eyecare

Your eyes are an important part of your health. Most people rely on their eyes to see and make sense of the world around them. But some eye diseases can lead to vision loss, so it is important to identify and treat eye diseases as early as possible. You should get your eyes checked as often as your health care provider recommends it, or if you have any new vision problems. And just as it is important to keep your body healthy, you also need to keep your eyes healthy.

There are things you can do to help keep your eyes healthy and make sure you are seeing your best:

• Eat a healthy, balanced diet. Your diet should include plenty or fruits and vegetables, especially deep yellow and green leafy vegetables. Eating fish high in omega-3 fatty acids, such as salmon, tuna, and halibut can also help your eyes.
• Maintain a healthy weight. Being overweight or having obesity increases your risk of developing diabetes. Having diabetes puts you at higher risk of getting diabetic retinopathy or glaucoma.
• Get regular exercise. Exercise may help to prevent or control diabetes, high blood pressure, and high cholesterol. These diseases can lead to some eye or vision problems. So if you exercise regularly, you can lower your risk of getting these eye and vision problems.
• Wear sunglasses.Sun exposure can damage your eyes and raise your risk of cataracts and age-related macular degeneration. Protect your eyes by using sunglasses that block out 99 to 100% of both UV-A and UV-B radiation.
• Wear protective eye wear. To prevent eye injuries, you need eye protection when playing certain sports, working in jobs such as factory work and construction, and doing repairs or projects in your home.
• Avoid smoking. Smoking increases the risk of developing age-related eye diseases such as macular degeneration and cataracts and can damage the optic nerve.
• Know your family medical history. Some eye diseases are inherited, so it is important to find out whether anyone in your family has had them. This can help you determine if you are at higher risk of developing an eye disease.
• Know your other risk factors. As you get older, you are at higher risk of developing age-related eye diseases and conditions. It is important to know you risk factors because you may be able to lower your risk by changing some behaviors.
• If you wear contacts, take steps to prevent eye infections. Wash your hands well before you put in or take out your contact lenses. Also follow the instructions on how to properly clean them, and replace them when needed.
• Give your eyes a rest. If you spend a lot of time using a computer, you can forget to blink your eyes and your eyes can get tired. To reduce eyestrain, try the 20-20-20 rule: Every 20 minutes, look away about 20 feet in front of you for 20 seconds.

Everyone needs to have their eyesight tested to check for vision and eye problems. Children usually have vision screening in school or at their health care provider's office during a checkup. Adults may also get vision screenings during their checkups. But many adults need more than a vision screening. They need a comprehensive dilated eye exam.

Getting comprehensive dilated eye exams is especially important because some eye diseases may not have warning signs. The exams are the only way to detect these diseases in their early stages, when they are easier to treat.

The exam includes several tests:

• A visual field test to measure your side (peripheral) vision. A loss of peripheral vision may be a sign of glaucoma.
• A visual acuity test, where you read an eye chart about 20 feet away, to check on how well you see at various distances
• Tonometry, which measures your eye's interior pressure. It helps to detect glaucoma.
• Dilation, which involves getting eye drops that dilate (widen) your pupils. This allows more light to enter the eye. Your eye care provider examines your eyes using a special magnifying lens. This provides a clear view of important tissues at the back of your eye, including the retina, macula, and optic nerve.

If you have a refractive error and are going to need glasses or contacts, then you will also have a refraction test. When you have this test, you look through a device that has lenses of different strengths to help your eye care professional figure out which lenses will give you the clearest vision.

At what age you should start getting these exams and how often you need them depends on many factors. They include your age, race, and overall health. For example, if you are African American, you are at higher risk of glaucoma and you need to start getting the exams earlier. If you have diabetes, you should get an exam every year. Check with your health care provider about if and when you need these exams.

Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose comes from foods you eat. The cells of your body need glucose for energy. A hormone called insulin helps the glucose get into your cells.

With type 1 diabetes, your body doesn't make insulin. With type 2 diabetes, your body doesn't make or use insulin well. Without enough insulin, glucose builds up in your blood and causes high blood sugar levels.

Over time, high blood sugar may damage the blood vessels and lenses in your eyes. This can lead to serious diabetic eye problems which can harm your vision and sometimes cause blindness. Some common diabetes eye problems include:

• Diabetic retinopathy, which is the leading cause of blindness in American adults. It affects blood vessels in the retina (the light-sensitive layer of tissue in the back of your eye). The blood vessels may swell and leak fluid into your eye. If it's not treated, it can cause serious problems such as vision loss and retinal detachment, where the retina is pulled away from its normal position at the back of your eye.
• Diabetic macular edema (DME), which happens when blood vessels in the retina leak fluid into the macula (a part of the retina needed for sharp, central vision). This usually develops in people who already have other signs of diabetic retinopathy.
• Glaucoma, a group of eye diseases that can damage the optic nerve (the bundle of nerves that connects the eye to the brain). Glaucoma from diabetes happens when the blood vessels in the front of your eye are damaged, and new blood vessels grow near the iris (the colored part of your eye). The blood vessels block the space where fluid drains from your eye. This causes fluid to build up and pressure to increase inside your eye.
• Cataract, which happen when the clear lens in the front of your eye becomes cloudy. Cataracts are common as people age. But people with diabetes are more likely to develop cataracts younger and faster than people without diabetes. Researchers think that high glucose levels cause deposits to build up in the lenses of your eyes.

Anyone with diabetes can develop diabetic eye disease. But your risk of developing it is higher if you:

• Have had diabetes for a long time
• Don't have good control over your high blood sugar or high blood pressure
• Are pregnant
• Have high blood cholesterol
• Smoke tobacco

In the early stages, diabetic eye problems usually don't have any symptoms. That's why regular dilated eye exams are so important, even if you think your eyes are healthy.

You should also watch for sudden changes in your vision that could mean an emergency. Call your doctor right away if you notice any of these symptoms:

• Many new spots or dark wavy strings floating in your vision (floaters)
• Flashes of light
• A dark shadow over part of your vision, like a curtain
• Vision loss
• Eye pain or redness

Talk with your doctor if you have these symptoms, even if they come and go:

• Spots or dark wavy strings floating in your vision
• Blurry or wavy vision
• Vision that changes a lot
• Trouble seeing colors

Eye doctors do dilated eye exams to diagnose eye problems. A dilated eye exam uses eye drops to open your pupils wide so your doctor can look for signs of eye problems and treat them before they harm your vision. Your doctor will also test your vision and measure the pressure in your eyes.

Treatment for diabetic eye problems depends on the problem and how serious it is. Some of the treatments include:

• Lasers to stop blood vessels from leaking
• Injections (shots) in the eye to stop new, leaky blood vessels from growing
• Surgery to remove blood and scar tissue or replace a cloudy lens
• Eye drops to lower fluid pressure in the eye

But these treatments aren't cures. Eye problems can come back. That's why your best defense against serious vision loss is to take control of your diabetes and get regular eye exams. It's also important to keep your blood pressure and cholesterol in a healthy range.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Some eye problems are minor and don't last long. But some can lead to a permanent loss of vision.

Common eye problems include:

• Refractive errors
• Cataracts - clouded lenses
• Optic nerve disorders, including glaucoma
• Retinal disorders - problems with the nerve layer at the back of the eye
• Macular degeneration - a disease that destroys sharp, central vision
• Diabetic eye problems
• Conjunctivitis - an infection also known as pink eye

Your best defense is to have regular checkups, because eye diseases do not always have symptoms. Early detection and treatment could prevent vision loss. See an eye care professional right away if you have a sudden change in vision, if everything looks dim, or if you see flashes of light. Other symptoms that need quick attention are pain, double vision, fluid coming from the eye, and inflammation.

NIH: National Eye Institute

Falls can be dangerous at any age. Babies and young children can get hurt falling off furniture or down the stairs. Older children may fall off playground equipment. For older adults, falls can be especially serious. They are at higher risk of falling. They are also more likely to fracture (break) a bone when they fall, especially if they have osteoporosis. A broken bone, especially when it is in a hip, may even lead to disability and a loss of independence for older adults.

Some common causes of falls include:

• Balance problems
• Some medicines, which can make you feel dizzy, confused, or slow
• Vision problems
• Alcohol, which can affect your balance and reflexes
• Muscle weakness, especially in your legs, which can make it harder for you to get up from a chair or keep your balance when walking on an uneven surface.
• Certain illnesses, such as low blood pressure, diabetes, and neuropathy
• Slow reflexes, which make it hard to keep your balance or move out of the way of a hazard
• Tripping or slipping due to loss of footing or traction

At any age, people can make changes to lower their risk of falling. It important to take care of your health, including getting regular eye exams. Regular exercise may lower your risk of falls by strengthening your muscles, improving your balance, and keeping your bones strong. And you can look for ways to make your house safer. For example, you can get rid of tripping hazards and make sure that you have rails on the stairs and in the bath. To reduce the chances of breaking a bone if you do fall, make sure that you get enough calcium and vitamin D.

NIH: National Institute on Aging

People in the U.S. are living longer, and the number of older adults in the population is growing. As we age, our minds and bodies change. Having a healthy lifestyle can help you deal with those changes. It may also prevent some health problems and help you to make the most of your life.

A healthy lifestyle for older adults includes:

• Healthy eating. As you age, your dietary needs may change. You may need fewer calories, but you still need to get enough nutrients. A healthy eating plan includes
  • Eating foods that give you lots of nutrients without a lot of extra calories. This includes fruits and vegetables, whole grains, lean meats, low-fat dairy, nuts, and seeds.
  • Avoiding empty calories, such as foods like chips, candy, baked goods, soda, and alcohol
  • Eating foods that are low in cholesterol and fat
  • Drinking enough liquids, so you don't get dehydrated
• Regular physical activity. Being physically active may help you maintain a healthy weight and avoid chronic health problems. If you have not been active, you can start slowly and work up to your goal. How much exercise you need depends on your age and health. Check with your health care provider on what is right for you.
• Staying at a healthy weight. Being either overweight or underweight can lead to health problems. Ask your health care professional what a healthy weight for you may be. Healthy eating and exercise can help you get to that weight.
• Keeping your mind active. Lots of activities can keep your mind active and improve your memory, including learning new skills, reading, and playing games.
• Making your mental health a priority. Work on improving your mental health, for example by practicing mediation, relaxation techniques, or gratitude. Know the warning signs of a problem and ask for help if you are struggling.
• Participating in activities that you enjoy. People who are involved in hobbies and social and leisure activities may be at lower risk for some health problems. Doing things that you enjoy may help you feel happier and improve your thinking abilities.
• Playing an active role in your health care. Make sure that you get regular checkups and the health screenings that you need. You should know which medicines you are taking, why you need them, and how to take them properly.
• Not smoking. If you are a smoker, quitting is one of the most important things that you can do for your health. It can lower your risk of several different types of cancer, certain lung diseases, and heart disease.
• Taking steps to prevent falls. Older adults have a higher risk of falling. They are also more likely to fracture (break) a bone when they fall. Getting regular eye checkups, getting regular physical activity, and making your house safer can lower your risk of falling.

Following these tips can help you to stay healthy as you age. Even if you have never done them before, it's never too late to start taking care of your health. If you have questions about these lifestyle changes or need help figuring out how to make them, ask your health care provider.

Telehealth is the use of communications technologies to provide health care from a distance. These technologies may include computers, cameras, videoconferencing, the Internet, and satellite and wireless communications. Some examples of telehealth include:

• A "virtual visit" with a health care provider, through a phone call or video chat
• Remote patient monitoring, which lets your provider check on you while you are at home. For example, you might wear a device that measures your heart rate and sends that information to your provider.
• A surgeon using robotic technology to do surgery from a different location
• Sensors that can alert caregivers if a person with dementia leaves the house
• Sending your provider a message through your electronic health record (EHR)
• Watching an online video that your provider sent you about how to use an inhaler
• Getting an email, phone, or text reminder that it's time for a cancer screening

Sometimes people use the term telemedicine to mean the same thing as telehealth. Telehealth is a broader term. It includes telemedicine. But it also includes things like training for health care providers, health care administrative meetings, and services provided by pharmacists and social workers.

Some of the benefits of telehealth include:

• Getting care at home, especially for people who can't easily get to their providers' offices
• Getting care from a specialist who is not close by
• Getting care after office hours
• More communication with your providers
• Better communication and coordination between health care providers
• More support for people who are managing their health conditions, especially chronic conditions such as diabetes
• Lower cost, since virtual visits may be cheaper than in-person visits

Some of the problems with telehealth include:

• If your virtual visit is with someone who is not your regular provider, he or she may not have all of your medical history
• After a virtual visit, it may be up to you to coordinate your care with your regular provider
• In some cases, the provider may not be able to make the right diagnosis without examining you in person. Or your provider may need you to come in for a lab test.
• There may be problems with the technology, for example, if you lose the connection, there is a problem with the software, etc.
• Some insurance companies may not cover telehealth visits

The types of care that you can get using telehealth may include:

• General health care, like wellness visits
• Prescriptions for medicine
• Dermatology (skin care)
• Eye exams
• Nutrition counseling
• Mental health counseling
• Urgent care conditions, such as sinusitis, urinary tract infections, common rashes, etc.

For telehealth visits, just like with an in-person visit, it is important to be prepared and have good communication with the provider.

If you have low vision, eyeglasses, contact lenses, medicine, or surgery may not help. Activities like reading, shopping, cooking, writing, and watching TV may be hard to do. The leading causes of low vision and blindness in the United States are age-related eye diseases: macular degeneration, cataract and glaucoma. Other eye disorders, eye injuries, and birth defects can also cause vision loss.

Whatever the cause, lost vision cannot be restored. It can, however, be managed. A loss of vision means that you may have to reorganize your life and learn new ways of doing things. If you have some vision, visual aids such as special glasses and large print books can make life easier. There are also devices to help those with no vision, like text-reading software and braille books.

The sooner vision loss or eye disease is found and treated, the greater your chances of keeping your remaining vision. You should have regular comprehensive eye exams by an eye care professional.

NIH: National Eye Institute