Here's why eye care matters: You want to be able to clearly see your kids and grandkids - and you want them to be able to see you. In fact, 7 out of 10 people would rather lose a limb than their eyesight, according to a new global survey by KRC Research for Bausch + Lomb. More than one million Americans 40 and older are legally blind, according to the National Eye Institute and Prevent Blindness America. And more than 68 percent of Americans 13 and older are "vision corrected," according to a Gallup poll.
What can you do to improve your family's vision? Dr. Calvin Roberts, chief medical officer for Bausch + Lomb and a clinical professor of ophthalmology at the Weill Medical College of Cornell University, talks with FamilyGoesStrong.com. Excerpts:
What survey result most surprised you?
What was interesting to me is how prevalent the myth is that if you see well, then you don't have a problem with your eyes, or the myth that the only reason you need to see an eye doctor is for your glasses or if you're having a problem seeing. There are so many conditions that are asymptomatic for a long period, and if you don't detect them early, you're not going to be able to do something to prevent the permanent loss of vision. [Eighty 80 percent of visual impairment can be prevented if it's detected and treated early enough.]
What do people need to know about glaucoma, which affects more than 2.3 million Americans 40 and older?
Glaucoma is a condition in which the pressure within your eye becomes too high. Your eye is like a beach ball or basketball. It has a certain inflation pressure that keeps it inflated. It's rare that the pressure becomes too low. But sometimes the pressure can become too high. The eye doesn't have the ability to expand. It's not elastic. So the pressure builds up, and the effect of it is it stops the ability of blood to do its normal flow in the eye and feed your eye. When you don't get the blood flow, you don't get the nutrition to the tissues in your eye that are responsible for vision. They die. The loss of vision from glaucoma is permanent. You can never get it back. This elevation of pressure doesn't hurt. You don't feel that the pressure in your eye is high. You have no symptoms. You don't know what's happening. As part of a routine examination, the doctor will measure the pressure within your eye, and if the pressure is too high, they can give you medication.
Is elevated pressure in your eye linked to high blood pressure?
It's not.
How is age-related macular degeneration different? [More than 2 million Americans 50 and older have advanced AMD.]
It's primarily a disease of the blood vessels within your eye. The blood vessels within the retina are the smallest blood vessels in your body. Should there be some process that's going on that slows down the ability of blood to circulate within your retina, then what happens is you lose that ability to read. People always ask do people with macular degeneration go blind. They lose the ability to read. They actually don't see the book. Initially they just see real blurry. It all brings back the importance of the routine eye exam. Smoking is the biggest risk factor for macular degeneration. When I see someone with early macular degeneration, my No. 1 request is get into a [smoking cessation] program.
What about cataracts, which affects nearly 22 million Americans 40 and older, according to the National Eye Institute? [As a practicing ophthalmologist from 1998 to 2008, Roberts performed more than 10,000 cataract surgeries.]
Macular degeneration doesn't happen to everyone, and glaucoma doesn't happen to everyone. Cataracts happen to everyone. It's just at what age. In your eye, there is this clear structure called the lens. The lens focuses the light within your eye and lets the light come in. As a normal part of aging, the lens loses its clarity. It starts developing a yellow color to it and over time loses more of its clarity. For some people, it happens as early as their 30s. The peak time for cataracts is the 60s and early 70s. The cloudiness of their lens gets to the point where they're not happy with the way they see, and now they want to have surgery. Surgery is the only treatment for cataracts. Either you live with the decreased amount of vision you have, or you have it operated on. Cataract surgery is the no. 1 most common surgery anywhere in the body. There are over 3 million cataract surgeries being done annually in the U.S.
It's not a big deal?
I think every surgery is a big deal. [But] it's ambulatory surgery. The surgery takes about 10 minutes. They take out the lens and replace it with a clear plastic lens.
Do people ever need to get it redone?
Once you've had cataract surgery, it should be good for your lifetime.
What about eye drops?
Sometimes we're in a very smoky environment, and smoke is quite an irritant to the eyes. Some lubricating eye drops will really help. Sometimes we're in a dry, low humidity environment. If you can keep these fine tissues most, that will help.
But you don't want to use lubricating drops all the time, right?
That's a myth. There's no such thing as overdoing how many eye drops you put in your eye, as long as they're purely lubricants. It's very different if you put a whitening drop in your eye. What happens with those, those have real active ingredients in there that are medicine. They constrict the blood vessels in your eye. Therefore, less blood flows through them. When you use these constrictors over time, you can develop a little dependence on them, so when you don't use them, your eyes can look redder. Eye whitening drops can be used sparingly, whereas pure lubricating drops can be used as much as needed. So something like Visine shouldn't be used excessively.
What about sunglasses?
Ultraviolet light, the way that it's harmful to your skin over time, is also harmful to your eyes and is one of the risk factors in the development of both cataracts and macular degeneration. What you want to do is be able to block ultraviolet light to your eyes. One way is with sunglasses. [Also], many of the contract lenses these days will have an ultraviolet filter. You can have clear glasses that block out ultraviolet. The tint is there mostly to reduce the volume of regular sunlight.
For comfort?
Correct. People often ask, "Should I have dark sunglasses or light sunglasses. Should I have gray? Should I have green?" That's really a personal preference. The color doesn't matter in terms of the protecting of your eyes. One thing that is important is you want to make sure the sunglasses are big enough that the light isn't coming around the lenses and into your eyes. Get either something that wraps around like an aviator or something a little bit larger.
Is it true that light-colored eyes are more sensitive than dark-colored ones?
There is some merit to that. Patients with lighter-colored eyes are more likely to get retinal problems like macular degeneration. It's just like skin color. The lighter eyes don't block the harmful rays as well as the darker color does.
What should people know about Lasik surgery?
Lasik is a great operation for the right person. The most important thing with Lasik surgery is to have a consultation with an experienced doctor who can tell you whether you are a right person. A person who needs their glasses or contacts all the time is the best candidate for Lasik surgery. I of course love when someone comes for a Lasix examination because it gives me an opportunity to do a full exam so we can detect all these other conditions. What's really common is someone thinks they're not seeing well, and comes for a Lasik examination, and it turns out they have cataracts. Or someone comes in for a Lasik examination, and I see the early signs of macular degeneration. The eye examination is not just about the eyes. In that eye examination, I'll be able to point to patients that they need to go see their internist about their blood pressure or potential heart disease or sometimes thyroid will show up in the examination. Through this eye examination, we could help to make the population healthier in terms of early detection of those diseases. The eyes are the windows into your body.
How can an eye exam detect heart disease?
Heart disease is primarily a disease of the blood vessels that supply the heart. A heart attack comes because you get a clog or a blockage in one of these blood vessels. The smallest blood vessels in the body are the ones that are in the retina of the eye. Whatever process is going to happen in the big blood vessels is going to happen sooner in the small blood vessels. We have readily available equipment that allows us to look into someone's eye and look at the blood vessels [to see] if there are any clogs or clots that are in there. That's a routine part of the eye exam. When the doctor gets real close and shines that bright light into your eye, he or she is looking primarily at the blood vessels in your eye.
What about age-related reading problems?
Everyone as they get older loses the ability to be able to focus their eyes from distance to near. The first symptom is that people will notice they need a little more light to be able to read. Then they notice they have to hold things farther away. Then they tell you their arm is not long enough. It's actually from the eye doctor's point of view a kind of good thing because it drives people into the office. Once they come in, worrying there's something wrong with their eyes that they can't read, you have an opportunity to examine them [for] early signs of glaucoma, macular degeneration and all these blood vessel changes.
What can midlifers who are already wearing contact lenses for distance do to correct their vision for reading, too?
Your choices are No. 1, one contact lens for distance, one for near. No. 2, bifocal contact lenses. The third is to wear your distance contact lenses and then to wear over-the-counter reading glasses.
Which is best to try first?
The best alternative is the multifocal contact lenses, if you can find them comfortable. You have the best of all worlds because you'll have good distance vision and near vision from both eyes. Not everyone is comfortable with that. There are a lot of subtleties about why, such as the shape of their eyes."
But there is no daily disposable bifocal contact lens, right?
There will be soon.
Is wearing one contact lens for distance and one for reading safe for driving?
That is safe for driving. It's a situation where some people make that adjustment really easily, and some people can't do it at all and find that they're off balance.
Responsible 8- and 9-year-olds can wear contact lenses. What's your take on the best eye care approach for young users?
Daily disposables are great. They take away the care issue from the process. They just wear them and throw that out. The negative is the daily disposables tend to be more expensive, probably a factor of three times more expensive to have daily disposables than to have the monthly replacements and the contact lens solution.
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