation.com/content/160683/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Langis Michaud ne travaille pas, ne conseille pas, ne possède pas de parts, ne reçoit pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'a déclaré aucune autre affiliation que son organisme de recherche.</span></em></p>Age-related macular degeneration (AMD) lives up to its name: Its prevalence increases with age and it is the leading cause of blindness in people over 65 years old.Langis Michaud, Professeur Titulaire. École d'optométrie. Expertise en santé oculaire et usage des lentilles cornéennes spécialisées, Université de MontréalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1550872021-03-11T15:14:08Z2021-03-11T15:14:08ZHow living life on a screen during COVID-19 affects your eyes<figure><img src="https://images.theconversation.com/files/383570/original/file-20210210-13-qukvya.jpg?ixlib=rb-1.1.0&rect=67%2C89%2C4910%2C3218&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">We're spending more and more time on our computers and beginning to notice eye problems. </span> <span class="attribution"><span class="source">(Annie Spratt/Unsplash)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Léa hated 2020. She missed out on a high school graduation ceremony, a class trip to Spain and her graduation dance. She was also deprived of the excitement that came with starting college — the welcome parties, living her first moments of adult life, taking responsibility for her career and life choices — and just having more freedom.</p>
<p>Instead, Léa spent hours staring at her tablet and her computer, whether it was to do online courses, watch a TV show like <em>Pandemic</em> or catch up with her friends. The year ended in a blur — not the blur of an uncertain future, but a very real, tangible blur. Today, whenever she tries to read, work or concentrate for long periods of time, her eyes become watery, strained and hot. She has a migraine headache by the end of the day. That’s what made Léa decide to consult an optometrist for the first time in years.</p>
<p>Prior to 2020, Léa’s vision had seemed perfect, although asymptomatic might actually be a more accurate description. Today she worries about changes and fluctuations in her vision, and wonders what’s causing these problems. She is even mulling over the idea of launching a class action lawsuit, <a href="https://www.ubyssey.ca/science/covid-computer-vision-syndrome/">realizing that she is not the only one whose vision is suddenly deteriorating</a>. Some authors <a href="https://dx.doi.org/10.4103%2Fijo.IJO_1782_20">are calling this a public health issue</a>. Even Martha Stewart claimed the <a href="https://www.marthastewart.com/7994190/eye-strain-tips-covid-19">pandemic was causing an outbreak of vision problems</a>. </p>
<p>There have always been patients like Léa, but I can confirm that in both my university and private optometry practices there have been more cases like this since the lockdowns started. Is there a cause and effect relationship?</p>
<h2>A syndrome exacerbated by the pandemic</h2>
<p>On the surface, Léa has the symptoms of computer vision syndrome or digital eye strain. Although there are no in-depth studies on this subject, one <a href="https://dx.doi.org/10.1136%2Fbmjophth-2018-000146">interesting article</a> quotes a <a href="https://www.thevisioncouncil.org/content/digital-eye-strain">survey of 10,000 people</a> that found nearly 65 per cent of the population that uses computers or other screens suffer from digital eye strain, and that it affects women, in particular. </p>
<p>A survey like this is based on self-reported symptoms and does not include objective measurements. It asks respondents about eye fatigue, migraine headaches, blurred or fluctuating (momentarily) vision, <a href="https://www.aoa.org/patients-and-public/caring-for-your-vision/protecting-your-vision/computer-vision-syndrome?sso=y">dry eyes, neck and shoulder pain</a>. This type of study suggests associations but does not clearly establish causal links.</p>
<p>To understand why these symptoms have appeared, it is important to understand that when eyes are looking at a computer they are working the same way they would while reading a book or staring at a landscape. Using our eyes more, as we have during the pandemic, often brings out an underlying defect that was already present.</p>
<h2>Poorly adjusted glasses</h2>
<p>For the visual system to work properly, the vision of each eye must be optimal and clear. The images acquired by both eyes (binocular vision) must then be appropriately combined.</p>
<p>For vision to be clear, the eye must be free of optical defects. Any defects must be properly corrected, but this doesn’t always happen. A large proportion of eyeglasses and contact lenses do not make the proper corrections, particularly when wearers have ordered glasses online. One American study concluded that <a href="https://www.optometricsofchatsworth.com/blog/study-finds-safety-and-accuracy-issues-with-glasses-purchased-online">almost half of the glasses ordered online have errors in the prescription</a>. Eyeglasses ordered online <a href="https://www.lapresse.ca/vivre/sante/201508/03/01-4890055-lunettes-dordonnance-risque-lachat-en-ligne.php">are often poorly centred</a>, which can cause symptoms very similar to those described by Léa.</p>
<p>The first thing to do when you notice that long periods looking at screens are causing eye pain, is consult an optometrist, have your vision checked and verify that the proper correction has been made. Eyeglasses wearers are often offered anti-blue light filters. To date, <a href="https://doi.org/10.1371/journal.pone.0169114">these have not been shown to be effective in reducing visual symptoms</a>. </p>
<p>However, they are highly recommended for teenagers because they reduce the negative impact of late night screen exposure <a href="https://doi.org/10.1016/j.jadohealth.2014.08.002">on the circadian rhythm</a>. They <a href="https://doi.org/10.1007/s00204-018-2344-3">may also protect against blue light toxicity in retinal cells, especially for smokers</a>. Limiting teenagers’ screen use to two hours before sleep is one of the best things you can do, <a href="https://doi.org/10.1016/j.smrv.2014.07.007">although this can be difficult to do</a>!</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/375460/original/file-20201216-21-1o8d8io.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/375460/original/file-20201216-21-1o8d8io.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/375460/original/file-20201216-21-1o8d8io.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/375460/original/file-20201216-21-1o8d8io.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/375460/original/file-20201216-21-1o8d8io.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/375460/original/file-20201216-21-1o8d8io.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/375460/original/file-20201216-21-1o8d8io.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Filters are recommended to reduce the negative impact of nighttime screen exposure on the circadian rhythm. However, limiting the use of screens two hours before sleep is the best choice.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Convergence insufficiency</h2>
<p>It’s also important to test how eyes work together. Generally speaking, your eyes converge more when you are reading since you look more towards your nose. This is a natural, normal movement. However, <a href="https://www.ncbi.nlm.nih.gov/books/NBK554390/">one person in five or six has convergence insufficiency</a>. Those affected by this problem have difficulty maintaining functional and comfortable vision at a normal reading distance (33-40 centimetres). Smart phones and tablets are viewed at an average distance of 18 centimetres. So there’s a problem!</p>
<p>The change in distance makes the visual system work much harder, <a href="https://doi.org/10.1111/cxo.12851">especially since screens are small and poorly lit</a>. A jogger who easily runs five kilometres in the morning will not necessarily be able to run a 42-kilometre marathon, without additional training. In the same way, eyes that converge properly at a longer distance may not at a shorter distance, especially when this extra effort is maintained for long periods.</p>
<p>Optometrists can use a series of tests to evaluate binocular vision, then propose exercise therapy (orthoptic or motor) if necessary. Training the muscles of the eye for a few weeks also makes it possible to optimize the integration of images in the brain, and therefore perception. That, in turn, makes the whole oculo-visual system more efficient.</p>
<p>The optometrist will also recommend keeping tablets, computers or telephones at a proper distance while reading them, generally, 33-40 centimetres for adults. For children, the distance should be the length of the forearm. The optometrist should also discuss the device’s lighting (using filters to reduce brightness and short wavelengths) and talk about ambient lighting (avoid cool LEDs and use fluorescent lights or warm LEDs). Here again, <a href="https://doi.org/10.1111/cxo.12851">short wavelengths (blue) should be minimized</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/375459/original/file-20201216-15-l4ta7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/375459/original/file-20201216-15-l4ta7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/375459/original/file-20201216-15-l4ta7s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/375459/original/file-20201216-15-l4ta7s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/375459/original/file-20201216-15-l4ta7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/375459/original/file-20201216-15-l4ta7s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/375459/original/file-20201216-15-l4ta7s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">After careful assessment, an optometrist can prescribe oculo-motor training (orthoptics) and make recommendation about lighting and reading distance when doing computer work.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Screen, blinking and dry eyes</h2>
<p>Another important thing to consider is the relative dryness of the eye while viewing a screen. <a href="https://doi.org/10.1016/j.exer.2020.108115">Tears cover the eye to protect, nourish and keep it moist</a>. They also ensure that the ocular surface remains uniform, which guarantees better vision. Tears are a refractive surface, <a href="https://doi.org/10.1136/bjophthalmol-2018-312333">which influences the patient’s vision</a>, so an unstable or rapidly evaporating tear film automatically leads to impaired vision.</p>
<p>However, when we work on a screen, <a href="https://doi.org/10.3109/02713683.2010.544442">our blink rate is significantly reduced (three times less)</a>. The tear film does not renew itself regularly, but evaporates and the eye dries. This chronic dryness leads to vision that fluctuates between clear (wet eye) and blurred (dry eye) periods. In contrast to dry eye syndrome, this type of dryness causes less discomfort (it may feel like there’s sand in the eyes) but can generate redness and warmth. Indeed, <a href="https://www.em-consulte.com/em/SFO/2015/html/file_100015.html">any dryness is likely to cause inflammation</a>.</p>
<p>The intuitive approach to treating this condition would be to add artificial tears to the eyes, but this may only have a short-term effect. Restoring a normal blinking rhythm (15 times per minute) is a better alternative. <a href="http://eyedoc2020.blogspot.com/2017/03/best-apps-to-remind-you-to-blink-your.html">There are now apps that remind you to blink</a>. In more severe cases, the optometrist may prescribe treatments such as massage and applying warm compresses to the eyelids, or prescribe medication to reduce inflammation.</p>
<h2>Go play outside!</h2>
<p>Léa’s examination revealed an “accommodative spasm” (uncorrected hyperopia, linked to a spasm of the internal muscle that allows the eye to focus close-up) and a slight lack of convergence. These defects in her vision will be corrected with glasses for reading or working on a screen and, if necessary, some exercises. I also gave her ergonomic advice on staying the correct distance from her screen, telephones and so on; told her how to illuminate her environment and adjust the screen brightness and suggested she take frequent breaks and blink often. </p>
<p>I also reassured her that her problem is not her computer, but that she uses it too much, given her underlying visual condition, which was probably present before, but not detected.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/375472/original/file-20201216-21-12y9g4q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/375472/original/file-20201216-21-12y9g4q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=407&fit=crop&dpr=1 600w, https://images.theconversation.com/files/375472/original/file-20201216-21-12y9g4q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=407&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/375472/original/file-20201216-21-12y9g4q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=407&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/375472/original/file-20201216-21-12y9g4q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=511&fit=crop&dpr=1 754w, https://images.theconversation.com/files/375472/original/file-20201216-21-12y9g4q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=511&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/375472/original/file-20201216-21-12y9g4q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=511&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">No exposure to any screen before the age of two is recommended, especially not within 10 centimetres of the face.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>As I walked her back to reception, I noticed that my next patient was waiting with her 18-month-old daughter who was staring at a smartphone held 10 centimetres from her nose. Yes, another parent who needs to be reminded <a href="https://www.npr.org/sections/ed/2016/10/21/498550475/american-academy-of-pediatrics-lifts-no-screens-under-2-rule">that exposure to any screen before the age of two is ill-advised</a>, except for short video chats with grandparents, and only under supervision.</p>
<p>Go outside to play and have fun with your child the old fashioned way. Their eyes will thank you for it! Make the choice to live your life on that big screen called nature instead of on that small one in your living room!</p><img src="https://counter.theconversation.com/content/155087/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Langis Michaud ne travaille pas, ne conseille pas, ne possède pas de parts, ne reçoit pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'a déclaré aucune autre affiliation que son organisme de recherche.</span></em></p>Staring at screens for long periods of time — as we are during the pandemic — can reveal previously undiagnosed eye problems.Langis Michaud, Professeur Titulaire. École d'optométrie. Expertise en santé oculaire et usage des lentilles cornéennes spécialisées, Université de MontréalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1558632021-03-07T14:36:27Z2021-03-07T14:36:27ZWhy you shouldn’t neglect eye care during the COVID-19 pandemic<figure><img src="https://images.theconversation.com/files/387366/original/file-20210302-15-11edc9e.jpg?ixlib=rb-1.1.0&rect=20%2C20%2C2294%2C1535&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">One-third of adults report deriorating eyesight since the pandemic began.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/aVvZJC0ynBQ">(Unsplash/David Travis)</a></span></figcaption></figure><p>Since COVID-19 emerged, access to eye care has continued to change. Lockdowns and concerns about virus exposure have caused people of all ages to cancel and delay routine appointments, raising red flags among eye-care professionals. As the pandemic continues into its second year, can ocular health be neglected any longer?</p>
<p>Our team of optometrists and clinical scientists at the <a href="https://core.uwaterloo.ca/">Centre for Ocular Research & Education</a> (CORE) hear the confusion and concerns about people’s eyes during COVID-19. Addressing the most common questions — many of which we keep up to date at <a href="https://covideyefacts.org/">COVIDeyefacts.org</a> — can help you and your family maintain the best vision while staying safe.</p>
<h2>Can I set aside my eye health?</h2>
<p>A survey commissioned by <a href="https://www.fightforsight.org.uk">Fight for Sight</a>, a charity in the United Kingdom devoted to eye research, reveals that <a href="https://www.fightforsight.org.uk/news-and-articles/articles/news/screen-time/">one in five adults in the U.K.</a> are less likely to visit an eye doctor during the pandemic. This is despite finding that one-third of adults have reported deteriorating eyesight since the pandemic began.</p>
<p>Thousands of patients who previously sought regular treatment for chronic, sight-threatening eye conditions are <a href="https://www.bbc.com/news/health-52968845">missing vital appointments</a> that help to preserve their vision. </p>
<p><a href="https://doi.org/10.2147/OPTH.S267950">Ophthalmologists report</a> that patients with retinal conditions such as macular degeneration and diabetic retinopathy are skipping hospital appointments for sight-preserving injections, which often leads to <a href="https://doi.org/10.2147/OPTH.S296345">devastating consequences such as disease progression</a>, giving rise to significant <a href="https://doi.org/10.1016/j.oret.2020.12.020">vision loss</a>.</p>
<h2>What eye conditions cannot wait?</h2>
<p>Putting aside COVID-19 concerns, there are seven reasons to urgently call your eye doctor, no matter the age of the patient:</p>
<ul>
<li><p>Eye injury</p></li>
<li><p>Eye pain</p></li>
<li><p>If you notice new floaters or flashes of light</p></li>
<li><p>Red eye</p></li>
<li><p>A sudden change in vision</p></li>
<li><p>Blank or wavy spots</p></li>
<li><p>Refills for prescription drops</p></li>
</ul>
<p>Delaying care in these situations may result in poor outcomes, including vision loss. Some clinics offer telephone consultations to triage care and discuss options. When in doubt, call.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/387361/original/file-20210302-13-cuw69r.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Infographic summarizing 7 reasons to urgently contact your eye doctor" src="https://images.theconversation.com/files/387361/original/file-20210302-13-cuw69r.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/387361/original/file-20210302-13-cuw69r.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/387361/original/file-20210302-13-cuw69r.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/387361/original/file-20210302-13-cuw69r.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/387361/original/file-20210302-13-cuw69r.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/387361/original/file-20210302-13-cuw69r.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/387361/original/file-20210302-13-cuw69r.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Infographic summarizing seven reasons to urgently contact your eye doctor.</span>
<span class="attribution"><span class="source">(Alison Ng/CORE, University of Waterloo)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Have eye exams changed?</h2>
<p>As with every aspect of our lives, significant modifications have been made to the way eye-care professionals and clinics are operating, putting safety first. You will see spaced appointments and physical distancing, staff and doctors using protective equipment, modifications to some tests, accommodations for ventilation and more — with the same commitment to patient health.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/387362/original/file-20210302-13-1pntb0y.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Infographic summarizing 7 key things to expect when getting an eye exam during the COVID-19 pandemic" src="https://images.theconversation.com/files/387362/original/file-20210302-13-1pntb0y.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/387362/original/file-20210302-13-1pntb0y.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1500&fit=crop&dpr=1 600w, https://images.theconversation.com/files/387362/original/file-20210302-13-1pntb0y.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1500&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/387362/original/file-20210302-13-1pntb0y.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1500&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/387362/original/file-20210302-13-1pntb0y.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1885&fit=crop&dpr=1 754w, https://images.theconversation.com/files/387362/original/file-20210302-13-1pntb0y.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1885&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/387362/original/file-20210302-13-1pntb0y.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1885&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Eye care professionals have put safety measures in place to help prevent the spread of COVID-19. Here’s what to expect at an eye exam during the pandemic.</span>
<span class="attribution"><span class="source">(Alison Ng/CORE, University of Waterloo)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Do I really need to have an exam?</h2>
<p>When your eye doctor is shining those bright lights into your eyes, they are checking for signs that might point to painless and progressive diseases that may not be apparent.</p>
<p>For example, glaucoma affects the optic nerve, causing gradual irreversible vision loss. It is the <a href="https://www.glaucoma.org/glaucoma/glaucoma-facts-and-stats.php">leading cause of irreversible blindness</a> globally and more than 80 per cent of those affected experience silent vision loss. Often, patients with glaucoma fail to notice any symptoms until 40 per cent of nerve damage has occurred. Early detection and timely treatment limits further damage.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/387364/original/file-20210302-23-j5i7xy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Eye doctor wearing a face mask, goggles and gloves, performing an eye exam with a patient." src="https://images.theconversation.com/files/387364/original/file-20210302-23-j5i7xy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/387364/original/file-20210302-23-j5i7xy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/387364/original/file-20210302-23-j5i7xy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/387364/original/file-20210302-23-j5i7xy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/387364/original/file-20210302-23-j5i7xy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/387364/original/file-20210302-23-j5i7xy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/387364/original/file-20210302-23-j5i7xy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An eye doctor examining the eyes of a patient. The eye doctor is wearing personal protective equipment including a face mask, goggles and gloves. There is a plastic breath shield between the eye doctor and the patient, and the patient is also wearing a face mask.</span>
<span class="attribution"><span class="source">(CORE, University of Waterloo)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Can I trust online sources for care information?</h2>
<p>Let’s say you wake up with red eyes. Dr. Google will likely tell you that you have conjunctivitis, or pink eye — a simple eye infection that disappears without consequences. However, increased eye redness is not only caused by pink eye. This is referred to as a “differential diagnosis” or “what else could this be?”</p>
<p>For example, inflammation of the iris also presents as a red eye. Without timely treatment involving prescription eye drops, this condition progresses to worsening pain, light sensitivity, blurred vision and can lead to cataracts, glaucoma or permanent vision loss. The only way to confirm the cause of an eye problem and get appropriate treatment is to see an eye care professional.</p>
<h2>What about the kids?</h2>
<p>With estimates that <a href="https://doi.org/10.1016/j.ophtha.2016.01.006">half of the world’s population will be myopic (nearsighted) by 2050</a> and the time that <a href="https://www.nytimes.com/2021/01/16/health/covid-kids-tech-use.html">kids spend on screens skyrocketing</a>, the <a href="https://www.thestar.com/local-brampton/news/2021/01/18/learning-at-home-parents-optometrists-concerned-about-long-lasting-effects-of-increased-screen-time.html">impact on their vision</a> might be around <a href="https://doi.org/10.1001/jamaophthalmol.2020.6239">long after this pandemic is over</a>. </p>
<p><a href="https://doi.org/10.1038/s41433-018-0015-5">A CORE study found</a> almost one-third of Canadian school children aged 11 to 13 were myopic, and 35 per cent of myopic children did not have glasses or contact lenses to help them see better. Some children simply do not know they have an eye problem, because they assume that everyone sees the same.</p>
<h2>Is it safe to get an eye exam?</h2>
<p>Every effort is being made to ensure that staff, doctors and patients are kept safe. Clinic personnel are expected to stay home and isolate if they have symptoms of COVID-19 in the same way that patients are. </p>
<p>In a time of continued uncertainty, one thing remains clear: your vision is important and you can take steps to keep it that way, even during a pandemic.</p><img src="https://counter.theconversation.com/content/155863/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Over the past 3 years, Alison Ng and the research group (CORE) has received research support or lectureship honoraria from Alcon, Allergan, Allied Innovations, Aurinia Pharma, BHVI, CooperVision, GL Chemtec, i-Med Pharma, Johnson & Johnson Vision, Lubris, Menicon , Nature’s Way, Novartis, Ophtecs, Oté Pharma, PS Therapy, Santen, Shire, SightGlass, SightSage and Visioneering. She is also a Tear Film and Ocular Surface Society (TFOS) Ambassador for Canada. </span></em></p><p class="fine-print"><em><span>Over the past 3 years, Mike Yang and the research group (CORE) has received research support or lectureship honoraria from Alcon, Allergan, Allied Innovations, Aurinia Pharma, BHVI, CooperVision, GL Chemtec, i-Med Pharma, Johnson & Johnson Vision, Lubris, Menicon , Nature’s Way, Novartis, Ophtecs, Oté Pharma, PS Therapy, Santen, Shire, SightGlass, SightSage and Visioneering.</span></em></p>The COVID-19 pandemic has caused people of all ages to cancel or delay routine eye care, raising red flags among eye care professionals.Alison Ng, Clinical Scientist at the Centre for Ocular Research & Education (CORE), University of WaterlooMike Yang, Clinical Scientist at Centre for Ocular Research & Education, University of WaterlooLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1320862020-10-08T00:57:37Z2020-10-08T00:57:37ZWe could be doing more to prevent vision loss for people with diabetes<figure><img src="https://images.theconversation.com/files/362307/original/file-20201008-18-zimff8.jpg?ixlib=rb-1.1.0&rect=0%2C17%2C5751%2C3707&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Diabetes-related vision loss is the leading cause of blindness for <a href="https://www.diabetesaustralia.com.au/what-is-diabetes">working-aged Australians</a>. Yet it’s almost entirely preventable. </p>
<p>A recent <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/ceo.13830">Australian study</a> found only half of people with diabetes get the <a href="https://www.sydney.edu.au/news-opinion/news/2020/10/01/living-with-diabetes-get-your-eyes-checked-.html?tc=edm%7Cnews-opinion-stream-brnd%7Cuniversity%7C%7C">recommended annual eye checks</a>.</p>
<p>We could be doing things better.</p>
<h2>One of many complications</h2>
<p>Around <a href="https://www.diabetesaustralia.com.au/about-diabetes">1.7 million Australians</a> have diabetes. Aboriginal and Torres Strait Islander people are <a href="https://healthinfonet.ecu.edu.au/healthinfonet/getContent.php?linkid=590810&title=Review+of+diabetes+among+Aboriginal+and+Torres+Strait+Islander+people">three times</a> more likely to develop diabetes than non-Indigenous Australians.</p>
<p>Diabetes occurs when glucose (sugar) in your blood is not converted into energy, so its level becomes too high. Blood glucose is our main source of energy and mostly comes from the food we eat.</p>
<p>Diabetes can be managed, for example through lifestyle modifications, medication, or insulin. <a href="https://www.diabetesaustralia.com.au/living-with-diabetes/managing-your-diabetes/">Diabetes management</a> will be <a href="https://www.tandfonline.com/doi/abs/10.1080/24735132.2020.1771926?journalCode=rfdh20">a different experience</a> for each person, and depend on the type of diabetes they have.</p>
<p>But the central aim is keeping blood sugar levels within a healthy range. When they’re not, people with diabetes are at higher risk of complications, which can affect <a href="https://www.diabetesaustralia.com.au/preventing-complications">all parts of the body</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-disease-that-breeds-disease-why-is-type-2-diabetes-linked-to-increased-risk-of-cancer-and-dementia-139298">A disease that breeds disease: why is type 2 diabetes linked to increased risk of cancer and dementia?</a>
</strong>
</em>
</p>
<hr>
<p>The most common complication of diabetes — <a href="https://www.iapb.org/wp-content/uploads/Global-Guideline-for-Type-2-Diabetes-IDF-2012.pdf">globally</a> and for <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-12-8/tables/4">Australians</a> — is eye disease.</p>
<p>Diabetes-related eye disease affects <a href="https://www.idf.org/component/attachments/attachments.html?id=396&task=download">more than one in three</a> people with diabetes. When left undiagnosed and untreated, it can cause vision loss and blindness.</p>
<h2>What causes it?</h2>
<p>Diabetes-related eye disease can occur when there is damage to the blood vessels on the retina, a thin layer at the back of the eye. This damage limits oxygen and other nutrients reaching <a href="https://www.visionaustralia.org/sites/default/files/docs/default-source/eye-health/Fact-sheets/diabetic-retinopathy-factsheet_v3_web-(accessible).pdf?sfvrsn=0">the eye</a>. </p>
<p>We need a <a href="https://www.opticalmasters.com/healthy-retina-important/">healthy retina</a> to be able to see.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/362070/original/file-20201007-24-115p1by.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/362070/original/file-20201007-24-115p1by.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=409&fit=crop&dpr=1 600w, https://images.theconversation.com/files/362070/original/file-20201007-24-115p1by.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=409&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/362070/original/file-20201007-24-115p1by.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=409&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/362070/original/file-20201007-24-115p1by.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=514&fit=crop&dpr=1 754w, https://images.theconversation.com/files/362070/original/file-20201007-24-115p1by.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=514&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/362070/original/file-20201007-24-115p1by.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=514&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Diabetes-related eye disease can occur when the blood vessels at the back of the eye become damaged.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>The chance of developing diabetes-related eye disease is <a href="https://www.ncbi.nlm.nih.gov/pubmed/22301125">higher for some people</a>, including those who have high blood pressure, high cholesterol, or who have had diabetes for many years.</p>
<p>Worryingly, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/ceo.13830">the study</a> we mentioned above found people who had been living with diabetes for ten or more years were even less likely to get regular eye checks. Almost 80% of people in this group didn’t have the recommended annual eye check.</p>
<h2>Prevention and treatment</h2>
<p>When diabetes-related eye disease becomes more advanced, it can cause <a href="https://www.visionaustralia.org/sites/default/files/docs/default-source/eye-health/Fact-sheets/diabetic-retinopathy-factsheet_v3_web-(accessible).pdf?sfvrsn=0">blurred or distorted vision</a> and blindness. But we can prevent most diabetes-related vision loss before it reaches this stage. </p>
<p>Special cameras allow us to look at the retina and see if irregular spots or blood vessels are developing. </p>
<p>At this early stage the disease has no impact on a person’s vision. Once we detect it, we can provide timely treatment with laser therapy or injections. </p>
<p>But without regular eye checks, we might not know until it’s too late.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-australians-die-cause-5-diabetes-57874">How Australians Die: cause #5 – diabetes</a>
</strong>
</em>
</p>
<hr>
<h2>We have made progress</h2>
<p>Strong social impact work from the government, not-for-profits and local health services is already preventing diabetes-related eye disease from developing into vision loss and blindness in many people.</p>
<p>2020 Australian of the Year, ophthalmologist James Muecke, cofounded the not-for-profit <a href="https://sightforall.org/">Sight For All</a> and has brought attention to the issue of <a href="https://www.optometry.org.au/sector_news/eye-surgeon-james-muecke-is-australian-of-the-year-for-2020/">preventable vision loss</a> for people with diabetes.</p>
<p>The federal government is investing in a <a href="https://www.keepsight.org.au/about">national diabetes eye screening program</a>, as well as <a href="http://www.vision2020australia.org.au/news/2018-08-01/good-news-continues-for-indigenous-eye-health-with-program-extension">primary health-care technology and training</a> to embed retinal care in 105 existing health services across Australia. But national programs can put a blanket solution over the population. </p>
<p>When one Aboriginal and Torres Strait Islander <a href="https://www.publish.csiro.au/py/py18030">health-care service</a> introduced cameras in 2008, they screened <a href="https://www.ncbi.nlm.nih.gov/pubmed/20618289">93% of regular clients with diabetes</a> for eye disease — a significant improvement on 16% the previous year. But we found these rates subsequently declined and by 2016, only 22% had an eye check. </p>
<p>We can see just having the technology in primary care is not enough. Ongoing quality improvement is integral to a successful service in the long term.</p>
<figure class="align-center ">
<img alt="A woman checks her blood sugar level." src="https://images.theconversation.com/files/362130/original/file-20201007-16-1x9mvps.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/362130/original/file-20201007-16-1x9mvps.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/362130/original/file-20201007-16-1x9mvps.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/362130/original/file-20201007-16-1x9mvps.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/362130/original/file-20201007-16-1x9mvps.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/362130/original/file-20201007-16-1x9mvps.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/362130/original/file-20201007-16-1x9mvps.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">About 1.7 million Australians have diabetes.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>What else can we do?</h2>
<p>In the case of diabetes-related eye disease, the science supporting early detection is advancing every day. But it’s not reaching those who need it the most, including Aboriginal and Torres Strait Islander people.</p>
<p>Having the technology, policy or medicine alone is not sufficient. We need to unlock the potential of communities, empowering everyone to have joint responsibility.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/words-from-arnhem-land-aboriginal-health-messages-need-to-be-made-with-us-rather-than-for-us-100655">Words from Arnhem land: Aboriginal health messages need to be made with us rather than for us</a>
</strong>
</em>
</p>
<hr>
<p>A model of <a href="https://eprints.qut.edu.au/201836/">person-centred eye care</a> would involve:</p>
<ul>
<li><p>making screening and treatment easy to access for people with diabetes. This means addressing physical barriers, such as distance and cost, but also cultural, emotional and social barriers that might stop people from getting their eyes checked</p></li>
<li><p>thinking about the screening experience, including:</p>
<ul>
<li><strong>before</strong>: how will we motivate people to get their eyes checked, especially if they’re not experiencing any problems with their vision?</li>
<li><strong>during</strong>: how can eye checks be streamlined with regular diabetes care, and how can we make the process as seamless as possible for patients?</li>
<li><strong>after</strong>: how do we ensure they come back every year?</li>
</ul></li>
<li><p>considering the experience of the diverse teams providing this care, including keeping staff well equipped, trained and motivated</p></li>
<li><p>investing in researching, developing and testing the non-medical components of eye care services. For example, the reminder system, the workflow of each eye check, and how the results are delivered to patients.</p></li>
</ul>
<p>We must pursue <a href="https://www.publish.csiro.au/py/PY18030">ongoing improvement</a> of eye care that involves and empowers people with diabetes, their health teams and communities to develop services, systems, new technology and policies that meet their needs.</p>
<p>There is potential for us to prevent blindness in more people with diabetes.</p><img src="https://counter.theconversation.com/content/132086/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Clare Villalba receives funding from the Australian Federal Government and the Queensland University of Technology. She previously worked for the Queensland University of Technology. </span></em></p><p class="fine-print"><em><span>Dr Anjali Jaiprakash is a co-founder of Integral Scopes Pty Ltd, an Australian start-up company developing retinal imaging technology.</span></em></p><p class="fine-print"><em><span>Anthony Russell is affiliated with the Australian Diabetes Society. </span></em></p>Diabetes-related eye disease affects more than one in three people with diabetes. But it doesn’t have to turn into vision loss and blindness.Clare Villalba, Service Designer and Researcher (PhD), Queensland University of TechnologyAnjali Jaiprakash, Senior Research Fellow and Deputy Director, Centre for Biomedical Technologies, Queensland University of TechnologyAnthony Russell, Associate Professor, Faculty of Medicine, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1432612020-08-19T16:00:32Z2020-08-19T16:00:32ZWhy face masks can make eyes feel dry, and what you can do about it<figure><img src="https://images.theconversation.com/files/353655/original/file-20200819-25336-1r3mhc4.jpg?ixlib=rb-1.1.0&rect=0%2C226%2C3680%2C2760&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Face masks may increase the risk of dry, irritated eyes.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Face masks help <a href="https://doi.org/10.1016/S0140-6736(20)31142-9">reduce coronavirus transmission</a>, which has prompted mandates and <a href="https://www.healio.com/news/primary-care/20200807/ama-campaign-urges-americans-to-wear-face-masks">expert recommendations</a> for their use where social distancing is difficult. As the world emerges from shutdowns, wearing face masks for extended periods of time in settings such as offices will increase. </p>
<p>While these protective measures are essential to combating COVID-19’s spread, a new phenomenon is emerging: <a href="https://link.springer.com/article/10.1007%2Fs00417-020-04808-3">increasing reports of dry, uncomfortable eyes</a>. What is the science behind this trend, who is at risk and is there a solution? </p>
<p>Dry eye has become much better understood in recent years, thanks to colleagues from the <a href="http://core.uwaterloo.ca">Centre for Ocular Research & Education (CORE)</a> at the University of Waterloo, the <a href="https://www.tearfilm.org/">Tear Film and Ocular Surface Society</a> and other researchers around the world. That knowledge provides a head start on deciphering this latest wrinkle.</p>
<h2>Making sense of MADE: Mask-associated dry eye</h2>
<p>The term mask-associated dry eye (MADE) <a href="https://www.healio.com/news/ophthalmology/20200622/blog-a-new-coronavirusassociated-eye-disease">was first described</a> by an ophthalmologist in June based on increasing incidents in his office. Additional reports have since circulated, and a <a href="https://doi.org/10.1007/s40123-020-00282-6">recent review</a> further examined the issue.</p>
<p>People with existing dry eye disease report worsening symptoms — a problematic occurrence for the <a href="https://www.reviewofcontactlenses.com/article/rccl0218-the-global-burden-of-dry-eye">tens of millions of people worldwide</a> who already struggle with the issue. Concurrently, previously asymptomatic patients are flagging uncomfortable eyes and variable vision for the first time, particularly when reading or using digital devices for a long period of time.</p>
<h2>Our tear film’s delicate balance</h2>
<p>When addressing MADE, it is helpful to understand our tear film, the liquid layer that coats the eye’s surface. This tiny volume of fluid, equivalent to one-tenth of a single water drop, has a highly <a href="https://doi.org/10.1016/j.jtos.2017.03.006">complex structure and composition</a>. It lubricates the surface of the eye, allowing smooth and comfortable passage of the eyelid during every blink. Ongoing <a href="https://www.tfosdewsreport.org/report-definition_and_classification/48_36/en/">imbalance in the tear film</a> leads to dry eye disease. </p>
<p>Eyes feel sore, dry and irritated, and may water and look red.</p>
<figure class="align-center ">
<img alt="Close-up of a very bloodshot blue eye" src="https://images.theconversation.com/files/352592/original/file-20200812-16-1wkkhu7.jpeg?ixlib=rb-1.1.0&rect=372%2C573%2C6045%2C3470&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/352592/original/file-20200812-16-1wkkhu7.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/352592/original/file-20200812-16-1wkkhu7.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/352592/original/file-20200812-16-1wkkhu7.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/352592/original/file-20200812-16-1wkkhu7.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/352592/original/file-20200812-16-1wkkhu7.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/352592/original/file-20200812-16-1wkkhu7.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A sore, irritated, uncomfortable dry eye.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>There are <a href="https://doi.org/10.1016/j.jtos.2017.05.003">many causes of dry eye disease</a>, including issues relating to eye and systemic health conditions, age, gender or medications. <a href="https://doi.org/10.1111/cxo.12851">Excessive use of digital devices</a>, <a href="https://doi.org/10.1016/j.ijheh.2018.01.015">poor indoor air quality</a> and <a href="https://doi.org/10.1016/j.jtos.2018.03.001">pollution</a> all result in symptoms. Situations that increase how quickly the tear film evaporates, such as <a href="https://doi.org/10.1097/OPX.0000000000001086">air-conditioned offices</a> or automobile air-blowers, can quickly and significantly dry the eye’s surface, leading to more pronounced symptoms.</p>
<h2>Masks, airflow and evaporation</h2>
<p>Face masks <a href="https://www.insightnews.com.au/cough-simulation-shows-protective-effect-of-breath-shield/">significantly reduce the spread of air outwards from the mouth and nose</a>. However, exhaled air still needs to disperse; when a mask sits loosely against the face <a href="https://link.springer.com/article/10.1007/s40123-020-00282-6">the likely route is upwards</a>. This <a href="https://www.notadryeye.org/blog-posts/how-to-wear-a-face-mask-when-you-have-dry-eye/">forces a stream of air</a> over the surface of the eye, creating conditions that accelerate the <a href="https://doi.org/10.1155/2012/983182">evaporation of the tear film</a>, like a steady breeze blowing over damp skin.</p>
<p>People who wear glasses are well aware of this, shown by the annoying <a href="https://augustafreepress.com/ways-to-avoid-fogging-up-your-glasses-when-wearing-a-mask/">lens fogging</a> that often occurs when breathing under a mask.</p>
<figure class="align-right ">
<img alt="A woman wearing a face mask and eyeglasses with fogged-up lenses" src="https://images.theconversation.com/files/352594/original/file-20200812-24-4gtz0f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/352594/original/file-20200812-24-4gtz0f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/352594/original/file-20200812-24-4gtz0f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/352594/original/file-20200812-24-4gtz0f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/352594/original/file-20200812-24-4gtz0f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/352594/original/file-20200812-24-4gtz0f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/352594/original/file-20200812-24-4gtz0f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Annoying, fogged-up spectacles due to a poor fitting mask.</span>
<span class="attribution"><span class="source">(Chau-Minh Phan/CORE, University of Waterloo)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>When masks are worn for extended periods, this repeated evaporation may lead to <a href="https://doi.org/10.1007/s40123-020-00282-6">dry spots on the ocular surface</a>.</p>
<p>Similar effects have been reported with <a href="https://doi.org/10.1177%2F0003489414525924">continuous positive airway pressure (CPAP)</a> masks that are used to treat sleep apnea. Eye dryness may also result when <a href="https://doi.org/10.1007/s40123-020-00282-6">face masks are taped</a> to seal the top edge, if that interferes with the eyelids’ natural movement, preventing full blinks. <a href="https://doi.org/10.1016/j.jtos.2018.06.001">Incomplete blinking can cause the tear film to become less stable</a>. </p>
<h2>Who may be affected?</h2>
<p>In addition to those with pre-existing dry eye disease, the general mask-wearing population may find themselves wondering why their eyes are inexplicably irritated. <a href="https://doi.org/10.1016/S1542-0124(12)70177-5">This includes the elderly, who naturally have less efficient tears</a>. </p>
<p>An extensive review demonstrated that <a href="https://doi.org/10.1016/j.clae.2020.03.012">wearing contact lenses does not raise the risk</a> of contracting COVID-19, as long as people follow <a href="https://core.uwaterloo.ca/covid-19/">good hygiene and cleaning measures</a>. However, <a href="https://doi.org/10.1167/iovs.13-13235">a contact lens can disturb the tear film</a>, potentially making wearers more MADE-susceptible if exhaled air further impacts tear film stability.</p>
<p>Prolonged use of face masks in air-conditioned locations may also trigger MADE. So too could increased digital device use while wearing masks — <a href="https://www.nytimes.com/interactive/2020/04/07/technology/coronavirus-internet-use.html">a rising trend during the pandemic</a>. </p>
<p>Beyond discomfort, MADE presents another risk: it may encourage people to rub their face and eyes for temporary relief. Coronavirus transmission is possible via the <a href="https://doi.org/10.1111/cxo.13088">mouth and nose, and, to a lesser extent, potentially the eyes</a>. Bringing unwashed hands near the face may increase the likelihood of infection. That is an additional reason to tackle MADE.</p>
<h2>Alleviating MADE</h2>
<p>Several simple measures can help reduce the drying effects of upward air flow from masks. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/353729/original/file-20200819-42876-vmugkt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/353729/original/file-20200819-42876-vmugkt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/353729/original/file-20200819-42876-vmugkt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/353729/original/file-20200819-42876-vmugkt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/353729/original/file-20200819-42876-vmugkt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/353729/original/file-20200819-42876-vmugkt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/353729/original/file-20200819-42876-vmugkt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/353729/original/file-20200819-42876-vmugkt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Mask Associated Dry Eye (MADE): Why does it happen and what can you do?</span>
<span class="attribution"><span class="source">(Karen Walsh, CORE, University of Waterloo)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>As with any new eye-related concern, first check with an eye care practitioner for advice and to rule out other causes.</p>
<p>Second, ensure that a mask is <a href="https://www.bbc.com/news/uk-53395513">worn appropriately</a>, particularly <a href="https://leamingtonobserver.co.uk/lifestyle/optometrists-advise-how-to-wear-glasses-with-face-masks-to-prevent-fogging-21667/">when wearing spectacles and sunglasses</a>. A close-fitted mask, or carefully taped top edge that does not interfere with blinking, may help direct air flow downwards. This helps <a href="https://augustafreepress.com/ways-to-avoid-fogging-up-your-glasses-when-wearing-a-mask/">prevent lenses from steaming</a> and reduces MADE. </p>
<figure class="align-right ">
<img alt="Woman wearing a face mask and eyeglasses" src="https://images.theconversation.com/files/352595/original/file-20200812-16-jalxss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/352595/original/file-20200812-16-jalxss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/352595/original/file-20200812-16-jalxss.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/352595/original/file-20200812-16-jalxss.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/352595/original/file-20200812-16-jalxss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/352595/original/file-20200812-16-jalxss.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/352595/original/file-20200812-16-jalxss.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Clear spectacles with a well fitting mask.</span>
<span class="attribution"><span class="source">(Chau-Minh Phan/CORE, University of Waterloo)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p><a href="https://doi.org/10.1016/j.jtos.2017.05.006">Lubricating drops</a> may help with comfort. Eye care practitioners can recommend the best type, based on medical history and circumstances.</p>
<p>Limit time in air-conditioned or windy environments when wearing masks, and take regular breaks from digital devices.</p>
<h2>Don’t ditch the mask</h2>
<p>Is wearing a mask worth it, when you may have to possibly contend with MADE? Absolutely! Masks are here for the foreseeable future. Along with social distancing and hygiene measures, they represent a crucial part of our defence against the spread of COVID-19.</p>
<p>The good news is that we understand why MADE occurs and can address it. Remaining alert and following a few simple steps can help increase eye comfort and promote good mask wear, and with it, we move further along in overcoming the global pandemic.</p><img src="https://counter.theconversation.com/content/143261/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Over the past 3 years, Lyndon Jones or his research group (CORE) has received research support or lectureship honoraria from Alcon, Allergan, CooperVision, GL Chemtec, iMed Pharma, J&J Vision, Lubris, Menicon, Nature’s Way, Novartis, Ote, PS Therapy, Safilens, Santen, Shire, SightGlass and Visioneering. He is also a consultant and/or serves on an advisory board for Alcon, CooperVision, J&J Vision, Novartis and Ophtecs.
</span></em></p>Face masks may help prevent the spread of COVID-19, but they may also contribute to dry, irritated eyes. Learn who is at risk, and how to prevent mask-associated dry eye (MADE).Lyndon Jones, Professor, School of Optometry & Vision Science, University of WaterlooLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1411172020-08-07T01:20:30Z2020-08-07T01:20:30ZHow to keep your contact lenses clean (and what can go wrong if you don’t)<figure><img src="https://images.theconversation.com/files/350537/original/file-20200731-21-1q06g7d.jpg?ixlib=rb-1.1.0&rect=4%2C5%2C994%2C660&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/contact-lens-on-female-finger-close-526301095">Shutterstock</a></span></figcaption></figure><p>You’re rushing and accidentally drop a contact lens on the bathroom floor. Should you:</p>
<p>a) run it under the tap and pop it in?</p>
<p>b) spit on it and do the same?</p>
<p>c) use the cleaning solution your optometrist insists you use?</p>
<p>d) replace it with a new lens?</p>
<p>e) do any of the above. It doesn’t really matter.</p>
<p>Don’t do what champion boxer and rugby league legend Anthony Mundine did in 2007 and go for (b) <a href="https://jcm.asm.org/content/38/12/4420">spit on your lens</a>. He ended up in hospital with a <a href="https://www.abc.net.au/news/2007-08-07/eye-infection-threatens-mundines-career/2524674">severe eye infection</a>.</p>
<p>If you chose c), it’s true that rubbing your lens with the cleaning solution for 20 seconds will remove some microbes. But you would need to soak the lenses in the solution for a minimum four to six hours to disinfect the lens effectively.</p>
<p>The best answer is d) replace with a new lens.</p>
<p>Running the lens under the tap, option a), risks your lens and eye becoming infected with a <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/cxo.13065">microorganism</a> found in tapwater that could lead you to losing your sight. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-will-i-go-blind-if-i-shut-my-eyes-and-face-the-sun-109070">Curious Kids: will I go blind if I shut my eyes and face the Sun?</a>
</strong>
</em>
</p>
<hr>
<h2>Not all eye infections are harmless</h2>
<p>Aren’t all eye infections <a href="https://www.rch.org.au/kidsinfo/fact_sheets/Conjunctivitis/">conjunctivitis</a>? Like the kids get, bit of redness, icky discharge, drops from chemist, all good after a week?</p>
<p>No. If your contact lens mixes with water, you could get a rare but severe infection called <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/opo.12271">acanthamoeba keratitis</a>. </p>
<p>Of the <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/cxo.12078">680,000 contact lens wearers</a> in Australia, we estimate <a href="https://www.nature.com/articles/s41433-019-0589-6">10-20</a> <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1442-9071.2004.00911.x">a year</a> are affected by the condition. </p>
<p>Of these, we estimate about two to four people a year will need a transplant at the front of their eye to regain vision; about two to five people will need treatment for more than a year.</p>
<p>The condition mostly affects people who wear soft contact lenses, the main type worn in Australia.</p>
<figure>
<iframe src="https://player.vimeo.com/video/209396655" width="500" height="281" frameborder="0" webkitallowfullscreen="" mozallowfullscreen="" allowfullscreen=""></iframe>
<figcaption><span class="caption">Here’s how the condition affects people and their partners (NIHR Moorfields BRC).</span></figcaption>
</figure>
<p>We found <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/cxo.13065">about one-third of bathroom sinks</a> in greater Sydney contain acanthamoeba. We assume it’s present in other parts of the country but no-one else has studied it so don’t know how common it is elsewhere in Australia.</p>
<p>Acanthamoeba are free-living <a href="https://microbiologysociety.org/why-microbiology-matters/what-is-microbiology/protozoa.html">protozoa</a> (single-celled microorganisms) that feed on bacteria and cells at the front of the eye, the cornea. This leads to inflammation, disorganisation and destruction of the cornea, blocking vision.</p>
<p>The <a href="https://bjo.bmj.com/content/86/5/536">vast</a> <a href="https://doi.org/10.1016/j.ophtha.2014.01.031">majority</a> of acanthamoeba keratitis occurs in contact lens wearers.</p>
<p>But you can minimise your chance of getting it. <a href="https://bjo.bmj.com/content/102/12/1621">Avoid exposing</a> your lenses to water, including running them under the tap, in the shower or while swimming.</p>
<p>In fact, many new packs of contact lenses now <a href="https://www.cclsa.org.au/tap/">carry</a> “no water” warning stickers like the one below.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/350534/original/file-20200731-35-1fi1f6t.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Sign warning contact lens users to avoid contact with water" src="https://images.theconversation.com/files/350534/original/file-20200731-35-1fi1f6t.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/350534/original/file-20200731-35-1fi1f6t.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=249&fit=crop&dpr=1 600w, https://images.theconversation.com/files/350534/original/file-20200731-35-1fi1f6t.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=249&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/350534/original/file-20200731-35-1fi1f6t.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=249&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/350534/original/file-20200731-35-1fi1f6t.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=313&fit=crop&dpr=1 754w, https://images.theconversation.com/files/350534/original/file-20200731-35-1fi1f6t.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=313&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/350534/original/file-20200731-35-1fi1f6t.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=313&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Contact lens packs are now clearly marked reminding users of the dangers of exposing lenses to water.</span>
<span class="attribution"><a class="source" href="https://www.cclsa.org.au/tap/">Cornea and Contact Lens Society of Australia</a></span>
</figcaption>
</figure>
<p>Another of our <a href="https://www.nature.com/articles/s41433-020-1015-9">studies</a> shows this particular warning sticker can change behaviour. Contact lens wearers who see this sticker are more likely to avoid water. Their contact lens storage cases were also less likely to be contaminated with bacteria, meaning less chance of bacterial infection and less food for acanthamoeba.</p>
<h2>You can catch other eye infections too</h2>
<p>While acanthamoeba infections are rare, bacterial eye infections are much more common, estimated to affect around <a href="https://www.sciencedirect.com/science/article/pii/S0161642008003072?via%3Dihub">four per 10,000</a> contact lens wearers a year.</p>
<p>About 13% of people whose eyes or contact lenses are infected with bacteria <a href="https://www.sciencedirect.com/science/article/abs/pii/S0161642008003072">lose substantial vision</a>. That’s equivalent to two lines or more on the vision chart optometrists use.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-conjunctivitis-and-how-did-i-get-it-64230">Explainer: what is conjunctivitis and how did I get it?</a>
</strong>
</em>
</p>
<hr>
<p>Most people’s infections improve in two to four weeks by using <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/cxo.12581">antibiotic drops</a>. </p>
<p>However, bacterial infections can be severe and fast-acting. The main bacterium responsible for contact lens related infections is <a href="https://journals.lww.com/optvissci/Fulltext/2007/04000/Pseudomonas_aeruginosa_Infection_and_Inflammation.8.aspx">pseudomonas</a>, another water-loving microorganism. It can sometimes burrow through the eye surface in hours.</p>
<p>There is <a href="https://www.sciencedirect.com/science/article/pii/S1367048420300552">no evidence</a> to suggest wearing contact lenses increases your risk of being infected with the virus that causes COVID-19.</p>
<h2>So how do I avoid all this?</h2>
<p>These <a href="https://www.cdc.gov/contactlenses/show-me-the-science.html">evidence-based</a> tips for healthy contact lens wear will help you avoid infections:</p>
<ul>
<li><p>wash and dry your hands before handling lenses or touching your eyes</p></li>
<li><p>rub, rinse and store contact lenses in <em>fresh</em> disinfecting solution. Topping up old solution with new is an infection risk</p></li>
<li><p>clean your storage case with the disinfecting solution and leave to air dry <a href="https://www.reviewofcontactlenses.com/article/what-is-happening-in-your-contact-lens-storage-case">upside down between uses</a> </p></li>
<li><p>don’t use water with lenses or cases</p></li>
<li><p>avoid wearing your lenses overnight.</p></li>
</ul>
<h2>How do I know if I have a problem?</h2>
<p>If your eyes sting, are red and watery, blurry or are otherwise uncomfortable while wearing your lenses, remove them.</p>
<p>If your symptoms get worse, visit an optometrist. GPs do not usually have equipment with enough magnification to diagnose potentially serious eye infections. </p>
<p>Pseudomonas is resistant to the strongest over-the-counter drops, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/ceo.12497">chloramphenicol</a>. But most optometrists can treat eye infections by prescribing eye drops and can refer you to an ophthalmologist (a specialist eye doctor) if needed.</p><img src="https://counter.theconversation.com/content/141117/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Carnt has received funding from J&J VisionCare, CooperVision, Alcon and Australian Government NHMRC . She is a council member for the International Society of Contact Lens Researchers and is Chair of the Australian Standards Contact Lenses Working group and Expert to International Standards Organization. </span></em></p>Simple hygiene goes a long way to avoid serious eye infections.Nicole Carnt, Scientia Senior Lecturer, School of Optometry and Vision Science, UNSW, Sydney, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1325852020-06-25T05:50:10Z2020-06-25T05:50:10ZCurious Kids: why are our top eyelashes longer than our bottom eyelashes?<figure><img src="https://images.theconversation.com/files/343104/original/file-20200622-75483-fa148z.jpg?ixlib=rb-1.1.0&rect=43%2C60%2C5687%2C3151&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Anna Stasia/ Shutterstock</span></span></figcaption></figure><blockquote>
<p><strong>Why are our top eyelashes longer than our bottom eyelashes? Lilia, aged 7</strong></p>
</blockquote>
<p><a href="https://theconversation.com/au/topics/curious-kids-36782"><img src="https://images.theconversation.com/files/291898/original/file-20190911-190031-enlxbk.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=90&fit=crop&dpr=1" width="100%"></a></p>
<p>Thanks for this great question, Lilia.</p>
<p>The upper eyelid is larger, longer and has deeper roots so it can support more luscious lashes. </p>
<p>All mammals have this feature, but why have the eyes developed this way?</p>
<p>The most significant reason is to protect our eyeballs. But having longer top eyelashes can also help us express our feelings and communicate with others.</p>
<h2>They protect you</h2>
<p>We have between 90 and 160 eyelashes in each upper lid, each of which grow between 8mm and 12mm long. In each lower lid, we have around 75 lashes which grow <a href="https://jamanetwork.com/journals/jamadermatology/article-abstract/531162">6–9mm long</a>.</p>
<p>Together, your long top and shorter bottom lashes provide a curtain of protection that covers the <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.14217">whole eye socket</a>. This stops dust, insects or sweat getting into your eye and hurting it. </p>
<p>Without eyelashes, your eye would also <a href="https://royalsocietypublishing.org/doi/full/10.1098/rsif.2014.1294">dry out much quicker</a>, and would be more likely to <a href="https://www.annualreviews.org/doi/10.1146/annurev-fluid-120710-101042">catch nasty germs</a>. This is why people without eyelashes have to blink much more often.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-will-i-go-blind-if-i-shut-my-eyes-and-face-the-sun-109070">Curious Kids: will I go blind if I shut my eyes and face the Sun?</a>
</strong>
</em>
</p>
<hr>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/318221/original/file-20200303-18287-dbip5v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/318221/original/file-20200303-18287-dbip5v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=276&fit=crop&dpr=1 600w, https://images.theconversation.com/files/318221/original/file-20200303-18287-dbip5v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=276&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/318221/original/file-20200303-18287-dbip5v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=276&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/318221/original/file-20200303-18287-dbip5v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=347&fit=crop&dpr=1 754w, https://images.theconversation.com/files/318221/original/file-20200303-18287-dbip5v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=347&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/318221/original/file-20200303-18287-dbip5v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=347&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The perfect length of eyelashes is one-third the width of the eye.</span>
<span class="attribution"><span class="source">Christian Moro/Author Provided</span></span>
</figcaption>
</figure>
<p>There is actually an “<em>ideal length</em>” for upper eyelashes.</p>
<p>Using eyelash lengths from humans, as well as across a range of animal species, this is <a href="https://royalsocietypublishing.org/doi/full/10.1098/rsif.2014.1294">one-third</a> the width of the eye. Any shorter and wind gets through too easily. Any longer and the wind starts to become caught under the lashes, with both scenarios causing the eyes to dry out more.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-do-tears-come-out-of-our-eyes-when-we-cry-84361">Curious Kids: Why do tears come out of our eyes when we cry?</a>
</strong>
</em>
</p>
<hr>
<h2>Eyelashes protect animals too</h2>
<p>Humans are not the only animals that have eyelashes — all mammals have them, including cats, dogs, elephants, and mice. But they differ in length and density depending on where the animal lives. In most cases, other animals also have much longer lashes on the upper lid.</p>
<p>For animals that live in dusty areas, their eyelashes stop them getting specks of dust in their eyes. This is why camels, kangaroos, <a href="https://seaworld.org/animals/all-about/elephants/senses/">elephants</a> and giraffes have <a href="https://royalsocietypublishing.org/doi/full/10.1098/rsif.2014.1294">several rows</a> of long eyelashes, not just one row.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/343127/original/file-20200622-75483-ovaat8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/343127/original/file-20200622-75483-ovaat8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/343127/original/file-20200622-75483-ovaat8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/343127/original/file-20200622-75483-ovaat8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/343127/original/file-20200622-75483-ovaat8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/343127/original/file-20200622-75483-ovaat8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/343127/original/file-20200622-75483-ovaat8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/343127/original/file-20200622-75483-ovaat8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Giraffes have long eyelashes to protect their eyes from dust.</span>
<span class="attribution"><span class="source">Evgeny Gubenko/ Shutterstock</span></span>
</figcaption>
</figure>
<p>In rodents, such as rats, eyelashes are positioned around the eye and act as <a href="https://link.springer.com/article/10.1007%2Fs00429-003-0341-6">sensors</a>. That way, rats can protect their eyes by blinking whenever they sense an unknown object near their eyes. </p>
<p>But it’s not just mammals. Birds have also developed <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1474-919X.2004.00211.x">eyelash-like feathers</a> around their upper eyelids.</p>
<p>These feathers protect birds’ eyes from sunlight by casting a shadow on their eye. Compared to mammals, these eyelash-like feathers are long (up to 2cm), thick, and widely spaced out. </p>
<h2>Other ways eyelashes are useful</h2>
<p>Our eyelashes are also important for when we <a href="https://www.sciencedirect.com/science/article/pii/S1888429618300487?via%3Dihub">meet and talk to other people</a>.</p>
<p>If you are feeling tired, surprised or concerned, your eyelashes can help <a href="https://www.ncbi.nlm.nih.gov/books/NBK537278/">someone else tell how you are feeling</a>. Also, fluttering your eyelashes at someone might be a way to indicate you really like them. The extra length of the top eyelashes helps to emphasise this.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-how-do-eyes-grow-108489">Curious Kids: how do eyes grow?</a>
</strong>
</em>
</p>
<hr>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/343124/original/file-20200622-75534-1u856xc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/343124/original/file-20200622-75534-1u856xc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/343124/original/file-20200622-75534-1u856xc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/343124/original/file-20200622-75534-1u856xc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/343124/original/file-20200622-75534-1u856xc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/343124/original/file-20200622-75534-1u856xc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/343124/original/file-20200622-75534-1u856xc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/343124/original/file-20200622-75534-1u856xc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Your eyelashes help you convey emotion.</span>
<span class="attribution"><span class="source">Maria Spb/ Shutterstock</span></span>
</figcaption>
</figure>
<h2>Lash facts</h2>
<ul>
<li><p>Unlike most other hairs in our body, eyelashes <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.14217">don’t have the tiny muscles</a> that make the hairs stand on end, giving us goosebumps</p></li>
<li><p>eyelashes are usually the darkest-coloured hair in our body, and they <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2133.2009.09487.x">never go grey</a>!</p></li>
<li><p>the <a href="https://onlinelibrary.wiley.com/doi/10.1111/srt.12401">early Egyptians</a> used makeup on their eyelashes, just like many people do today. They lived more than 5,000 years ago</p></li>
<li><p>eyelashes <a href="https://onlinelibrary.wiley.com/doi/10.1111/srt.12401">vary a lot between people</a>. Different people can have big differences in the number, thickness, curliness, shape or length of their eyelashes</p></li>
<li><p>lashes curve outwards from the eye so the top and bottom hairs don’t get tangled up when we <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2133.2009.09487.x">blink</a></p></li>
<li><p>if we pull out our eyelashes it takes about <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2133.2009.09487.x">eight weeks</a> for them to grow back. So it’s probably best not to!</p></li>
</ul>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/B9SpRripM_F/?utm_source=ig_web_button_share_sheet","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-do-our-toes-and-fingers-get-wrinkly-in-the-bath-120229">Curious Kids: why do our toes and fingers get wrinkly in the bath?</a>
</strong>
</em>
</p>
<hr>
<hr>
<p><em>Hello, curious kids! Have you got a question you’d like an expert to answer? Ask an adult to send your question to <a href="mailto:curiouskids@theconversation.edu.au">curiouskids@theconversation.edu.au</a></em></p>
<hr><img src="https://counter.theconversation.com/content/132585/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Having longer top eyelashes can enhance our ability to express our feelings and communicate with others. But the most significant reason we have them is to protect our eyes.Christian Moro, Associate Professor of Science & Medicine, Bond UniversityZane Stromberga, PhD candidate, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1402422020-06-17T19:38:59Z2020-06-17T19:38:59ZDoes wearing contact lenses put you at greater risk of getting COVID-19?<figure><img src="https://images.theconversation.com/files/340429/original/file-20200608-176585-157dyb1.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1356%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">SARS-CoV-2 has been observed in the tears of some sick patients, but this is an unlikely route of COVID-19 transmission.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Can the SARS-CoV-2 virus, responsible for COVID-19, be transmitted by tears or by touching the eyes? Are contact lens wearers therefore more at risk? As these questions arise, here’s what you need to know.</p>
<p>A Chinese ophthalmologist was one of the first victims of COVID-19 after being exposed to an asymptomatic patient. That raised the question of the potential presence of the virus in the eye and its <a href="https://doi.org/10.1007/s00417-020-04641-8">possible transmission through tears</a>. Some organizations were quick to <a href="https://www.aao.org/eye-health/tips-prevention/coronavirus-covid19-eye-infection-pinkeye">issue advisories</a> regarding the <a href="https://doi.org/10.1016/j.clae.2020.03.007">potential risk </a>of wearing contact lenses during a pandemic.</p>
<p>However, these positions need to be qualified by the evidence that has since been disseminated. It is now possible to properly advise lens wearers based on the latest scientific advances.</p>
<h2>Respect hygiene measures</h2>
<p>Let’s establish right away that wearing contact lenses remains safe as long as patients follow the required hygienic measures. This conclusion comes from a <a href="https://doi.org/10.1111/cxo.13088">literature review</a> published on April 22, based on nearly 200 peer-reviewed articles.</p>
<p>Some of these articles report the ability of the virus to bind to cells on the <a href="https://doi.org/10.1101/2020.03.30.015644">ocular surface</a> due to <a href="https://doi.org/10.1038/s41591-020-0868-6">the affinity</a> of one or another of its components. However, such binding does not automatically translate into the ability of the virus to generate an eye infection.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/336855/original/file-20200521-102632-23v61v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/336855/original/file-20200521-102632-23v61v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=387&fit=crop&dpr=1 600w, https://images.theconversation.com/files/336855/original/file-20200521-102632-23v61v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=387&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/336855/original/file-20200521-102632-23v61v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=387&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/336855/original/file-20200521-102632-23v61v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=486&fit=crop&dpr=1 754w, https://images.theconversation.com/files/336855/original/file-20200521-102632-23v61v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=486&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/336855/original/file-20200521-102632-23v61v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=486&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Handwashing, always important for contact lens wearers, becomes more essential than ever in a pandemic.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>In fact, because of the frequent blinking and exchange of tears, the virus is very unlikely to stay on the eye surface long enough to cause problems. The same concern has been expressed about other diseases, such as <a href="https://doi.org/10.1002/ana.410200304">AIDS</a> or <a href="https://www.nih.gov/news-events/nih-research-matters/detecting-prions-eyes">Creutzfeldt-Jakob disease</a>. Traces of these pathogens have been found in the tears of patients but no cases of direct infection or transmission through the ocular surface have ever been documented. It is the same situation with COVID-19.</p>
<h2>Rare eye damage</h2>
<p>Ocular manifestations caused by COVID-19 <a href="https://doi.org/10.3389/fpubh.2020.00155">are rare</a>. When they do occur, less than <a href="https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf">one per cent</a> of infected people experience eye irritation in the form of conjunctivitis, a mild inflammation of the white of the eye (conjunctiva). Generally speaking, viruses, and not bacteria, are the <a href="https://doi.org/10.1001/jama.2013.280318">main cause of conjunctivitis</a>. </p>
<p>The COVID-19 conjunctivitis can last 10 to 20 days after the first symptoms related to virus appear. Rarely, the cornea is also affected, in which case <a href="https://doi.org/10.1016/j.jcjo.2020.03.003">it is referred to as keratoconjunctivitis</a>. These conditions are well controlled with the usual treatments for these diagnoses, without major long-term complications.</p>
<h2>Are contact lenses a vector?</h2>
<p>Contact lenses are worn by more than 140 million people worldwide and remain a <a href="https://doi.org/10.1016/j.clae.2020.03.012">very effective and safe</a> way to correct vision.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/336863/original/file-20200521-102628-1z01mp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/336863/original/file-20200521-102628-1z01mp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/336863/original/file-20200521-102628-1z01mp7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/336863/original/file-20200521-102628-1z01mp7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/336863/original/file-20200521-102628-1z01mp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/336863/original/file-20200521-102628-1z01mp7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/336863/original/file-20200521-102628-1z01mp7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Single-use lenses are recognized as the safest and most effective way to protect eye health in all conditions.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>The first element to consider is the lens itself. Can it be a vector for the propagation of the virus? </p>
<p>Although the virus can live on inert surfaces, there are no studies proving that in the ocular environment, the virus can colonize the lens and remain there. Therefore, the lens cannot be seriously considered as a vector for the transmission or spread of the disease. The use of daily disposable (single use) lenses further reduces this possibility. This mode of wear is <a href="https://pubmed.ncbi.nlm.nih.gov/22227912/">recognized as the safest</a> in all conditions for eye health.</p>
<p>The second element is lens handling, which involves touching the eyes during insertion and removal of the lens. It is becoming apparent that <a href="https://aocle.org/index.php/healthy-soft-cl-habits/">hand washing, usually recommended</a> during lens wear, is even <a href="https://www.quebec.ca/en/health/advice-and-prevention/accidents-injuries-and-diseases-prevention/washing-hands/">more critical in a pandemic</a>.</p>
<p>That being said, hands should be thoroughly dried before handling lenses because tap water may be contaminated with pathogens, other than SARS-CoV-2, that are more virulent and damaging to the eye. <a href="https://www.canada.ca/en/health-canada/services/healthy-living/your-health/medical-information/contact-lenses.html">Never rinse your lenses or the lens case with tap water</a>, let alone store them in it. Hands should be dried with disposable paper, not reusable towels that can easily become contaminated.</p>
<p>Finally, lens care should be performed with products recommended by eye-care professionals and specifically formulated for this purpose. Ideally, a <a href="https://doi.org/10.1097/icl.0000000000000542">peroxide solution</a> should be used for disinfection and overnight soaking. A saline solution formulated for contact lenses should be used to rinse lenses in the morning prior to insertion. </p>
<h2>Glasses are not the solution</h2>
<p>For those who hesitant, is it better to consider wearing glasses while waiting for a return to normal? The answer is no. Indeed, it is proven that glasses are often poorly adjusted and that they slip, forcing the person to touch their face more frequently than when wearing lenses, most of the time without being able to wash their hands beforehand. The risk of transmission therefore increases proportionately.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/336870/original/file-20200521-102682-rh2l71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/336870/original/file-20200521-102682-rh2l71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/336870/original/file-20200521-102682-rh2l71.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/336870/original/file-20200521-102682-rh2l71.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/336870/original/file-20200521-102682-rh2l71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/336870/original/file-20200521-102682-rh2l71.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/336870/original/file-20200521-102682-rh2l71.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Eyeglasses should not be considered as a protection against the virus.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>This risk is all the more present since the virus <a href="https://doi.org/10.1128/mbio.01697-15">can live for several days on plastic</a> as well as on frames. Contamination by droplets that the person is exposed to and the adhesion of the virus on this surface is more likely than in the case of contact lenses. Finally, the eyewear does not act as a shield against the virus: the nose and mouth remain the doorways for entry. In short, regular corrective glasses <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Finfection-control%2Fcontrol-recommendations.html">should not be considered a personal protective device</a> against COVID-19.</p>
<p>In the rare event that the lens wearer develops abnormal symptoms (redness, pain, sensitivity to light, foreign body sensation, abnormal secretions during or after wearing the lenses) he or she should contact an optometrist or ophthalmologist immediately. A remote (telemedicine) or, if required, in-office consultation can then be arranged quickly.</p>
<h2>Some hygiene tips</h2>
<p>Although the presence of the SARS-CoV-2 virus has been observed in the tears of some sick patients, it is highly unlikely that this route of transmission leads to the development of systemic disease or localized infection of the eye.</p>
<p>In these circumstances, contact lenses may be considered safe to wear provided that the following hygiene recommendations are strictly followed:</p>
<ol>
<li><p>Thoroughly clean hands before and after handling contact lenses.</p></li>
<li><p>Dry hands thoroughly with a clean, disposable cloth.</p></li>
<li><p>Do not use tap water to rinse, clean or soak the lens, even temporarily.</p></li>
<li><p>If you can, use disposable soft lenses every day (single use), so that no solutions or cases are needed.</p></li>
<li><p>If reusable lenses are worn, use only the lens care products recommended by your eye-care professional.</p></li>
<li><p>Replace the lens case after no more than two months. Clean it daily with a contact lens solution. Do not use water, boil it or put it in the dishwasher.</p></li>
<li><p>Avoid sleeping with contact lenses.</p></li>
<li><p>Consult an optometrist or ophthalmologist promptly if any unusual symptoms occur.</p></li>
</ol><img src="https://counter.theconversation.com/content/140242/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Langis Michaud ne travaille pas, ne conseille pas, ne possède pas de parts, ne reçoit pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'a déclaré aucune autre affiliation que son organisme de recherche.</span></em></p>Contact lenses are safe to use during the pandemic as long as you follow strict hygiene recommendations, including frequent hand washing.Langis Michaud, Professeur Titulaire. École d'optométrie. Expertise en santé oculaire et usage des lentilles cornéennes spécialisées, Université de MontréalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1298982020-01-15T03:44:20Z2020-01-15T03:44:20ZBushfire smoke is bad for your eyes, too. Here’s how you can protect them<figure><img src="https://images.theconversation.com/files/310124/original/file-20200115-151880-optgd3.jpg?ixlib=rb-1.1.0&rect=0%2C15%2C3524%2C2330&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">When the hazardous particles found in bushfire smoke come into contact with our eyes, this can cause inflammation.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p>As we continue to contend with smoke haze in various parts of the country, many Australians may find themselves with watery, burning, irritated or red eyes.</p>
<p>Data from countries with consistently poor air quality suggest there could also be a risk of longer term effects to our eyes, particularly with prolonged exposure to bushfire smoke.</p>
<p>Although <a href="https://www.health.nsw.gov.au/environment/air/documents/protect-yourself-from-bushfire-smoke.pdf">P2/N95 masks</a> can protect us from inhaling harmful particles, unfortunately they can’t protect our eyes.</p>
<p>But there are certain <a href="https://www.optometry.unsw.edu.au/sites/default/files/documents/Bushfires%20and%20your%20eyes%202020%20Advice%20Sheet%20FINAL%20%281%29.pdf">things you can do</a> to minimise irritation and the risk of any longer term effects.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-know-bushfire-smoke-affects-our-health-but-the-long-term-consequences-are-hazy-129451">We know bushfire smoke affects our health, but the long-term consequences are hazy</a>
</strong>
</em>
</p>
<hr>
<h2>Irritation in the short term</h2>
<p>The eye’s surface is continuously exposed to the environment, except when our eyes are shut when we sleep. </p>
<p>Bushfire smoke contains dust, fumes (such as carbon monoxide and nitrogen oxides), and <a href="https://www.health.nsw.gov.au/environment/air/Pages/particulate-matter.aspx">tiny particles</a> called PM10 and PM2.5.</p>
<p>When the smoke comes into contact with our eyes, the fumes and small particles dissolve into our tears and coat the eye’s surface. In some people, this can trigger inflammation, and therefore irritation.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/bushfire-smoke-is-everywhere-in-our-cities-heres-exactly-what-you-are-inhaling-129772">Bushfire smoke is everywhere in our cities. Here's exactly what you are inhaling</a>
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<p>The presence of a marker called matrix metalloproteinase-9, or MMP-9, indicates the eye is inflamed. </p>
<p>During periods of poor air quality from bushfires in the United States, MMP-9 was present in the eyes of <a href="https://www.healio.com/ophthalmology/cornea-external-disease/news/online/%7Bb8dad2b8-5df1-4412-a5f2-886a099210bb%7D/poor-air-quality-associated-with-dry-eye">more people</a> than it ordinarily would be.</p>
<h2>Longer term risks</h2>
<p>We know very little about how pollution from bushfire smoke might affect our eyes over the longer term, or what damage repeated or chronic exposure might do. </p>
<p>But we do know people who live in areas with high levels of air pollution, such as China, are <a href="https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-019-1794-6">three to four times more likely</a> to develop dry eye. </p>
<p>Dry eye is a condition where a person <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/dry-eye">doesn’t have enough tears or they are of such poor quality</a> they don’t lubricate and nourish the eye. We need high quality tears to maintain the health of the front surface of the eye and provide clear vision.</p>
<p>For people who already have dry eyes – often older people – poor air quality may <a href="https://www.sciencedirect.com/science/article/pii/S0269749118304056?via%3Dihub">increase the damage</a>. The smoke and pollution may cause intense stinging and a feeling of grittiness to the point they can barely open their eyes.</p>
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<img alt="" src="https://images.theconversation.com/files/310130/original/file-20200115-93792-yumjkb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/310130/original/file-20200115-93792-yumjkb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/310130/original/file-20200115-93792-yumjkb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/310130/original/file-20200115-93792-yumjkb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/310130/original/file-20200115-93792-yumjkb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/310130/original/file-20200115-93792-yumjkb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/310130/original/file-20200115-93792-yumjkb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Avoid rubbing your eyes, as this could make the irritation worse.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
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</figure>
<p>While dry eye is a result of damage to the surface of the eyes, it’s also possible pollutants entering the blood stream after we breathe them in could affect the blood supply to the eye. This in turn could damage the fine vessels within the eye itself.</p>
<p>Research has suggested high levels of air pollution in Taiwan may increase the risk of <a href="https://jim.bmj.com/content/67/7/1076">age-related macular degeneration</a>, which could be an example of this. </p>
<p>We need more research into the long-term effects on our eyes of prolonged poor air quality, particularly from bushfire smoke. But what we do know suggests it’s possible bushfire smoke could be causing subtle damage to the eyes, even in people without any symptoms.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/even-for-an-air-pollution-historian-like-me-these-past-weeks-have-been-a-shock-129141">Even for an air pollution historian like me, these past weeks have been a shock</a>
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<h2>What can you do to protect your eyes from the smoke?</h2>
<ul>
<li>the best option is to avoid going outside when air quality is at is worst, where possible</li>
<li>wearing sunglasses or glasses when outside if you need them might stop some of the dust carried in the wind from contacting the eye’s surface (but it won’t stop the tiny particles getting in)</li>
<li>avoid wearing contact lenses if possible.</li>
</ul>
<h2>Some tips if your eyes are irritated</h2>
<ul>
<li>flush your eyes as often as you can, with over-the-counter <a href="https://www.aao.org/eye-health/treatments/lubricating-eye-drops">lubricant eye drops</a> if you have some on hand. If not, use sterile saline solution or clean bottled water</li>
<li>if your eyes are itchy, flush them and then place a cool face washer over your closed lids</li>
<li>don’t rub your eyes, as this could make the irritation worse.</li>
</ul>
<p>If your eyes are red and sore and these steps don’t help, it’s best to see an eye care professional.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-face-masks-to-air-purifiers-what-actually-works-to-protect-us-from-bushfire-smoke-128633">From face masks to air purifiers: what actually works to protect us from bushfire smoke?</a>
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<img src="https://counter.theconversation.com/content/129898/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katrina Schmid receives funding from Carl Zeiss Vision Germany</span></em></p><p class="fine-print"><em><span>Isabelle Jalbert received or receives funding from the Australian Government Office for Learning and Teaching, the Macular Diseases Foundation Australia, Johnson & Johnson Vision Care Inc., and Alcon Laboratories (Australia).</span></em></p>Another troubling consequence of the bushfire smoke is its effects on our eyes. But there are some steps we can take to minimise irritation and any risk of longer term harms.Katrina Schmid, Associate Professor, Queensland University of TechnologyIsabelle Jalbert, Associate Professor, School of Optometry and Vision Science, UNSW Sydney, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1268952019-11-13T23:26:04Z2019-11-13T23:26:04ZFrom cataracts to macular degeneration: Age-related eye problems and how to treat them<figure><img src="https://images.theconversation.com/files/301388/original/file-20191112-178506-poyu44.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1356%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Cataracts are a vision problem that can affect anybody as they age. It happens when the lens of the eye gradually loses its transparency. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/">Shutterstock</a></span></figcaption></figure><p>Monique is 77 years old. I met her when she came to the eye clinic at the University of Montréal, where I am a professor. A retired teacher, Monique has enjoyed an active and full life with her students and family and considers herself lucky to be in good health. </p>
<p>She is concerned, however, about a recent visual loss that prevents her from reading and enjoying her painting workshops. It also prevents her from driving safely, which is important if she wants to maintain her independence.</p>
<p>A complete examination of Monique’s vision and eye health quickly revealed the cause of her problems: she has developed cataracts and her retina shows early signs of macular degeneration. </p>
<p>Cataracts are a normal phenomenon, resulting from the aging process of the eye and affecting everyone, without exception. They occur when the <a href="https://www.mayoclinic.org/tests-procedures/cataract-surgery/about/pac-20384765">lens of the eye gradually loses its transparency</a>, like a window that gets dirty with the seasons.</p>
<p>The light that enters the eye passes through opaque areas and generates blurred vision, without the possibility of improving it with glasses, lenses or magnifiers. Only surgery can restore the clarity of the eye. </p>
<h2>The aging of the crystalline lens</h2>
<p>The crystalline lens is particular and its metabolism is very fragile. When disturbed, the lens accumulates deposits and loses its transparency. This lens also absorbs a large part of the sun’s ultraviolet rays to protect the retina at the back of the eye. </p>
<p>The amount of UV absorbed accumulates over the years, contributing to the premature aging of the lens. That is why it is recommended to protect yourself with sun lenses from an early age. </p>
<hr>
<p>
<em>
<strong>
À lire aussi :
<a href="https://theconversation.com/summer-is-here-why-you-need-to-protect-your-childrens-eyes-116498">Summer is here! Why you need to protect your children's eyes</a>
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<p>Other factors that disrupt its functioning include the use of certain medications such as oral cortisone, the presence of diseases such as diabetes or a shock to the head, which can contribute to the arrival and progression of cataracts. Very rarely, cataracts are transmitted during pregnancy, especially <a href="https://www.ncbi.nlm.nih.gov/pubmed/6964280">following infections </a>such as rubella, toxoplasmosis and herpes. </p>
<p>Finally, very strong links have been established between <a href="https://www.sciencedirect.com/science/article/abs/pii/S0886335005005274">smoking and cataracts</a>. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5452183/">Food</a>, on the other hand, does not seem to have an impact. Quitting smoking and protecting your eyes with good sunglasses are therefore considered effective ways to delay the onset and progression of cataracts. </p>
<h2>Implants to the rescue</h2>
<p>Cataract treatment is quite simple. The ophthalmologist will perform surgery to exchange the natural lens of the eye with a new lens, called an implant. This surgery is very safe and can be performed at any time during cataract development, although surgery will usually only be offered if there is a significant impact on the patient’s vision and quality of life. </p>
<p>Implants are permanent and remain clear for life, without the need for replacement. They can be used to correct distance vision, including astigmatism, which would be accomplished through the use of a specially designed toric implant. Also, nearsightedness can be fixed via bifocal or multifocal implants, thus avoiding the need for glasses later on, <a href="https://www.cochrane.org/CD003169/EYES_multifocal-versus-monofocal-intraocular-lenses-people-having-cataract-surgery">in most cases</a>. </p>
<p>However, the patient may be subject to seeing halos and may be more sensitive to light. It is also necessary to ensure that the retina is in good health, otherwise the final result will not be very good. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/289236/original/file-20190823-170951-zjz8dq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/289236/original/file-20190823-170951-zjz8dq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/289236/original/file-20190823-170951-zjz8dq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/289236/original/file-20190823-170951-zjz8dq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/289236/original/file-20190823-170951-zjz8dq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/289236/original/file-20190823-170951-zjz8dq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/289236/original/file-20190823-170951-zjz8dq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Very strong links have been found between smoking and macular degeneration.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>This is particularly the case for Monique, who also has the onset of age-related macular degeneration (AMD). This is a phenomenon affecting one per cent of people exceeding 40 years of age, but whose <a href="https://doi.org/10.1016/j.jfo.2009.04.009">prevalence reaches 30 per cent at 80 years of age.</a></p>
<p>The at-risk population is composed of Caucasians (those of European origin) and women more than men. Systemic diseases — everything that affects blood vessels such as diabetes, high blood pressure, high cholesterol and obesity — are important risk factors, as are <a href="https://www.ncbi.nlm.nih.gov/pubmed/27125062">oxidative causes such as smoking, high saturated fat nutrition and UV exposure</a>. </p>
<h2>Prevent macular degeneration</h2>
<p>Essentially, the best retinal cells, which allow good vision (macular area), degrade over time if not well nourished by the vascular network and <a href="https://www.mayoclinic.org/diseases-conditions/dry-macular-degeneration/symptoms-causes/syc-20350375">accumulate deposits that prevent their normal functioning</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/289235/original/file-20190823-170927-yo74n2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/289235/original/file-20190823-170927-yo74n2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/289235/original/file-20190823-170927-yo74n2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/289235/original/file-20190823-170927-yo74n2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/289235/original/file-20190823-170927-yo74n2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/289235/original/file-20190823-170927-yo74n2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/289235/original/file-20190823-170927-yo74n2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Light exercises, such as walking, may be enough to delay the progression of macular degeneration.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>These deposits become visible as <a href="https://www.ncbi.nlm.nih.gov/books/NBK315804/">small yellow spots</a> at the fundus — the part of the eyeball opposite the pupil. These deposits, known as drusen, can become confluent. The degradation of cells is accompanied by a change in their colouring (pigment reworking), a phenomenon that is also visible when the retina is examined. This is called dry macular degeneration. Vision is more or less affected depending on the number of affected cells. </p>
<p>Over time, the system’s response can lead to the formation of new blood vessels to supply dying cells. These are fragile and have no real place to stay. They can easily burst. Their membrane formation, like roots invading a pipe, and their flow (bleeding) contribute to a very severe reduction in vision. This is when we speak of <a href="https://www.cos-sco.ca/vision-health-information/conditions-disorders-treatments/retinal-diseases/amd/">wet degeneration</a>. This more severe form affects 10 per cent of AMD cases, but anyone with the dry form can progress at this stage. </p>
<h2>Nutritional supplements</h2>
<p>AMD treatments are limited and aim to limit the progression of the disease. They cannot cure it. Quitting smoking, good nutrition, regular exercise and following the doctor’s recommendations in the control of vascular diseases such as diabetes and hypertension, can delay the progression of the dry form of AMD. </p>
<p>Wearing sunglasses also helps, even on cloudy days. Taking <a href="https://www.ncbi.nlm.nih.gov/pubmed/18779490">omega 3</a> at the right dosage and fish oil extracts may help although <a href="https://www.dx.doi.org/10.1001/jama.2013.4997">more recent results</a> have called this strategy into question. </p>
<p>In more advanced stages of the dry form, <a href="http://dx.doi.org/10.1155/2014/901686">taking oral nutritional supplements</a> including vitamins and antioxidants are recommended, except in some patients with a <a href="https://doi.org/10.1155/2017/6469138">particular genetic profile</a>. </p>
<p>The wet form has recently been effectively treated by injecting drugs directly into the eye, to prevent the formation of new blood vessels. These injections must be repeated periodically and restore vision when the procedure is performed at <a href="https://www.ncbi.nlm.nih.gov/pubmed/27220225">the appropriate time</a>. </p>
<p>Monique’s case is a mixed one. On the one hand, it is possible to greatly improve her short-term vision with cataract surgery, for which she will be referred to ophthalmology. Implants protect against UV rays, another factor in preventing the progression of macular degeneration. This will allow her to drive safely and resume her activities. She will also monitor her diet, which she admits is deficient, and take omega supplements. Her AMD is at a stage that is too early for vitamins or antioxidants.</p>
<p>Monique does not smoke and is not taking medication for vascular problems. If she does one day, she will follow her doctor’s recommendations and begin a light exercise program. Walking may be enough. Finally, she will be followed every six months in an optometry office, will perform simple <a href="https://www.aao.org/eye-health/tips-prevention/facts-about-amsler-grid-daily-vision-test">home screening tests</a> and will come in for a consultation as soon as a change is noted. </p>
<p>Monique is reassured! She will be able to remain active and independent to enjoy the good times of life. </p>
<p>[ <em>Like what you’ve read? Want more?</em> <a href="https://theconversation.com/ca/newsletters?utm_source=TCCA&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=likethis">Sign up for The Conversation’s daily newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/126895/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Langis Michaud ne travaille pas, ne conseille pas, ne possède pas de parts, ne reçoit pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'a déclaré aucune autre affiliation que son organisme de recherche.</span></em></p>Cataracts, which can be experienced by anyone as they age, happen when the lens of the eye gradually becomes less transparent. There are ways, however, to correct this.Langis Michaud, Professeur Titulaire. École d'optométrie. Expertise en santé oculaire et usage des lentilles cornéennes spécialisées, Université de MontréalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1224272019-09-26T21:29:29Z2019-09-26T21:29:29ZPoor vision: Do drivers always see what is happening on the road?<figure><img src="https://images.theconversation.com/files/293675/original/file-20190923-54813-9e0ufe.jpg?ixlib=rb-1.1.0&rect=102%2C87%2C4469%2C2646&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Vision is the most important source of information on which driving conduct is based. Poor vision of drivers has been found to be the cause of many accidents.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/">Shutterstock</a></span></figcaption></figure><p>A <a href="https://www.cbc.ca/news/canada/montreal/highway-330-bonnardel-1.5247853">recent tragic pile-up on a major highway near Montreal</a> has spurred the Québec government into action — to find the best ways to improve roads and prevent such disasters from happening again.</p>
<p>However, this investigation into the crashes on Highway 440 which left four people dead did not mention the main tool for safe driving — vision.</p>
<p>The <a href="https://www.ncbi.nlm.nih.gov/pubmed/24563119">Cochrane Institute published an analysis in 2014</a> indicating that vision is the most important source of information on which to assess driving. Poor vision of drivers is one of the causes of many accidents.</p>
<p>The potential causes of vision impairment are well known: cataracts, macular degeneration, diabetic retinopathy, glaucoma and corneal scars, to name a few. In addition, there are binocular vision problems (visual coordination) that can lead to unstable, double vision, lack of third dimensional perception and<a href="https://www.ncbi.nlm.nih.gov/pubmed/21870915"> delayed reaction to an unexpected event</a>, such as a child appearing in front of the car.</p>
<p>Finally, refractive errors are also very present. <a href="https://www.mayoclinic.org/diseases-conditions/farsightedness/symptoms-causes/syc-20372495">Uncorrected hyperopia (farsightedness) can lead to drowsiness while driving</a>. A myopic and/or astigmatic person who does not wear his glasses while driving — it often happens, believe it or not — does not see well into the distance, at least not to a safe distance allowing him to anticipate incidents.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/288539/original/file-20190819-123720-xsve0g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/288539/original/file-20190819-123720-xsve0g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288539/original/file-20190819-123720-xsve0g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288539/original/file-20190819-123720-xsve0g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288539/original/file-20190819-123720-xsve0g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288539/original/file-20190819-123720-xsve0g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288539/original/file-20190819-123720-xsve0g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Binocular vision problems can lead to unstable, double vision, lack of perception of the third dimension, as well as a delayed reaction to an unexpected event, such as a child who appears in front of the car.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Young people also affected</h2>
<p>Although the incidence of visual pathologies and problems increases with age, some of them also impact younger drivers. More than 200,000 Québecers are affected by a combination of <a href="http://www.vision2020canada.ca/en/resources/Pages/default.aspx">all types of eye problems</a>. That suggests that each time you venture onto the road, you are likely to encounter a driver who is affected by an eye or visual impairment that puts his or her driving at risk.</p>
<p>In addition to visual acuity, other elements of visual function contribute to safe driving. For example, <a href="https://www.ncbi.nlm.nih.gov/pubmed/12517356">the visual function includes an intrinsic element of perception</a>. That allows you to grasp a scene that takes place in front of your eyes with the best possible clarity, your eye movements allowing you to appreciate the dynamics of the scene. The study of visual function — and not just visual acuity — is therefore essential to reducing the number of accidents.</p>
<p>Mosty eye problems or <a href="https://www.ncbi.nlm.nih.gov/pubmed/25000871">abnormalities of oculo-visual function are asymptomatic</a> and are only detected during a complete examination by an optometrist. This is particularly the case with diabetic retinopathy or ocular lesions, already present in <a href="http://guidelines.diabetes.ca/Browse/Chapter30">25 per cent of patients at the time of diagnosis</a>.</p>
<h2>Lax regulations</h2>
<p>While science confirms the importance of vision to safe driving, regulatory agencies treat this element negligently. They only require often inappropriate or late checks on the visual condition of drivers. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/288536/original/file-20190819-123749-48rhyv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/288536/original/file-20190819-123749-48rhyv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288536/original/file-20190819-123749-48rhyv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288536/original/file-20190819-123749-48rhyv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288536/original/file-20190819-123749-48rhyv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288536/original/file-20190819-123749-48rhyv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288536/original/file-20190819-123749-48rhyv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Although science confirms the importance of vision for safe driving, regulatory agencies are often lax about this element.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>For example, the screening test conducted in the service centres of the <a href="https://saaq.gouv.qc.ca/en/">Société de l'assurance automobile du Québec</a> (the Québec auto insurance board) when a temporary permit is issued is very brief and neglects fundamental aspects of eye health. The SAAQ requires more comprehensive tests much later for the majority of drivers.</p>
<p>In the case of private vehicles (classes 5 and 6), the examination is required at age 75 and then from age 80, every two years. For commercial vehicles (classes 1 to 4), if driving involves a presence in the United States, an examination is required every five years until age 45, then every three years from age 45 to 65. However, if the driver lives in the rest of Canada, his or her examination is generally only required at age 45, then every five years from age 55 to 65 and every two years thereafter. </p>
<p>The provinces, which follow National Safety Code standards and the <a href="https://ccmta.ca/images/pdf-documents-english/CCMTA-Medical-Standards-2017-English.pdf">Canadian Council of Motor Transport Administrators Medical Standards for Drivers</a>, also add other conditions in certain circumstances as well. For example, Ontario and Alberta require vision testing when a driver requests a change in the classification of their licence. Ontario also requires vision testing when a licence has been expired for more than a year or when an optometrist advises of any issues with a driver’s vision. </p>
<p>There is no reason for such varying standards. The risk is the same everywhere. Although periodic inspection of drivers from the age of 45 is happening, it would seem more important to carry out a full assessment of everyone when they apply for a licence.</p>
<h2>Recommendations left unheeded</h2>
<p>Lack of adequate regulation prompted the Ordre des Optométristes du Québec (Quebec Order of Optometrists) to create <a href="https://auto.lapresse.ca/actualites/201703/03/01-5075284-securite-routiere-examen-de-la-vue-obligatoire-des-65-ans-plutot-qua-75-.php">specific recommendations during the provincial transportation ministry’s consultation in 2017</a>. </p>
<p>The Order proposed that the statutory examination for Class 5 and 6 drivers be scheduled for at least 70 years of age, and possibly even 65 years. It also suggested that statutory examination for commercial drivers (Class 1 to 4) be applied in the same way, whether or not the driver drives in the United States. The examination of these drivers should include a complete eye and visual examination.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/288538/original/file-20190819-123727-wu3ykn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/288538/original/file-20190819-123727-wu3ykn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288538/original/file-20190819-123727-wu3ykn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288538/original/file-20190819-123727-wu3ykn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288538/original/file-20190819-123727-wu3ykn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288538/original/file-20190819-123727-wu3ykn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288538/original/file-20190819-123727-wu3ykn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The Order of Optometrists recommends that the statutory audit examination be moved to age 65, instead of age 75 as is currently the case.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>The Order also proposed that assessment tests conducted at the time of obtaining a driver’s licence should not be limited but should cover the detection of abnormalities in refraction, <a href="https://www.ncbi.nlm.nih.gov/pubmed/20385890">visual field</a>, binocular vision and screening for eye diseases that may influence driving. </p>
<p>These recommendations, which have not yet been adopted by the authorities, are scientifically justified. They are also full of common sense, insofar as we must be concerned about the safety of road users and in order to improve the driving record in Quebec.</p>
<h2>It’s time to act</h2>
<p>By recognizing vision as a key element of safe driving, policy makers and public agencies would make a significant contribution to improving road conditions across the country. </p>
<p>Drivers themselves must be proactive by consulting their eye-care professional on a regular basis. They must comply with their recommendations. They must also adequately treat any ocular or visual condition that could lead to sight loss or dysfunction of visual perception.</p>
<p>[ <em>Deep knowledge, daily.</em> <a href="https://theconversation.com/ca/newsletters?utm_source=TCCA&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/122427/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Langis Michaud ne travaille pas, ne conseille pas, ne possède pas de parts, ne reçoit pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'a déclaré aucune autre affiliation que son organisme de recherche.</span></em></p>When you head out onto the road, there’s always a chance that you might encounter a driver who has a vision problem, putting his or her driving at risk. Regulations need to change.Langis Michaud, Professeur Titulaire. École d'optométrie. Expertise en santé oculaire et usage des lentilles cornéennes spécialisées, Université de MontréalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1214512019-08-18T08:17:31Z2019-08-18T08:17:31ZWhy it’s proving hard to eliminate the eye disease trachoma by 2020<figure><img src="https://images.theconversation.com/files/287051/original/file-20190806-84230-46o1al.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Trachoma can lead to blindness if left untreated.</span> <span class="attribution"><a class="source" href="https://phil.cdc.gov/Details.aspx?pid=19295">Alaine Kathryn Knipes/CDC</a></span></figcaption></figure><p><em>Trachoma is a disease that can cause blindness and visual impairment in about <a href="https://www.who.int/en/news-room/fact-sheets/detail/trachoma">1.9 million</a> people every year. Poor communities in rural areas of countries in Africa, Central and South America, Asia, Australia and the Middle East are most affected.</em> </p>
<p><strong>What is trachoma?</strong></p>
<p>It is a bilateral eye disease ranked as the <a href="https://www.who.int/bulletin/volumes/82/11/en/844.pdf">leading cause of preventable blindness</a> of infectious origin in the world. It is caused by the vector borne <em>Chlamydia Trachomatis</em> bacteria. </p>
<p>The particular strains of the bacteria are the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC523557/">Serovars A through C</a>. Flies spread the disease by coming into contact with infected individuals. The bacteria can also be contracted through bodily fluids either by physical contact or sexual intercourse. The bacterium is also spread through contaminated bedding and clothing materials. </p>
<p>The bacterium is notoriously stubborn as it has the ability to alternate between its reticulate (smaller) and elementary (larger) bodily forms. </p>
<p>This bacterium is an <a href="https://www.ncbi.nlm.nih.gov/pubmed/28835360">obligate intracellular pathogen</a> similar to Trypanosomia and Rickettsia. This means it can only survive inside a host cell. Therefore, properly eliminating the disease means loss of cell bodies in the host. </p>
<p>Poverty, <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001605">poor sanitation habits</a> and overcrowded areas are <a href="https://www.ncbi.nlm.nih.gov/pubmed/26860629">common factors</a> that encourage the spread of the disease. </p>
<p>Young people are most susceptible to the disease. A study out of <a href="https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0002240">northern Cameroon</a> showed a higher prevalence in participants younger than nine than in participants older than 15. Pupils come in contact with their peers’ bodily fluids or get infected from flies.</p>
<p>Trachoma is characterised by episodes of a keratoconjunctivitis (inflammation of the conjunctiva and cornea). This presents with redness and pain in the eye.</p>
<p>In the early stages of infection, the edges of the eyelid get deformed, causing the eyelashes to fold into the eye. This can lead to the cornea being scarred or eroded. This inward turning of the eyelashes is called a <a href="https://www.ncbi.nlm.nih.gov/pubmed/22285842">trachomatous trichiasis</a>. </p>
<p>Twenty years ago the World Health Organisation (WHO) passed a <a href="https://www.who.int/blindness/causes/WHA51.11/en/">resolution</a> to combat the scourge of trachoma. </p>
<p><strong>What are the rates of incidence and distribution of the disease?</strong> </p>
<p>Trachoma is currently endemic in <a href="https://www.who.int/news-room/fact-sheets/detail/trachoma">44 countries</a>. The African continent is most affected. The disease is endemic in the inner countries of the Sahel belt such as Sudan and Ethiopia. The one ray of hope has been Ghana which last year became the first country in Africa to be declared trachoma free. </p>
<p>Available data show that the situation has improved dramatically over the past 20 years. In 2009, 41 million people still had trachoma. That was down from 83 million six years earlier. The WHO’s most recent data show that there <a href="https://www.who.int/news-room/fact-sheets/detail/trachoma">are 1.9 million people</a> who have been blinded by trachoma or suffered severe visual impairment. With the implementation of the WHO’s resolution, there has been a reduction in the prevalence worldwide.</p>
<p><strong>What can be done to control it? How is it treated?</strong></p>
<p>The WHO has provided a <a href="https://www.ncbi.nlm.nih.gov/pubmed/22285842">rapid grading system</a> for the assessment of trachoma. This is to help manage the disease. The aim is to minimise damage to the eye during specific stages of the disease. </p>
<p>As part of the drive it set out a strategy to combat the disease that included: </p>
<ul>
<li><p>Surgery to correct Trichiasis. In 2018 146,112 people underwent surgery for correction of trachomatous trichiasis, while another 89 million sufferers received various antibiotics for the earlier stages of the disease.</p></li>
<li><p>Antibiotic coverage to control infection: Pfizer is the producer of aithromycin and has donated more than <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5093790/">500 million units of the drug so far</a>. </p></li>
<li><p>Face washing to improve hygiene</p></li>
<li><p>Environmental health improvement to reduce the transmission of the disease and breeding of vectors.</p></li>
</ul>
<p>Improving the health of an environment and promoting face washing are geared towards preventing the spread of the disease.</p>
<p>Cleaner environments would mean little or no breeding space for the flies that serve as vectors. It would also mean that personal contact from infected individuals’ infected personal belongings will be minimised. </p>
<p>Face washing is especially important in rural communities where the disease is endemic.</p><img src="https://counter.theconversation.com/content/121451/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Musa Mutali does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Trachoma is the leading cause of preventable blindness.Musa Mutali, Lecturer of Optometry , University of BeninLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1164982019-06-18T23:49:20Z2019-06-18T23:49:20ZSummer is here! Why you need to protect your children’s eyes<figure><img src="https://images.theconversation.com/files/272898/original/file-20190506-103063-n27j3r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Climate change and especially variations in the ozone layer have increased the danger from the sun's harmful rays during the last 25 years. Children are particularly at risk.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/">Shutterstock</a></span></figcaption></figure><p>Should we buy sunglasses for children? And if so, how do we choose a quality product?</p>
<p>It’s a question that I get a lot in clinics. I reply that it is good to remember what the sun’s effects on eye health are, and how they often act without us even realizing. Exposure to harmful sunlight has increased during the past 25 years, especially with climate change and the variations in the ozone layer.</p>
<p>In considering this, we must first differentiate between the types of radiation — in other words the rays the sun emits and that touch us, the intensity of the light and the brightness associated with glare.</p>
<p>Emitted rays can be perceived as visible light or remain unseen, as light which is invisible to the human eye. It is the latter that are harmful to eye health. These include short rays — ultraviolet rays (UV-0 to 400 nanometers of wavelength) and the <a href="https://www.livescience.com/50260-infrared-radiation.html">longest infrared rays</a>, which are more associated with heat and burns. Each of these rays is subdivided into three families: A, B and C.</p>
<p>UVA rays, which are 315 to 400 nanometres, are known for their harmful effects associated with the development of skin cancer. UVB (280-315 nm) are the most damaging to the structures of the human eye. UVC (0-280 nm) have negligible effects because they are mostly blocked by the ozone layer when it is in good condition. </p>
<p>Infrared rays, on the other hand, <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Biohazards+of+ultraviolet%2C+visible+and+infrared+radiation">pose a risk to the retina</a>.</p>
<h2>Children at risk</h2>
<p>The damage to our body tissues is also proportional to the amount of time we spend in the sun throughout our lives. Children are, in theory, the ones who spend the most time outdoors and the cumulative dose of sun exposure is therefore maximum between birth and 16 years of age. That means they are the most at risk today. </p>
<p>The amount of sunlight absorbed also depends on where you live and the time of day you are exposed. We receive more sunlight near the Equator than further north or south. The radiation is also more direct. </p>
<p>The same principle applies to the time of day. One might think that the maximum radiation occurs at noon, when the sun is at its zenith. But solar damage, at least to the eyes, actually occurs more in the morning and afternoon, when the sun is at an angle of about <a href="https://doi.org/10.1080/15459624.2012.737700">30 degrees to 40 degrees</a> to the horizon. For example, in Québec, the risk is therefore greatest between 9 a.m. and 10 a.m., then between 3:30 p.m. and 5 p.m. in the evening, during the summer. </p>
<h2>Harmful reflection</h2>
<p>Reflection can significantly increase harmful radiation. A surface of water such as a lake or river, sand, something white like snow, a wall covering or metal are all mirrors that increase and concentrate solar rays. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5820813/">Snow blindness</a>, which occurs when the eye is exposed to radiation on a snowy or icy surface for too long, is an example. <a href="https://www.who.int/uv/faq/uvhealtfac/en/">UVA rays that accumulate in the lens promote the development of cataracts</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/270829/original/file-20190424-121228-17y9c32.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/270829/original/file-20190424-121228-17y9c32.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/270829/original/file-20190424-121228-17y9c32.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/270829/original/file-20190424-121228-17y9c32.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/270829/original/file-20190424-121228-17y9c32.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/270829/original/file-20190424-121228-17y9c32.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/270829/original/file-20190424-121228-17y9c32.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Harmful radiation can be significantly increased by reflection, such as with snow.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Minor deformities of the bulbar conjunctiva — the white of the eye — are also possible. <a href="https://www.aao.org/eye-health/diseases/pinguecula-pterygium">Pingueculas are benign but obvious as small bumps</a>, sometimes vascularized, making the eyes chronically red. Pterygium is more damaging. It is a membrane that invades and pulls on the cornea, which can reduce vision. In advanced cases, this requires surgery. </p>
<p>If UV rays reach the retina, they will create a damage that can <a href="https://www.ncbi.nlm.nih.gov/pubmed/21646979">contribute to the development of macular degeneration</a>. The effects of the solar eclipse are well known — if you look at it without protection, <a href="https://www.ncbi.nlm.nih.gov/pubmed/3998365">infrared rays can then burn the retina</a>, often irreparably.</p>
<p>Don’t let your guard down on cloudy, humid days, however. They also pose an increased risk. Clouds don’t block the harmful rays and water particles also act as a mirror. As a result, radiation and the risk of glare is increased.</p>
<p>Glare is the intensity of light perceived by the eye and tolerance to brightness varies from one person to another. It depends on the amount of retinal pigments they have inherited. People with dark eyes and skin will have more pigments than people with blond hair and blue eyes. The latter will wrinkle their eyes more in front of medium intensity light and will need the protection of a darker coloured filter.</p>
<p>To sum up, <a href="https://www.arpansa.gov.au/understanding-radiation/radiation-sources/more-radiation-sources/sun-exposure">the sun emits harmful rays 365 days a year</a>, no matter if it is cloudy or rainy. The damage suffered is proportional to the amount of exposure and children absolutely must be protected. If they are highly exposed and unprotected, they will be among those who will develop cataracts at an earlier age, between 55 and 65 years of age, and run the risk of skin cancer of the eyelids, which are more fragile than the rest of the dermis.</p>
<h2>How do we protect ourselves?</h2>
<p>There are ways to protect yourself. Wearing a cap or hat helps to limit exposure. Because that is not completely effective, it is also necessary to use sun lenses, which are available in glasses and contact lenses. It is even better to have a combination of both.</p>
<p>Sunglasses must be ophthalmic quality. In other words, the lenses, which are often molded, do not have an effective power and do not create distortion. </p>
<p>Maximum protection is key and the 100 per cent UV or UV 400 label is the standard. Avoid UV 100 — without the percentage at the end — or other denominations. It is important to note that UV filters are invisible and the quality of protection has nothing to do with the colour. They can also be added to prescription lenses for those who have to wear glasses on a daily basis. </p>
<p>Finally, the frame must be curved and not leave any space between the bezel and the eye. Otherwise, the window protects against direct radiation, but all the rays that arrive from the side and even from the back will reach the eye. The damage can then be even greater. That is because the pupil is dilated since it is under a sunscreen reducing the brightness, so more harmful rays enter the eye. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/270832/original/file-20190424-121241-eynheo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/270832/original/file-20190424-121241-eynheo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/270832/original/file-20190424-121241-eynheo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/270832/original/file-20190424-121241-eynheo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/270832/original/file-20190424-121241-eynheo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/270832/original/file-20190424-121241-eynheo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/270832/original/file-20190424-121241-eynheo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Hat, sunglasses and protective cream. Now, you’re ready for summer!</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>The shade is chosen according to activity and visual needs. Grey or green are common and neutral in terms of colour perception. Brown and amber are ideal for driving. Pink/violet increases the contrast on golf greens. Options can also be added, such as polarization, which can reduce glare by at least 50 per cent, making it ideal for those working in water, snow or reflective surfaces. </p>
<p>The quality of the lens is not proportional to the price paid. However, in general, a good quality, break-resistant frame, which is especially good for children, and with adequate ophthalmic lenses will not be cheap. </p>
<p>Opticians and optometrists should be consulted if protective contact lenses are to be used. For active wearers, there are several lens brands that already offer adequate UV protection. A well-known company has also just launched the first photochromic contact lens, which tints when exposed to the sun. </p>
<p>The combination of contact lenses and sunglasses is optimal and ideal. The lens covers the entire cornea and pupil, as well as part of the white of the eye, blocking the sun’s rays. Besides cutting the sun that reaches the eyes directly, the lens also protects the sides. The sunglasses also provide total UV protection, reduce glare and the choice of shade ensures adequate patient comfort. </p>
<p>Anyone who is exposed to or works in the sun should also consider applying sunscreen — and then you’re ready for summer!</p><img src="https://counter.theconversation.com/content/116498/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Langis Michaud ne travaille pas, ne conseille pas, ne possède pas de parts, ne reçoit pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'a déclaré aucune autre affiliation que son organisme de recherche.</span></em></p>The sun emits harmful rays 365 days a year, even when cloudy or rainy. Children must be protected or they may develop cataracts at an earlier age and run the risk of skin cancer of the eyelids.Langis Michaud, Professeur Titulaire. École d'optométrie. Expertise en santé oculaire et usage des lentilles cornéennes spécialisées, Université de MontréalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1172002019-05-16T09:26:41Z2019-05-16T09:26:41ZEbola survivors can lose their eyesight. What we’re doing to prevent it<figure><img src="https://images.theconversation.com/files/274875/original/file-20190516-69192-luwiec.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A health worker looks on at an Ebola transit centre in Beni in North Kivu province, DRC. </span> <span class="attribution"><span class="source"> Hugh Kinsella Cunningham/EPA</span></span></figcaption></figure><p>The ongoing Ebola outbreak in the Democratic Republic of Congo (DRC) is the largest outbreak in the country since <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2395567/">1976</a> when the Ebola virus was first identified in what was then known as Zaire. </p>
<p>The outbreak is happening against a backdrop of security instability, distrust of outsiders and limited resources. More than <a href="https://www.who.int/ebola/situation-reports/drc-2018/en/">1700</a> cases of the disease and over 1100 deaths have been reported since it began in August 2018.</p>
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Read more:
<a href="https://theconversation.com/ebola-returns-to-the-drc-for-the-10th-time-heres-what-we-know-101048">Ebola returns to the DRC for the 10th time: here's what we know</a>
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<p>To improve clinical outcomes and quell the spread of the outbreak in the DRC, lessons from the West African Ebola outbreak of <a href="https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html">2013 to 2016</a> have been implemented. Given that thousands of Ebola survivors reside in West Africa, the global community also learned about the high risk of health complications after acute Ebola virus disease. </p>
<p>Research done so far has identified a range of complications. These include arthritis, abdominal pain, mental health as well as eye complications.</p>
<p>We have done extensive investigation on <a href="https://www.ncbi.nlm.nih.gov/pubmed/27914832">how Ebola affects the vision</a> of people who have survived the disease. So far we have established that an inflammatory disease of the eye develops in around 25% of survivors and the risk increases over time.</p>
<p>To take our earlier patient care and research forward, we recently partnered with the Ministry of Health in the DRC and the World Health Organisation <a href="https://extranet.who.int/goarn/">Global Outbreak and Alert Response Network</a> to evaluate Ebola survivors in the DRC. The partnership is based on the knowledge that Ebola virus could lead to eye complications and vision problems.</p>
<p>The goal was to identify patients with eye disease as soon after they left an Ebola treatment centre as possible. And to treat them to avoid the kind of vision-threatening complications that we observed in West Africa.</p>
<h2>After disease recovery</h2>
<p>In our past research we identified a condition that develops in Ebola survivors – <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547451/">uveitis</a>. Uveitis is an inflammatory condition of the eye that may lead to redness, pain, light sensitivity and ultimately vision loss. Given the range of systemic symptoms that can develop after surviving Ebola, <a href="https://www.nytimes.com/2017/10/19/health/ebola-survivors-cataracts.html">the risk of vision loss</a> can be particularly challenging to activities of daily living, school and work. </p>
<p>We showed in earlier research that Ebola virus may persist in the eye, even after it has cleared from the bloodstream, in the same manner that it persists in other organs that are isolated from the immune system. These include the central nervous system, reproductive organs and eyes. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547451/">Ebola virus was first identified in the eye</a> of a repatriated US health care worker and survivor who developed sight-threatening uveitis after recovering from critical Ebola illness in 2014. </p>
<p>After this initial description of Ebola virus persistence leading to uveitis, physicians from Emory University and partnering organisations evaluated over 1200 Ebola survivors in West Africa. This led to a better understanding of how uveitis affected vision, and the development of treatment protocols for medical and surgical care.</p>
<p>The insights we gained in West Africa directly informed the work we are doing with Ebola survivors it the DRC.</p>
<h2>Translating lessons</h2>
<p>In March this year ophthalmologists worked together to conduct an <a href="https://www.who.int/news-room/feature-stories/detail/eye-care-for-ebola-survivors">“Eye Care in Ebola Survivor” symposium</a> for 10 ophthalmologists from multiple cities in DRC. The cities they came from included Bukavu, Butembo, Bunia, Goma, and Kinshasa. </p>
<p>The training symposium provided a forum to discuss eye complications associated with Ebola, the current status of eye care in the DRC as well as ways of strengthening vision care in the region. We also discussed case presentations to learn to distinguish Ebola from other infectious diseases.</p>
<p>After the training we screened more than 250 survivors for eye disease and treated their ailments. The eye problems we found included uveitis, retinal scarring, corneal disease and glaucoma.</p>
<p>While some of these, such as uveitis and retinal scarring, have been associated with Ebola, others were non-specific. This emphasised the need for a range of ophthalmic care in the eastern DRC. Strikingly, nearly one-third of survivors requiring eye examinations were infants and children. This underscores the need for vision care services for paediatric patients. </p>
<p>This is the earliest that an intervention has been put in place during an Ebola outbreak. The hope is that it will significantly reduce long term damage to people’s eyes.</p>
<h2>Continuing surveillance</h2>
<p>Although the Ebola outbreak in West Africa taught the global community about uveitis and the danger of vision impairment, translating these lessons into improved vision health remains an ongoing necessity in the DRC.</p>
<p>A key component of survivor health includes counselling patients on the risk of uveitis and the symptoms they should be aware of so they can seek urgent eye care. </p>
<p>Surveillance of eye disease in survivors remains critical – given the security concerns and instability, community mistrust, and funding gaps, the growing Ebola outbreak will require ongoing ophthalmic support.</p><img src="https://counter.theconversation.com/content/117200/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steven Yeh receives funding from the National Institutes of Health, Research to Prevent Blindness, Bayer Global Ophthalmology Awards Program, Emory University, World Health Organization and the Macula Society. </span></em></p><p class="fine-print"><em><span>Dr. Shantha receives funding from the Building Interdisciplinary Research Careers in Women’s Health of the National Institutes of Health K12HD085850.</span></em></p><p class="fine-print"><em><span>Jean-Claude Mwanza does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Research has identified a range of health complications in Ebola survivors. These include eye complications and vision problems.Steven Yeh, Professor of Ophthalmology, Emory UniversityJean-Claude Mwanza, Associate professor, University of North Carolina at Chapel HillJessica Shantha, Assistant Professor , Emory UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1072162018-12-05T15:13:12Z2018-12-05T15:13:12ZWhy Victorians feared modern technology would make everyone blind<figure><img src="https://images.theconversation.com/files/248998/original/file-20181205-186076-caliv1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Examination by ophthalmoscope in JF Phillips' Ophthalmic Surgery and Treatment, 1869.</span> <span class="attribution"><a class="source" href="https://wellcomelibrary.org/item/b21072280#?c=0&m=0&s=0&cv=509&z=-0.2641%2C-0.1021%2C1.7312%2C1.2445">Wellcome Library </a></span></figcaption></figure><p>From concerns over <a href="https://www.thisisinsider.com/do-blue-light-blocking-glasses-work-2018-11">blue light</a> to <a href="https://www.bustle.com/p/are-smartphones-making-our-eyes-worse-heres-how-to-protect-yourself-according-to-experts-9179808">digital strain</a> and <a href="https://www.nhs.uk/news/lifestyle-and-exercise/office-screen-work-linked-to-dry-eye-syndrome/">dryness</a>, headlines today often worry how smartphones and computer screens might be affecting the health of our eyes. But while the technology may be new, this concern certainly isn’t. Since Victorian times people have been concerned about how new innovations might damage eyesight. </p>
<p>In the 1800s, the rise of mass print was both blamed for an increase in eye problems and was responsible for dramatising the fallibility of vision too. As the amount of known eye problems increased, the Victorians predicted that without appropriate care and attention Britain’s population would become blind. In 1884, an article in The Morning Post newspaper proposed that: </p>
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<p>The culture of the eyes and efforts to improve the faculty of seeing must become matters of attentive consideration and practice, unless the deterioration is to continue and future generations are to grope about the world purblind. </p>
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<p>The 19th century was the time when opthamology <a href="http://fs.aoa.org/optometry-archives/optometry-timeline.html">became a more prominent field</a> of healthcare. New diagnostic technologies, <a href="https://www.college-optometrists.org/the-college/museum/online-exhibitions/virtual-ophthalmic-instrument-gallery/test-charts.html">such as test charts</a> were introduced and spectacles became a <a href="http://blog.wellcomelibrary.org/2016/08/what-did-the-victorians-make-of-spectacles/">more viable treatment method</a> for a range of vision errors. But though more sight problems were being treated effectively, this very increase created alarm, and a subsequent perceived need to curtail any growth. </p>
<p>In 1889 the Illustrated London News questioned: </p>
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<p>To what are we coming? … Now we are informed by men of science that the eyes used so effectively by our forefathers will not suffice for us, and that there is a prospect of England becoming purblind.</p>
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<p>The article continued, considering potential causes for this acceleration, and concluded that it could be partly explained by evolution and inheritance. </p>
<h2>Urban myopia</h2>
<p>Other commentators looked to “modern life” for explanation, and attributed the so-called “deterioration of vision” to the built environment, the rise of print, compulsory education, and a range of new innovations such as steam power. In 1892, an article, published in The Nineteenth Century: A Monthly Review, reflected that the changing space of Victorian towns and lighting conditions were an “inestimable benefit” that needed to be set against a “decidedly lower sight average”. Similarly, a number of other newspapers reported on this phenomenon, headlining it as “urban myopia”.</p>
<p>In 1898, a feature published in The Scottish Review – ironically entitled “The Vaunts of Modern Progress” – proposed that defective eyesight was “exclusively the consequence of the present conditions of civilised life”. It highlighted that many advances being discussed in the context of “progress” – including material prosperity, expansion of industry and the rise of commerce – had a detrimental effect on the body’s nervous system and visual health. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/248997/original/file-20181205-186052-hmkbow.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/248997/original/file-20181205-186052-hmkbow.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/248997/original/file-20181205-186052-hmkbow.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=376&fit=crop&dpr=1 600w, https://images.theconversation.com/files/248997/original/file-20181205-186052-hmkbow.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=376&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/248997/original/file-20181205-186052-hmkbow.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=376&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/248997/original/file-20181205-186052-hmkbow.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=473&fit=crop&dpr=1 754w, https://images.theconversation.com/files/248997/original/file-20181205-186052-hmkbow.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=473&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/248997/original/file-20181205-186052-hmkbow.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=473&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Reading advice from JD Browning’s 1887 book Our Eyes and How to Preserve Them from Infancy to Old Age.</span>
<span class="attribution"><a class="source" href="https://wellcomelibrary.org/item/b20392473#?c=0&m=0&s=0&cv=0&z=-0.6516%2C-0.0828%2C2.303%2C1.6556">Wellcome Library</a></span>
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<p>Another concern of the time – <a href="https://www.joh.cam.ac.uk/early-19th-century-guide-getting-fitness-spirit">sedentariness</a> – was also linked to the rise in eye problems. Better transport links and new leisure activities that <a href="https://theconversation.com/anthropocene-why-the-chair-should-be-the-symbol-for-our-sedentary-age-105319">required the person to be seated</a> meant people had more time to read. Work changed as well, with lower-class jobs moving away from manual labour and the written word thought to have superseded the spoken one. While we now focus on “screen time”, newspapers and periodicals emphasised the negative effects of a “reading age” (the spread of the book and popular print).</p>
<h2>Education to blame</h2>
<p><a href="https://www.thetimes.co.uk/article/bad-news-pupils-studying-damages-eyesight-mnsd8vh09">In a similar manner to today</a>, schools were blamed for the problem too. Reading materials, lighting conditions, desk space, and the advent of compulsory education were all linked to the rise in diagnosed conditions. English ophthalmologist Robert Brudenell Carter, in his government-led study, Eyesight in Schools, reached the balanced conclusion that while schooling conditions may be a problem, more statistics were required to fully assess the situation. Though Carter did not wish to “play the part of an alarmist”, a number of periodicals dramatised their coverage with phrases such as “The Evils of Our School System”. </p>
<p>The problem with all of these new environmental conditions was that they were considered “artificial”. To emphasise this point, medical men frequently compared their findings of poor eye health against the superior vision of “savages” and the effect of captivity on the vision of animals. This in turn gave a more negative interpretation of the relationship between civilisation and “progress”, and conclusions were used to support the idea that deteriorating vision was an accompaniment of the urban environment and modern leisure pursuits – specific characteristics of the Western world. </p>
<p>And yet the Victorians were undeterred, and continued with the very modern progress that they blamed for eyesight problems. Instead, <a href="https://www.college-optometrists.org/the-college/museum/online-exhibitions/virtual-spectacles-gallery/nineteenth-century-spectacles.html">new protective eyewear was developed</a> that sought to protect the eye from dust and flying particles, as well as from the bright lights at seaside resorts, and artificial lighting in the home.</p>
<p>Despite their fears, the country did not become “purblind”. Neither is Britain now an “island full of round-backed, blear-eyed book worms” as predicted. While stories reported today tend to rely on more rigorous research when it comes to screen time and eye health, it just goes to show that “modernity” has long been a cause for concern.</p><img src="https://counter.theconversation.com/content/107216/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gemma Almond has received AHRC funding for this research as part of her collaborative doctoral award at Swansea University and the Science Museum. </span></em></p>Screen time wasn’t a issue in the 19th century but that didn’t stop concerns over how new developments might damage eyesightGemma Almond, PhD Researcher, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.