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Presbyopia – Reading Difficulties

Ever heard of presbyopia? If you’re over the age 40, you have probably noticed changes in your vision. Most noticeably, would be changes in your near vision. This is called Presbyopia. It is the normal age-related loss of near focusing ability.

When you develop presbyopia, you may find that you need to hold books, magazines, newspapers, menus and other reading material at arms length in order to focus clearly. Near work, like writing or sewing may cause headaches, eye strain or you may feel tired.

Presbyopia

What Causes Presbyopia?

Presbyopia is caused by an age-related process. It is due to the loss of elasticity and hardening of the natural lens inside your eye. As a result the eye has a harder time focusing up close. It differs from astigmatism, short-sightedness or far-sightedness, which are related to the shape of the eyeball and are caused by genetic and environmental factors.

Treatment Options for Presbyopia

The best way of treating presbyopia is with eyeglasses. Surgery is the other option.

Eyeglasses with bifocal or multifocal (progressive) lenses are the most common correction for presbyopia. Bifocal lenses have 2 focus points:

  1. The upper portion of the spectacle lens is designed for distance vision,
  2. The lower portion of the lens is designed for near vision.

The two portions of the eyeglasses are separated by a line.

Multifocal (progressive) lenses have a more gradual vision change between the two prescriptions, with no visible line between them.

Reading glasses are another choice. Unlike bifocals or multifocals, which you would wear all day, reading glasses are worn just during close work.

If you wear contact lenses, your optometrist can prescribe reading glasses, which you wear while your contact lenses  are in.

Multifocal contact lenses are also an option. These contact lenses work just as multifocal eyeglasses would, giving you clear vision at all distances.

Monovision is an option where one eye is corrected for distance and the other is corrected for near.

Your optometrist will discuss the best option for you.

The natural lens in your eye continues to change as you get older. Therefore, your presbyopia prescription will need to be increased over time as well. Your optometrist will prescribe a stronger correction for near work as you need it.

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    Computer Vision Syndrome

    Computer vision syndrome (CVS) most often occurs when the viewing demand of the task exceeds the visual abilities of the computer user. Because computer use is such a visually demanding task, vision problems and computer vision syndrome symptoms are very common. Most studies indicate that computer users report more eye-related problems than non-computer office workers. Studies also show that visual discomfort occurs in 75-90% of computer users.

    Computer Vision Syndrome Symptoms

    Here are some of the most common symptoms optometry patients will com in complaining of with computer vision syndrome:

    • Eyestrain
    • Headaches
    • Blurred vision (distance and/or near)
    • Dry and irritated eyes
    • Slow refocusing
    • Neck and/or backache
    • Light sensitivity
    • Double vision
    • After images and colour distortion

    Reflections and Glare

    The most common complaint of computer users is glare. Glare is created by improper lighting in the workspace. The two main sources are from light directly shining into the eyes (direct glare e.g. light from an overhead light) and from reflections from surrounding surfaces (reflected glare e.g. white paper).

    Anti-glare filters which fit over the display screen are readily available. It makes it easier to read your screen and helps your productivity. It must be pointed out, however, that anti-glare filters themselves are not necessarily the entire solution to visual stress on computers.

    Lighting

    Controlling the lighting of the workspace is critical in maintaining proper visual efficiency. Always turn off offending lights. If you notice glare on a screen from a light source, turn it off. Most offices have been designed for paper work and are overly lit for computer use.

    Re-orient the work station so that bright lights are not in the field of view. Many people make the mistake of placing their computers right in front of a window, wishing to capitalize on a scenic view. This causes a lot of discomfort glare. The best solution is usually vertical blinds because they can be adjusted to allow for a view while re-directing glare.

    Brightness and Contrast

    Adjust the display settings on your computer so that the brightness of the screen is about the same size as your work environment. Ideally, your font size should be about 3 times larger than the smallest font size you can see from a normal viewing position. Black text on a white background is the best colour combination for your eyes.

    Work Habits

    Viewing a computer screen attracts the attention of the viewer more so than any paper object. Because of this, we ‘forget’ to blink. Blinking is an automatic reflex and beyond our conscious efforts. Studies have shown that there is less blinking while viewing a computer screen and this also causes dry eyes. One reason for this is because of the height of the monitor. Because it is in a higher field of view, the eyes are wider open. This creates a wider gap between the eyelids making blinking more of an effort. By lowering the screen, the size of this gap is reduced and allows the lids to blink easier. Also the use of artificial tears can help a great deal. Ask your optometrist which brand he recommends.

    When office work still involved typewriters, pencils and paper, there was a great deal of physical activity in the work area. Hands were moving in all directions to insert paper, return the typewriter carriage, grab a pencil or turn a page. Office workers were getting up to make copies, deliver papers to another office, look for carbon paper and other types of physical tasks. With the integration of computers into the workplace, much of these movements are accomplished by the push of a button. Our bodies are designed for movement and should be moved routinely.

    This holds especially true for the visual system. Our eyes have many muscles associated with them. If these muscles are ‘stuck’ in the same position for extended periods of time, they will adversely affect vision. Taking visual breaks is a very easy thing to do because they do not involve leaving the desk and do not have to be long in duration.

    A micro break consists of simply looking into the distance every 10-15 minutes. This should be done for 15 seconds.

    A mini break should be performed every 30 minutes and involves closing the eyes for about 2 minutes.

    A maxi break should follow along with your routine work breaks where you get up and move around for at least 15 minutes. This should be done every 2 hours.

    This scheme will allow the eyes to change their viewing condition regularly and still allow the worker to produce effectively.

    Computer Glasses

    Most prescribed eyeglasses are for general purposes: driving, movies, TV, shopping, allowing you to perform a variety of tasks. However, there are also task specific lenses which are made for you to do a specific task. Computer glasses are designed with these types of lenses.

    A ‘computer’ prescription is any lens which allows you to see the display screen clearly and comfortably. They do not, however, necessarily allow clear vision at any other distance. There are a number of combination lenses which allow for this type of vision. If your bifocals or multifocals don’t give you much comfort, consider a pair of computer glasses.

    Anti-Reflective Coatings

    A normal eyeglass lens only allows 92% of light to pass completely through it. The remainder of the light is reflected by the front or back surface. However, a coating applied to the front surface of the lens cancels out this reflection and allows 99% of the light to pass through. This has a double benefit to the general eyeglass wearer. Firstly, it allows your eyes to be more visible to someone looking at you. Secondly, the anti-reflective coating, by allowing more light to pass through them, also makes the view through the lenses more distinct.

    This is most noticeable by viewing lights at night, whereby you might normally notice glare around street lights or oncoming headlights. The anti-reflective coating allows lights to pass through the lens without the extra glare or distortion. These lenses make all types of viewing easy on the eyes.

    Where to buy Computer Glasses?

    Always try to avoid buying over the counter reading glasses for use on a computer. An accurate eye glass prescription is essential if you want to get the full benefits of computer glasses. It’s best to purchase this eyewear from a trained eye care professional like an optometrist.

    Before scheduling your appointment, measure the distance from your computer screen to the bridge of your nose. This measurement will help your optometrist prescribe the optimum lens power for your computer glasses.

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      Diabetes and the Eye

      Are you worried about diabetes affecting your eyes and vision. Well today we will be talking more about the effect diabetic patients may experience with their eyes. So the first question to answer is “What is Diabetes?”

      In diabetes, there is too much sugar in the blood.

      When the blood sugar is constantly or frequently high, many complications occur: eyesight can suffer, heart attacks and other blood vessel problems can occur, and one’s lifespan can be shortened. When the blood sugar is maintained at a normal level, the complications of diabetes including serious diabetic retinopathy can be reduced. Controlling blood sugar is the single most important thing a person with diabetes can do to prevent the complications of diabetes.

      Type 1 diabetes usually occurs at a young age. People with Type 1 diabetes must take insulin to survive and to control blood sugar. They should test their own blood sugar levels with a glucometer several times a day so they can adjust their diet, exercise, and insulin doses to keep the blood sugar at the required level. They should follow a diet controlled in carbohydrates and low in fat and cholesterol. Regular exercise is also important as it helps reduce blood sugar.

      Type 2 diabetes usually starts in adult life and is often not dependant on insulin for control of blood sugar. Maintaining normal weight and a diet low in calories, fat and cholesterol is very important. Blood sugar can be controlled either with diet alone or in combination with pills to lower blood sugar. In some cases, insulin treatment is also necessary.

      In addition to the importance of diet and exercise, there are other factors that can affect diabetes. High blood pressure is very bad for people with diabetes because it increases the risk of complications, including vision loss. Smoking is known to be particularly bad for people with diabetes because it promotes the closure of blood vessels.

      What is Diabetic Retinopathy?

      Diabetic Retinopathy is the most common eye disease associated with diabetes. In diabetic retinopathy, the blood vessels of the retina become abnormal and this causes the problems that people with diabetes have with their eyesight. Normally, the blood vessels of the retina do not leak. But with diabetes, the retinal blood vessels can develop tiny leaks. These leaks cause blood to seep into the retina. The retina then becomes wet and swollen and cannot work properly. The form of diabetic retinopathy caused by leaking retinal blood vessels is called Nonproliferative Diabetic Retinopathy (NPDR).

      Another problem with the retinal blood vessels in diabetes is that they can close. The retinal tissue which depends on those vessels for nutrition, will no longer work properly. This causes the growth of new abnormal blood vessels, which can be very bad for the eye. These new blood vessels are weak and can cause bleeding and scar tissue which can cause blindness (total loss of vision). This type of retinopathy which causes closure of blood vessels and the growth of new vessels is called Proliferative Diabetic Retinopathy (PDR).

      Nonproliferative Diabetic Retinopathy (NPDR)

      In diabetes, the retinal blood vessels can develop tiny leaks. Blood and fluid seep from the retinal blood vessels and fatty material deposits in the retina. This causes swelling of the retina, and it is called nonproliferative diabetic retinopathy (NPDR).

      When this occurs in the central part of the retina (macula), vision will be reduced or blurred. Leakage elsewhere in the retina will have no effect on vision.

      A patient with a wet, swollen macula, or with exudates in the macula, will have some loss of vision, including blurring, distortion, or darkening. If one eye is affected, the other eye may also be affected, though the problem may not be equally severe in both eyes. If diabetic retinopathy has affected each macula severely, central vision may be lost from each eye and the ability to see detail will be lost. These patients learn to use the areas outside the macula to see some detail. This ability to look slightly off centre usually improves with time, though the eyesight will never be as good as it was before the central retina (macula) was damaged by leaky blood vessels. So people who have NPDR will usually be able to see well enough to take care of themselves and continue those activities that do not require detailed vision.

      Proliferative Diabetic Retinopathy (PDR)

      In PDR, retinal blood vessels close off and large areas of the retina lose their source of nutrition. When this happens, peripheral or side vision is reduced, and the person’s ability to see at night and adjust from light to dark is often diminished.

      As a result of this loss of nourishing blood flow, the retina responds by developing new blood vessels that are abnormal. This can be a huge problem and can be very dangerous to the eye. These new vessels do not nourish the retina properly and may start to bleed and cause scar tissue on the retina. The scar tissue pulls the retina off the back of the eye and causes a detachment. This can lead to severe vision loss or even total blindness.

      Sometimes these new blood vessels can also grow on the iris (coloured part of the eye), and it may close off the normal flow of fluid out of the eye. This results in increased pressure in the eye and causes glaucoma. This causes permanent changes, resulting in vision loss, pain, and even total loss of the eye.

      It may be impossible for a person with diabetes and early PDR to know that any of these changes are occurring. For this reason, it is essential that every person with diabetes be examined regularly by an ophthalmologist or optometrist. These examinations should occur regularly, every 6-12 months, depending on the degree of retinopathy. The earlier theses changes are discovered, the better the chance of saving vision. The later these changes are discovered, the greater the chance of blindness.

      Treatment of Diabetic Retinopathy

      Laser Surgery

      Laser surgery can be very helpful in the treatment of diabetic retinopathy. The laser beam is a high energy light that turns to heat when it is focused on the parts of the retina to be treated. In NPDR, the laser seals the leaking blood vessels or reduces the leakage and allows the retina to dry. In PDR, the laser destroys the diseased portions of the retina to stop the growth of the abnormal new blood vessels.

      Essentially, the major purpose of laser surgery is to prevent further vision loss. Laser surgery may not always be best or even possible. The decision to use laser depends mostly on the type of diabetic retinopathy, its severity, and a judgment regarding how well it may respond to laser surgery.

      Because diabetes is a condition for which there is currently no cure, the diabetes may continue to damage the retina. Even with laser surgery patients may continue to lose vision. But when laser is the right treatment, the chances are that it can prevent further visual loss.

      Questions about Laser Surgery

      What is the purpose of laser surgery?

      In NPDR, the leaking blood vessels cause the retina to become wet and swollen, causing vision loss. Laser surgery stops the leakage from these vessels to prevent vision loss.

      In PDR, the growth of new abnormal blood vessels causes severe visual loss by bleeding into the eye and forming scar tissue which pulls on the retina causing a retinal detachment. The laser stops this growth and detachment and thus prevents further visual loss.

      Will I have to go to hospital?

      Laser surgery is usually done in the doctor’s office or in the hospital as outpatient surgery. After the surgery, you will be able to go home and resume your normal activities without special restrictions.

      Is the surgery safe?

      In most cases, no complications occur but, as with all surgery, there are some risks. There is a small chance that the laser beam might not be aimed properly and that healthy retina might be destroyed and vision lost. Laser might also cause bleeding and scarring. Fortunately, these complications are rare.

      What are the after effects of laser surgery?

      Certain types of laser surgery may cause loss of night vision. So these patients might not be able to drive at night. Sometimes peripheral or side vision may be reduced after surgery. Most patients have some degree of blurring of central vision which passes with time but in a few patients it may be permanent. Rarely, there is a lot of swelling after surgery which causes an increase in eye pressure. This is very painful and the patient should call the treating ophthalmologist immediately.

      Are the effects of the laser permanent?

      In most cases, leaking blood vessels remain closed and the growth of new abnormal blood vessels is stopped permanently after surgery. But because diabetes continues, it is common for the leakage to develop in new areas. If laser surgery is indicated, however, the outcome is always better than if no surgery is done.

      Does laser surgery cause any pain?

      For NPDR, laser surgery is almost always painless, though a few patients do experience some discomfort. After the laser surgery, the eye is patched for the rest of the day. In PDR, many patients experience some pain. The eye is usually anesthetized.

      How long does laser surgery take?

      Depending on the extent of the problem, laser surgery for NPDR may take anywhere from a few minutes to a half hour. For PDR it may take from 15 minutes to an hour or more.

      What will my vision be like after laser?

      Vision is often blurred but it usually improves within a month. There will be small black areas or blind spots where the laser spots were placed. These will be permanent but become less noticeable with time. Peripheral and night vision is likely to be reduced.

      How many treatments will I need?

      For NPDR, usually one treatment is all that is required. However, if new leaks develop later, additional surgery will be necessary. For PDR, two or three sessions are usually required.

      Can anything help if central vision is lost in each eye?

      Those patients who have lost central vision in both eyes will be referred to a low vision specialist who helps patients learn to use their remaining vision to its fullest. They make use of low vision aids like magnifying lenses, telescopic lenses, special filters etc.

      Will using my eyes hurt them?

      You cannot hurt your eyes by using them. There is no way in which using your eyes can do your eyes any harm, whether by reading, watching television or driving.

      Diabetes and Your Eyes

      If there is a fairly large, rapid shift in your blood glucose level, you may notice that your vision becomes blurry. This may occur prior to the diagnosis of diabetes, or it may develop after the initiation of treatment or a change in treatment of diabetes. This difficulty with vision or focusing will disappear once the blood sugar has been stabilized for about 1 week. So, measure your own vision in each eye, separately, each day. Know what you can see each day. If you notice a change in your vision, call your optometrist or ophthalmologist for an appointment. It is important for all patients with diabetes to have a thorough retinal exam regularly, about every 6-12 months, even when there are no problems. Also, be sure to talk to your own medical doctor about the importance of diet and exercise and the dangers of smoking and high blood pressure. And, most of all learn to maintain the best possible control of blood sugar.

      Pineslopes Optometrists will always be available to answer your questions and to help in every way possible. You are encouraged to call with any unusual symptom or worry. We are here to help you.

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        Welcome to Pineslopes Optometrists

        Hello, and welcome to the Eye Guy website. My name is Nishan and I am the owner and principle Optometrist Fourways at your service at The Eye Guy here in Fourways, Sandton, Johannesburg, Gauteng, South Africa. What I would love to do for you is to help you understand why your eyes are so important to your health. The eyes are neglected and abused everyday till we cannot see properly anymore or we need glasses.

        I have a passion for educating people on eye health and love helping everyone to look good and see better with whatever vision needs they require. So you might be wanting your first pair of eyeglasses, a pair of contact lenses or maybe your want to customise your sport sunglasses with prescription lenses to see better. Well guess what? An optometrist can help you with those vision needs and more.

        You need to take care of your eyes as you only get one pair in your lifetime. So you should get an eye examination which you can at Pineslopes Optometrists or at least get the very basic free vision screening, so you know how healthy your eyes really are.

        Again I hope Pineslopes Optometrists can help you with your vision an optical needs and there will be plenty of information coming in the near future on eye health in our blog. In the meantime, you can read some more about the what is an optometristeye productseye health services or how to find Pineslopes Optometrists right here.

        Oh and one last added bonus, again, I want you to have  healthy vision and eyes. So if you have a question about your eyes or glasses needs, then please let me at least try get you to see an optometrist or an opthalmologist who can help you. We look forward to seeing you at Pineslopes Optometrists.

        Regards,

        Pineslopes Optometrist Nishan

        Remember give us a call at Pineslopes Optometrist for any eye needs on 011 465 4028/9

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