Is There A Visual Gender Gap'?

The discussion of 'women's health' often centers on breast disease, hormone replacement and poorly communicated gynecologic issues. That's unfortunate because women experience many other familiar health maladies disproportionately more than males. For example, more women over age 65 die from heart attacks than do men. This kind of information doesn't get publicized enough. By the way, two-thirds of adults over 40 with diabetic retinopathy are women. I bet you didn't know that either.

The same thing applies to Age-Related Macular Degeneration (AMD). About 200,000 new cases of AMD are diagnosed yearly in America, females almost double the number of males. Since advanced age is the top risk factor for developing AMD and because women typically live longer than men there are more older females and more of them develop AMD.

Other known AMD risk factors include smoking, obesity, family history, and race.

The early stage of AMD may have no symptoms (or the symptoms may overlap with the development of cataract or other active eye conditions). It takes a dilated retinal evaluation in order for AMD to be diagnosed. Early AMD is followed conservatively since most folks do not progress to the more worrisome intermediate and advanced stages of AMD.

Routine eye exams and at-home testing with a handheld paper chart is all that's necessary for early AMD. Any changes in vision warrant prompt re-examination.

Aggressive consumption of vitamins, minerals and antioxidants may delay progression of AMD from the intermediate stage to the advanced stage. When abnormal blood vessels grow and leak underneath the retina the advanced stage of AMD has arrived. Laser treatment and injectable biologic compounds can stop these abnormal vessels and preserve precious reading and driving vision.

Did you know that April has been declared 'Women's Eye Health and Safety Month'? You can learn more by visiting the national nonprofit Prevent Blindness.

Related Topics:

• Eye Problems and Diabetes
• Health Checklist for Women Over 40

Technorati Tags: women, health, eye health, diabetic retinopathy, AMD


Image: istockphoto.com

Airbags Save Lives, May Sacrifice Eyesight

Compared to 25 years ago, today's motor vehicle occupants survive high impact collisions 32% more frequently thanks to the use of seat belts (primary restraints) and vehicle airbags (supplemental restraints). Believe me, I would much rather drive around with these devices in my car than without them. As with every safety system there have to be compromises. For example, above 50 mph seat belts are pretty useless in a head-on collision because the mechanics of the crash exceed the physical tolerance of the seat belt webbing. At low speeds an unrestrained front seat passenger is in grave danger if the airbag deploys. The airbag may cause more injuries than the crash itself.

Five percent of motor vehicle accident victim injuries involve eye trauma caused by facial contact with a deploying airbag. With sudden deceleration the body is moving forward to meet the exploding airbag. That's right, exploding! The airbag inflates in less than 50 milliseconds - faster than a blink. The expanding gas used for rapid airbag inflation is generated by a small controlled explosion inside the dashboard.

Ophthalmologists from Brown University and Penn State University medical schools wanted to analyze the variety of eye injuries that occur in airbag-deployed collisions. They scoured over 9,000 records from a single metropolitain Level 1 trauma center between 1997-2005. They discovered 47 documented eye injuries.

Here's how the numbers broke down with the occupants of the 47 airbag-worthy crashes:

• 21 of 47 occupants did not wear seatbelts and 71% of them sustained serious eye injuries
  
• Only 76% of this group recovered 20/40 vision or better
  
• 14% of this group ended up legally blind

Meanwhile

• 26 of 47 occupants were wearing seatbelts and only 31% sustained serious eye injuries
  
• 96% of this group recovered 20/40 vision or better
  
• Nobody in this group ended up legally blind

The authors conclude that seatbelt use is associated with fewer airbag eye injuries, less severe eye injuries, and better visual outcomes.

So, now you have two reasons to wear your seatbelt: to protect your life after colliding with other vehicles and to protect your precious eyesight from your own airbag.

REFERENCE: Rao SK. Ophthalmology, March 2008, pages 573-576.

Related Topics:

• Test Your Skills: Car Safety Quiz
• Whiplash: What Predicts Recovery?

Technorati Tags: auto, safety, airbags, eye, injury

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'Robo4' Gene May Unlock Cure for Blinding Conditions

Age-Related Macular Degeneration (AMD) and Proliferative Diabetic Retinopathy (PDR) are two leading causes of permanent vision loss. Their clinical presentations and their causes are very different. Even so, both severe eye disorders share one important feature: an abnormal proliferation of weepy blood vessels that leads to hemorrhage, inflammation, membrane formation and progressive retinal obliteration.

Until recently both AMD and PDR were treated in similar fashion: perform photographic studies to document new vessel growth followed by laser treatments to temporarily arrest the new vessels. The above photo shows what the retina looks like after hundreds of therapeutic laser spots have been applied. It was a real cat-and-mouse game. Injectable medications have recently been FDA-approved for AMD and many patients do enjoy a vigorous response. Neither laser or injectable anti-vessel drugs are permanent cures.

According to recent findings published in the journal Nature Medicine, there may be an easier and more effective way to protect the eye from these ambitious new blood vessels.

Vision researchers from numerous teaching centers collaborated in the discovery of a natural protein expressed by a strip of DNA called the 'Robo4' gene. When activated, Robo4 deactivates the powerful chemical signals that stimulate growth of those leaky blood vessels.

According to a press release from the host laboratory at the University of Utah:

"Many diseases are caused by injury or inflammation destabilizing blood vessels and causing them to leak fluid into adjacent tissues as well. We found a natural pathway - the Robo4 pathway - that counterattacks this by stabilizing blood vessels. Robo4 tells the vessels not to grow, to stabilize, not to explore. The blood vessels have an instruction system that tells them to do the opposite, to stabilize. This is a major breakthrough in an area where the advances have been minimal. We are excited about taking this opening and moving the frontier forward with real hope for patients who have but few, often disappointing, options."

The researchers tested the power of Robo4 in mice eyes because they are very similar to human eyes. They successfully demonstrated that Robo4 activation curbed new vessel development.

It is theorized that some type of gene therapy involving Robo4 could be prescribed for humans at-risk for either AMD or PDR - perhaps an injection or an eyedrop. Lengthy clinical studies must prove that Robo4 treatment is safe and effective, so it will be years before it could be available to AMD and PDR patients. Impatience aside, if Robo4 can deliver as promised a huge number of adults could be spared permanent visual disability.

Related Topics:

• 'Robo' Gene Fights Macular Degeneration
• 7 Health Challenges of Aging

Technorati Tags: Robo 4, blindness, AMD, macualr degeneration, PDR, diabetic retinopathy, vision

Is Red Your Favorite Color?

Photo Credit: Chris Vaughan

Anybody who visits our WebMD Eye & Vision Disorder member community quickly discovers that many online visitors are dealing with red eyes. Some are inflamed, painful red eyes that need emergency attention. Some red eyes are mildly irritated or itchy. Others are red from time-to-time but generate no other symptoms.

I enjoy helping people understand the likely reasons for the redness and offering sensible precautions in order that they protect themselves from serious problems.

The most challenging red eye inquiries involve contact lens wearers:

• My eyes turn red only when wear my contact past 18 hours.


• The redness starts as soon as I insert my contact lenses.


• I removed my contact lens but the redness and pain persisted.


• I have dry eyes but I cannot function without my contact lenses.

Any of these sound familiar to you?

There's good reason to be paranoid about contact lenses. Sometimes the most fastidious (germophobic, soap-loving) person can get into serious trouble (corneal ulcer, for example), and redness is often the earliest clue. I have some powerful advice to share.

Here it comes, and I hope that you are sitting down:

If your eye turns red while wearing a contact lens immediately remove and store the contact lens. Do not reinsert the contact lens until your eye doctor gives permission.

Even if the contact lens is not the cause of the eye's redness, its presence may add to the irritation. This occurs all the time with viral pinkeye.

Now let's say that whatever problem causing the red eye is resolved. When is it appropriate to resume contact lens wear? All too often impatient contact lens wearers jump the gun and end up right back at square one. Once the inflammation/irritation has cleared and the eye turns white give yourself 5-7 days before resuming contact lenses. It would also be wise to begin with an abbreviated wearing schedule: 2-4 hours on the first day and build up from there. If redness recurs, remove the contact lenses and contact your prescribing eye doctor.

If you need to visit the eye doctor for any contact lens-related symptoms always be sure to bring your contact lenses, the carrying case and all lens solutions with you to the clinic. Should infection be suspected, each of these items may be tested for contamination.

Remember, red is universally recognized as a warning, and that applies to your eyes as well.

Related Topics:

• WebMD Video: Contact Lenses That Breathe
• Contact Lens Care

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Contemplating LASIK? Medication Checklist

Photo Credit: Drew McKinney

As part of routine preoperative counseling ophthalmologists give lots of instructions to their surgery candidates. Do this, don't do that...you know the drill.

Even so, it often comes as a surprise to LASIK patients that there is a long list of outlawed medications. These are drugs that can suppress tear production.

Why should tear formation matter in a young, healthy pre-LASIK eye?

When the LASIK corneal flap is created many delicate nerve fibers are severed. These nerves usually signal when fresh tears are needed. Until those nerves heal the tear output signal is interrupted.

It's very important to know before your surgery if you are a borderline dry-eye patient. Be sure to discuss the situation with your surgeon before giving your consent to undergo any kind of refractive surgery.

LASIK causes dry eyes in over 80% of healthy individuals. Most folks quickly recover and bide their time with artificial tears. Upwards of 2% develop chronic dry eyes. On the other hand, if you already have dry eyes or almost have a dry eye problem LASIK can definitely make things worse.

Here comes the list. Be sure your LASIK surgeon knows if you are currently taking any of the following medications (whether prescribed, over-the-counter, or natural herbal remedy):

• Antihistamines


• Decongestants


• Diuretics


• Antidiarrheal agents


• Antihypertensives (lower blood pressure)


• Tranquilizers


• Antidepressants


• Antipsychotics

Remember, never change or discontinue any medication without notifying the prescribing physician. Feel free to print this page and share it with your ophthalmologist.

Related Topics:

• WebMD Video: Eye Surgery 101
• WebMD Video: Laser Eye Surgery Helps More People See Better

Technorati Tags: LASIK, medication, eye surgery, vision, health and wellness

Rebuttal: Glasses for Preschoolers Often Unnecessary

Photo: Mark Probst

Just last week we explored new research regarding the cognitive benefits to children who wear corrective eyewear. Traditionally most eye doctors do not prescribe for small amounts of hyperopia (farsightedness) because they will grow out of it on their own. Click here to learn more.

Well, another published clinical research study says, "Not so fast!" Eye specialists at Vanderbilt University reviewed the records of over 100,000 Tennessee preschoolers who received vision screening. 3,600 were referred to the eye doctor. 890 of these referred youngsters were found to have no eye problems yet 20% of them received a prescription for glasses anyway.

The prescribing trend varied with the qualifications of the health provider:

• Optometrists prescribed glasses for 35% of their patients


• General ophthalmologists prescribed glasses 12% of the time, and


• Pediatric ophthalmologists (the acknowledged experts) recommended eyewear for children only 2% of the time

Given that the costs for the exam and any spectacle prescription averaged $250 per child, the authors contend that universal comprehensive eye exam programs for preschoolers are unnecessary and possibly wasteful. Parents, pediatricians and existing school screenings do an adequate job in identifying the children in need.

Those same funds could be better used for teachers' salaries or child obesity prevention programs.

The big argument concerns the small number of children who may 'fall through the cracks' in the current system. Funny thing about cracks, they tend to appear in whatever system is developed. No system is perfect no matter how much money you throw at it. Expect to hear much more about this debate!

Related Topics:

• Do Preschoolers Need Glasses?
• WebMD Video: Vision Therapy and Children

Technorati Tags: vision, children, preschoolers, toddlers, eye exam

Do Preschoolers Need Glasses?

We previously mentioned how a child's eye grows between birth and age 5. Once a child reaches their fifth birthday (hello, Chuck E. Cheese!) the eyeball has acquired adult dimensions. All along, the optics of the eye are frantically trying to keep up with the dynamic anatomy. Beyond age 5 the anatomy remains stationary but the optics continue to progress. Most refractive errors stabilize around age 30.

Following this explanation, the refractive error in infants and toddlers is very liquid. Most preschoolers are hyperopic (farsighted) because their growing eye is still a bit short. This physiologic hyperopia tends to disappear by first grade or so. Doctors traditionally declined to prescribe glasses for this age group because:

• Eyeglasses are expensive


• The child won't wear them


• The child involuntarily relies on their abundant accommodation (near focusing power) to provide clear focusing


• The child won't wear them


• Nobody has ever performed a controlled clinical research study on the topic, and finally


• The child won't wear them!

Vision scientists from the University of California San Diego wanted to know if spectacle wear made any measurable behavioral difference in preschoolers. They have published the findings of their research in the Archives of Ophthalmology.

This is the first controlled study to document that preschool children with uncorrected refractive errors score significantly worse on visual-motor integration and cognitive ability tests. Within six weeks of wearing glasses, the visual-motor function of the children wearing eyeglasses was similar to normal children. Since low visual-motor skill scores correlate with lower academic achievements, the authors conclude that spectacle correction might lead to improved cognitive and verbal performance.

Before heading off to the optical shop it's important to note that the study only evaluated children between ages 3-5 with +2.00 diopters or more of hyperopia. Today a refractive error less than +2.00 diopters would still probably not warrant spectacle correction.

Astigmatism (excessive corneal curvature) is a very different matter. Most eye doctors would correct for astigmatism, especially if it was present in one eye only. A significant refractive error between the two eyes could lead to amblyopia (lazy eye) in the blurrier eye.

Parents can expect to hear more about the results of this groundbreaking study. We will keep you up-to-date here at WebMD if changes occur to published eyecare recommendations.

REFERENCE: Archives of Ophthalmology, February 2008, pages 252-258.

Related Topics:

• WebMD Video: Preschool Eye Exams: Get Kids Tested Early
• Your Child's Development: Age 2-5

Technorati Tags: preschool, glasses, education, learning, eye health