Revised Adult Eye Exam Recommendations

In a recent WebMD Eye on Vision blog we discussed the need for periodic eye exams for preschoolers and students.

So, what about adults? How often should they get to the eye clinic?

Did you know that 43 million American adults will face significant vision loss or blindness from age-related eye diseases? Many are treatable (even curable) if they are promptly diagnosed and treated.

It just so happens that the American Academy of Ophthalmology (AAO) has just revised its adult screening recommendations:

• Adults with no risk factors should get a baseline eye disease screening at age 40 - the time when early signs of disease and changes in vision may start to occur - and have follow-up screenings at regular intervals prescribed by an ophthalmologist. There is no universal formula (every 2 years, every 5 years, etc.) mandated.


• Those with symptoms or those at risk for eye disease at any age should see an ophthalmologist to determine how frequently their eyes should be examined. This specifically applies to those at-risk for glaucoma or with a family history of inherited eye disorders.

According to AAO these new recommendation do not replace regular visits to the ophthalmologist to treat ongoing disease or injuries, or vision examinations for eye glasses or contact lenses. Much like mammograms at 40 or colon screenings at 50, this new eye disease screening is a health care reminder to adults as they age that they need to be screened for possible eye diseases.

For most adults the process is automatic! Since most folks start noticing problems focusing at near around age 40 (presbyopia) they are likely to initiate that first visit.

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• WebMD Video: Age-Related Vision Loss
• Milestone Medical Tests in your 40s

Technorati Tags: eye exam, vision, eye health, health and wellness

Good News About Botulism?

By now you've probably heard about the FDA nationwide recall of canned meat products (and, curiously, dog food!) from a Castleberry Food Products plant in Augusta, Georgia. Hot dog chili sauce and other canned items marketed under multiple different brands are involved - including Kroger.

FDA claims these canned products are contaminated with a dangerous bacterium, Clostridium botulinum. The germ releases a deadly, paralyzing toxin - that's botulism.

People have feared botulism since they began canning food. Remember your mom's advice never to buy food in swollen cans with protruding (convex) tops? That wise advice still rings true today.

So, why should an ophthalmologist care about botulism? Microdoses of purified botulinum toxin constitutes BOTOX, the miracle wrinkle eradicator. Long before healthy adults began voluntarily eliminating their facial expressions ophthalmologists were injecting BOTOX into eligible patients with overactive eyelid muscles (treating blepharospasm) and overactive extraocular muscles (correcting strabismus).

For medical trivia buffs, blepharospasm was the first FDA-approved indication for injectable BOTOX back in the 1980s. Prior to BOTOX, patients with blepharospasm (continuous involuntary blinking) often underwent surgery to have the twitching muscles removed, leaving the patient with unattractive droopy lids.

As a drug, injectable BOTOX selectively paralyzes overacting muscle fibers. It only works for a few months but repeated injections result in muscle atrophy and permanent resolution.

Before long this canned food contamination crisis will pass. Hopefully very few folks will be exposed to these deadly germs. Meanwhile, medical-grade botulinum toxin (BOTOX) continues to help patients with a wide range of concerns: chronic back pain, crooked eyes, blepharospasm, excess sweating, and deeply-furrowed facial wrinkles!

Believe in silver linings? The BOTOX story is proof that good things can come from what was once (and is still) feared!

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• Botulism FAQs
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Technorati Tags: Botox, FDA recall, food poisoning, botulism, Castleberry Food, health and wellness

Are Preschool Eye Exams Necessary?

It seems that schools open earlier and earlier each year. Many families are already busy with their back-to-school checklists.

Should an eye exam be on your checklist for your young students?

Here is an excerpted Joint Policy Statement from the American Academy of Pediatricians, the American Academy of Ophthalmology, and the American Association for Pediatric Ophthalmology and Strabismus:

Early detection of treatable eye disease in infancy and childhood can have far reaching implications for vision and, in some cases, for general health.

Good vision is essential for proper physical development and educational progress in growing children. The American Association for Pediatric Ophthalmology and Strabismus, the American Academy of Ophthalmology, the American Academy of Pediatrics, the American Academy of Family Physicians and the American Association of Certified Orthoptists recommend early vision screening.

Vision screening programs should provide widespread, effective testing of preschool and early school-age children.

Many school systems have regular vision screening programs that are carried out by volunteer professionals, school nurses, and/or properly trained lay persons. Screening can be done quickly, accurately, and with minimum expense by one of these individuals. The screener should not have a vested interest in the screening outcome. As with all screening programs, vision screening should be performed in a fashion that maximizes the rate of problem detection while minimizing unnecessary referrals and cost. Beginning in the preschool years, those conditions which can be detected by vision screening using an acuity chart are: reduced vision in one or both eyes from amblyopia, uncorrected refractive errors or other eye defects and, in most cases, misalignment of the eyes (called strabismus).

Refractive errors cause decreased vision, visual discomfort ("eye strain"), and/or amblyopia. The most common form, nearsightedness (poor distance vision) is usually seen in school-age children and is treated effectively, in most cases, with glasses. Farsightedness can cause problems with focusing at near and may be treated with glasses. Astigmatism (imperfect curvature of the front surfaces of the eye) also requires corrective lenses if it produces blurred vision or discomfort. Uncorrected refractive errors can cause amblyopia particularly if they are severe or are different between the two eyes.

In addition to detection of vision problems, effective screening programs should also place emphasis on a mechanism to inform parents of screening failures and attempt to ensure that proper follow-up care is received.

The American Academy of Ophthalmology and the American Association for Pediatric Ophthalmology and Strabismus recommend an ophthalmological examination be performed whenever questions arise about the health of the visual system of a child of any age. They recommend that infants and children be screened for vision problems as follows and any child who does not pass these screening tests have an ophthalmological examination.

Vision screening should also be performed between 3 and 3 1/2 years of age. Vision and alignment should be assessed by a pediatrician, family practitioner, ophthalmologist, optometrist, orthoptist, or individual trained in vision assessment of preschool children. Emphasis should be placed on checking visual acuity. as soon as a child is cooperative enough to complete the examination. Generally, this occurs between ages 2 ½ to 3 ½. It is essential that a formal testing of visual acuity be performed by the age of 5 years.

Further screening examinations should be done at routine school checks or after the appearance of symptoms. Routine comprehensive professional eye examination of the normal asymptomatic child has no proven medical benefit.

School aged children who pass standard vision screening tests but who demonstrate difficulties learning to read, should be referred to reading specialists such as educational psychologists for evaluation for language processing disorders such as dyslexia. There is not adequate scientific evidence to suggest that “defective eye teaming”, and “accommodative disorders” are common causes of educational impairment. Hence, routine screening for these conditions is not recommended.

Here's a nutshell summary:

• Every child does not need a preschool eye exam every year


• Vision should be measured in every child before age 5


• Properly performed school vision checks are sufficient if good vision is recorded


• Children with any vision symptoms deserve a prompt, comprehensive eye examination by a qualified eye doctor
  

Related Topics:

• WebMD Video: Preschool Eye Exams - Get Kids Tested Early
• WebMD Video: Contact Lenses for Your Child?

Technorati Tags: eye exam, vision, pediatrics, back to school, health and wellness

Carmona: Heroic Legacy?

Not long ago someone asked me to define heroism. A hero is a person who will say or do the right thing to help others even at great personal expense. Are there any heroes in modern-day politics?

Highly critical comments made by former Surgeon General Richard Carmona against the Bush Administration (photo taken when President Bush announced Carmona's 2002 nomination) fail to meet the "sniff test" for heroism. In fact, I smell something totally different.

Dr. Carmona was a political appointee, plain and simple. After spending four years enduring White House and Cabinet restrictions regarding his comments as the nation's top physician, Camona has now decided to cry foul.

Carmona claims the White House gagged him regarding his observations regarding stem cell research, sex education, and plenty of other controversial topics. Did he have some special arrangement giving him autonomy to speak his mind - even if it conflicted with Administration policy?

Two mysteries remain to be solved. First, why on earth did Doctor Carmona continue to serve for four years despite what he described as "offensive treatment?" Wouldn't resignation offer an honorable platform upon which he could continue to educate the public on his own terms? Second, why would he then wait another full year to lambast the White House? Yeah, that's the real "sniff test!"

In summary, let's apply the heroes' test: As America's leading health official Richard Carmona remained silent when he should have been screaming, even if it would have cost him his job. His silence served neither his President or his fellow citizens.

Test results: No hero.

It's no big deal - he apparently didn't like the job anyway. Having left Washington, Carmona is now an executive with Canyon Ranch health resorts and a director for health-centric Taser International.

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Contact Lenses and Dry Eyes: New Thoughts Emerge

Folks with a proper fitting pair of contact lenses would rather surrender their firstborn (okay, too harsh, make it the TV remote) than give up the convenience and crisp vision offered by their daily disposables! That means they would possibly continue wearing contacts even if they were told that it was no longer a good idea.

Eye doctors often identify contact lens wearers that have developed dry eyes, typically middle-aged females. Up until now the dry eyes were attributed to the fact that baseline maintenance tear production decreases with age and with decreased sex hormone synthesis.

Oh, forgive this digression. Did you notice I used the phrase "sex hormone" and not simply estrogen? Researchers now say the balance between androgens (present in both genders, more so in men) and estrogen (present in both genders, more so in women) is critical in moderating tear production. Both men and women develop dry eyes but more so women, possibly because of the abrupt estrogen shift that occurs in women. We know for a fact that hormone replacement therapy in eligible menopausal women can greatly relieve their dry eyes.

Back to the conflict involving dry eyes in contact lens wearers. One myth perpetuated by eye doctors is the "competing sponge" theory. Dry eye patients already make insufficient moisture for the naked eye. Introducing that thirsty soft contact lens will absorb what little water is available in the tear film to further dessicate the cornea.

Useful, new information is now available. In many patients the contact lens itself is responsible, not hormones, not sponges. The presence of the contact lens partially (or totally) numbs the surface of the cornea. Here's what happens. The delicate sensory nerves residing within the superficial cornea, (the tiny nerve fibers that sense smoke or overly chlorinated pool water), also sense very tiny changes in tear film chemistry (pH, osmolarity, etc.). These nerves automatically send the appropriate signal to the lacrimal glands: make less tears, make more tears. Loss of corneal sensation interrupts that critical tear feedback loop. Numb corneas don't send signals!

The race is on to develop contact lenses that do not anesthetize the ocular surface, thus permitting continued, comfortable wear for many folks who stand ready to surrender that TV remote.

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• WebMD Video: Contact Lens Comfort
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Technorati Tags: contact lenses, dry eye, tears, vision, health and wellness

When "You're Normal" Fails to Reassure

As a WebMD Health Professional I see trends in health care and among health consumers. I don't create the trends, mind you, I only observe them. This is especially true when I moderate the WebMD Vision & Eye Disorders message board.

One worrisome trend is a familiar experience encountered by many WebMD visitors: "I sense something is wrong but my doctor tells me everything is normal." This has been the most frequent comment sent to me over the past few months - more and more patients aware that something in their vision is just not right yet the eye doctor's exam produces nothing.

In this situation, "You're normal" is not only not reassuring, it can be very frustrating. You've lived with those two eyes all your life and you know when something has changed. Where does that leave you?

Here are some thoughts on how to approach this good news/bad news scenario:

1. A "normal" exam can't be all bad. Imagine a worst-case scenario: you are fearful of a retinal detachment or an intraocular tumor (or both!) A comprehensive eye evaluation checks for all kinds of vision-threatening problems. Subtle, early changes can be identified. When the doctor finds nothing worrisome that is valuable information.


2. Don't jump to conclusions. A "normal" exam does not mean "missed diagnosis." If nothing else, it is a superb baseline for future comparison. All of the findings are recorded in the exam notes and will be kept indefinitely.


3. Keep communications open. Politely probe for the doctor's reasoning that explains your symptoms. Beware of cliches like "You're just getting older" or "We really don't know why everything looks blue to you." This is 2007 and we have some workable answers for most eye problems. No, there's not always a remedy, but good doctors usually can offer an accurate explanation. Failing that, a more extensive workup would be advised.


4. Ask for a follow-up plan. Don't be brushed aside. Ask specific questions regarding if/when you should return. Ask about any warning signals.


5. Consider a second opinion. This is not necessarily going over your doctor's head. In fact, your doctor can help arrange a consultant exam. Most busy doctors welcome the expert opinion of a more experienced practitioner when the diagnosis is elusive.

Follow your instincts. Get ready for this: You may be right and your doctor may be wrong. In my own practice I have witnessed the power of persistence. Patients with unexplained symptoms are more likely to get to the bottom of their problems by partnering with the eye doctor, clearly and emphatically describing those genuine concerns without resentment or hysterics.

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Technorati Tags: vision, eye exam, eye disorders, health and wellness

SiCKO: Disappointingly Entertaining

Well, I've done it. I followed my own advice, plopped down $10 and sat through Michael Moore's new mockumentary SiCKO.

Not long ago I posted here that everybody should go see the film simply to stimulate discussion about our nation's health care delivery system.

Most filmgoers are aware of Moore's nonjournalistic approach. He does not play fair, nor is he required to play fair. Most of the folks he interviews are shills. Again and again Moore expresses mock amazement whenever he hears that a Canadian or European does not pay (directly) for their health care. It's a bit overacted.

The segment that really captivated me was an interview with a retired British politician named Tony Benn. He's an extraordinarily articulate gentleman. As Benn explained, the UK universal health plan evolved after WWII. An enormous sum of money was spent to win the war and to rebuild the damaged country afterwards. The national debate boiled down to one fundamental concept, "If we have enough money to kill Germans we have enough money to protect the health of our own citizens." I found this a disturbingly simple and unarguable concept. Ten days later and I'm still thinking about it.

Two bits chafed: one involving a mislabeled act of charity and the second demonstrating no charity whatsoever. Moore describes how he "anonymously" sent $12,000 to a long-time critical blogger who had medical bills but no health insurance. The massive debt required the blogger to discontinue his online "anti-Moore" activities. If this was a genuine, anonymous act the audience (and the recipient) should never have learned about it. The stunt involving the transport of sick 9-11 rescue volunteers to Cuba was uncaring grandstanding. The footage was staged and unconvincing. Perhaps Moore simply should have written a few more anonymous checks.

Enough already, it's only a film!

Go see it. Enjoy it. Ponder it. Discuss it. Help fix the health care mess.

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Technorati Tags: health insurance, Michael Moore, Sicko, medicine, health and wellness

Selecting Sensational Shades

Photo Credit: Ummo

Sunglasses are one of the most prominent fashion statements a person can make. The change they provide to your appearance is immediate and dramatic. The price tage can be equally dramatic - some tinted eyewear can cost $500 per pair.

Whether your next pair of shades is found at Neiman-Marcus or at a nearby red light intersection, here's a helpful checklist to help savvy consumers select useful features and avoid worthless add-ons.

Here's the first bright idea. No matter what style shaded interest you make sure the lenses offer 100% UVA/UVB protection. UV rays can damage nearly every structure inside the eye as well as the eyelid skin. Ultraviolet is invisible so the degree of tinting makes no difference (in fact, clear spectacle lenses ought to be 100% UVA/UVB safe as well!) Quality eyewear sold by the leading manufacturers usually offer full UV protection.

Lens durability is just as important. For those who wear their shades while engaged in vigorous physical activity (volleyball, water skiing, weed edging) should look for polycarbonate lenses. This sturdy lightweight material is extremely shatter resistant.

Don't get hung-up on designer labels. Hugo Boss does not make sunglasses. Calvin Klein does not make sunglasses, instead they sell sunglasses with the 'CK' stamped on them! Truth be told, there is a relatively small number of eyewear frame fabricators who license the designers' names in order to market their product line. The designers themselves would advise you to choose quality, the ultimate value.

Photo Credit: Yu-Chi Lee

Are frames getting bigger or does everyone just look more like Spiderman? Be careful when buying large, wraparound sunglass frames if you need prescription lenses. Some lens designs will not fit these trendy curved frames - check with your optician beforehand.

Pay extra for Polarization? By eliminating harsh rays from the horizontal plane you can reduce glare and the intensity of sunlight. Drivers and boaters will immediately notice the difference.

Turn down the intensity. Neutral density lenses can be clear or grey and they absorb lots of visible light to make the great outdoors more tolerable on bright, sunny days. Pilots have relied on 'ND' lenses for years. This option is expensive but many discover the comfort justifies the added cost.

Photo Credit: Paolo Tonon

How dark do you go? Tinted lenses filter (absorb) very little visible light; tints mostly alter the wearer's color perception. This can be extremely subjective. I suggest you conduct the parking lot test with every new sunglass purchase. Once you've found a pair you like, ask the merchant if you can step outside into the parking lot. The real-world lighting conditions are very different than the artificially illuminated environment inside the store. It's outside where you can really decide if you like what you see.

If color perception is important to you try a G-15 tint, another favorite of aviators.

Don't want two pair of glasses? Consider photochromic lenses that darken when you go outdoors. Ask the optician to try a trial pair before making the investment. Time how long it takes for the lenses to revert when entering/exiting a building...should be seconds, not minutes.

Photo Credit: Elizabeth Ellis

Save your money! Antireflective coatings aren't relevant to sunglasses. The coating spares observers from seeing lights reflecting off of your eyewear. You, the wearer, appreciate nothing but the added expense. TV personalities use antireflective coatings on their eyeglasses to eliminate studio light reflections.

Save more money! The eyewear business is extremely competitive. Look for package deals that include the eye exam and a new refraction. Some retailers offer free prescription sunglasses when you but a pair of regular spectacles. Does the merchant offer insurance against loss or damage? Do your homework and save your cash for your next trip to the beach to show off those fabulous new shades!

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• WebMD Video: Tips for Choosing Sunglasses
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Technorati Tags: sunglasses, summer, sun, eyes, vision, health and wellness

Safety Eyewear Fails Testing

They're heavy, they're dorky, but they're made that way to protect your eyes from accidental injuries.

Every year in this country safety glasses are prescribed to millions of industrial workers, emergency responders, athletes and ordinary folks seeking protection from blinding eye injuries.

Most accidental eye injuries are preventable and safety eyewear is a time-honored preventive step. Many employers (as well as OSHA and insurers) demand that at-risk employees use safety glasses.

Did you know that over 2,000 work-related eye injuries occur every day in the USA? Eye injuries cost the economy over $300 million annually due to lost productivity, medical expenses and workers' compensation.

New data from the Illinois College of Optometry (ICO) challenges the effectiveness of protection in safety eyewear offered by several leading manufacturers.

The issue concerns a voluntary industry safety standard called ANSI Z87.1. Safety eyewear that claims to meet the ANSI 287.1 standard are expected to withstand a high velocity, high energy impact. ICO researchers tested 75 safety spectacle frames from five different manufacturers. Each frame was fitted with durable polycarbonate lenses by laboratory experts. The eyewear then underwent a series of high velocity, high mass pellet strikes that simulated real-world mechanical forces. The frames from half of the eyewear samples failed the safety tests. Metal frames fared poorest.

Only one manufacturer's products passed all of the tests - A2 frames from Hilco (photo above).

Eye safety experts point out that there is no government oversight regarding ANSI standards - it depends solely on manufacturer self-regulation. When eyewear frames break the lens can become dislodged, severely injuring the eye and other facial structures.

What to do? People exposed to the more dangerous types of projectile injuries (heavy industry, machinists, etc.) should have their present safety eyewear inspected. For all others their current spects will likely protect them from an opponent's thumb or a flying twig. If you are thinking about new safety spectacles check the labels! Ask the optician if their merchandise passed ANSI testing performed by an independent testing laboratory.

Reference: McMahon JM, Beckerman S. Testing safety eyewear: how frame and lens design affect lens retention. Optometry 2007; 78:78-87.

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Technorati Tags: vision, health and wellness, eye injuries, safety glasses