Eight Ways To Protect Your Eyesight

Sight-threatening eye problems affect one in six adults age 45 and older, and the risk for vision loss increases with age. In fact, a recent American Academy of Ophthalmology (AAO) report estimates that more than 43 million Americans will develop age-related eye diseases by the year 2020.

Tips for protecting your eyes

To protect your eyesight and keep your eyes healthy as you age, follow these guidelines:

  1. Be aware of your risk for eye disease. Know your family’s health history. Do you or any of your family suffer from diabetes or have high blood pressure? Are you over the age of 65? Are you an African-American over the age of 40? All of these factors increase your risk for sight-threatening eye diseases.
  2. Have regular exams to check for diabetes and high blood pressure. If left untreated, these diseases can cause eye problems. In particular, diabetes and high blood pressure can lead to diabetic retinopathy, macular degeneration, glaucoma and ocular hypertension. Regular eye exams can detect problems early and help preserve your eyesight.
  3. Look for changes in your vision. If you start noticing changes in your vision, see your eye doctor immediately. Trouble signs include double vision, hazy vision and difficulty seeing in low light conditions. Other signs to look for include frequent flashes of light, floaters, and eye pain and swelling. All of these signs and symptoms can indicate a potential eye health problem that needs immediate attention.
  4. Exercise frequently. According to the AAO, some studies suggest that regular exercise – such as walking – can reduce the risk of macular degeneration by up to 70 percent.
  5. Protect your eyes from the sun’s UV rays. Overexposure to ultraviolet (UV) radiation is associated with an increased risk of cataracts and other eye damage. When outdoors, wear sunglasses that provide 100 percent UV protection to shield your eyes from the sun’s harmful rays.
  6. Eat a healthy and balanced diet. Numerous studies have shown that a diet high in antioxidants may reduce the risk of cataracts. Antioxidant-rich foods include colorful fruits and vegetables. Eating fish that contain plenty of omega-3 fatty acids (salmon and herring, for example) also may help prevent macular degeneration.
  7. Get your eyes checked at least every two years. A thorough eye exam, including pupil dilation, can detect major eye diseases such as diabetic retinopathy, which has no early warning signs or symptoms. A comprehensive eye exam also can ensure that your prescription for eyeglasses or contact lenses is accurate and up-to-date.
  8. Don’t smoke. The many dangers of smoking have been well documented. When it comes to eye health, people who smoke are at greater risk of developing age-related macular degeneration and cataracts.

Following these steps is no guarantee of perfect vision throughout your lifetime. But maintaining a healthy lifestyle and having regular eye exams will certainly decrease your risk of sight-stealing eye problems and help you enjoy your precious gift of eyesight to the fullest.

Your Comprehensive Eye Exam

A comprehensive eye exam includes a number of tests and procedures to examine your eyes and evaluate your eye health and the quality of your vision. These tests range from simple tasks such as reading an eye chart, to complex procedures using sophisticated imaging devices and computerized equipment.

Here are some tests you are likely to encounter during a routine comprehensive eye exam:

Retinoscopy

This test is an objective way for your eye doctor to get a good approximation of your eyeglasses prescription. The room lights are dimmed and an instrument containing wheels of lenses (called a phoropter) is positioned in front of your eyes. You will be asked to look at an object across the room (usually the big “E” on the wall chart or screen) while your doctor shines a light from a hand-held instrument into your eyes from arm’s length and flips different lenses in front of your eyes.

Based on the way the light reflects from your eye during this procedure, your doctor can get a very good idea of what your eyeglasses prescription should be. This test is especially useful for children and non-verbal patients who are unable to accurately answer the doctor’s questions.

With the widespread use of automated instruments to help determine eyeglass prescriptions today, your eye doctor might forgo performing retinoscopy during your eye exam. However, this test can provide valuable information about the clarity of the internal lens and other media inside the eye. So doctors who no longer perform this test routinely may still use it when examining someone who may be at risk of cataracts or other internal eye problems.

Refraction

This is the test your doctor uses to determine your exact eyeglasses prescription. During a refraction, the doctor puts the phoropter in front of your eyes and shows you a series of lens choices. He or she will then ask you which of the two lenses in each pair (“1 or 2,” “A or B,” for example) make the letters on the wall chart look clearer.

Based on your answers, your doctor will determine the amount of myopia (nearsightedness), hyperopia (farsightedness) and/or astigmatism you have, and the eyeglass lenses required to correct these vision problems (which are called refractive errors).

Automated tests

Your eye doctor also may use one of two types of automated instruments (an autorefractor or an automated aberrometer) to help determine your glasses prescription. With both devices, a chin rest stabilizes your head while you view a pinpoint of light or other image.

An autorefractor evaluates the way an image is focused on the retina, where vision processing takes place, without the need for you to say anything. This makes autorefractors especially useful when examining young children or people who may have difficulty with a regular (“subjective”) refraction. Often, the results obtained from an autorefractor are verified and refined with a manual subjective refraction during the exam to determine your eyeglasses prescription.

An aberrometer uses advanced wavefront technology to detect even obscure vision errors based on the way light travels through your eye. In some cases, an aberrometer is used to prescribe specially designed high-definition eyeglass lenses.

Cover test

The cover test is a simple procedure that helps your eye doctor determine if your eyes are aligned properly and work together as a team.

While you are focusing on a small object either across the room or up close, your eye doctor will cover one of your eyes at a time with a small hand-held tool. Depending on how your eyes move when covered and uncovered, he or she can determine your eye alignment and eye teaming ability.

Cover tests can detect even very subtle misalignments that can interfere with your eyes working together properly (binocular vision) and cause amblyopia or “lazy eye.”

Slit-lamp exam

The slit lamp (also called a biomicroscope) is an instrument that your eye doctor uses to examine the health of your eyes. A slit lamp gives your doctor a highly magnified view of the structures of your eye, including the lens behind the pupil, so he or she can thoroughly evaluate your eye health and check for cataracts and other problems.

The slit lamp is basically an illuminated binocular microscope that is mounted on a table. It includes a chin rest and headband to help you hold your head and eyes still during the exam. With the help of hand-held lenses, your doctor also can use the slit lamp to examine the retina (the light-sensitive inner lining of the back of the eye.)

Tonometry (glaucoma testing)

Tonometry is the name for a variety of tests used to determine the pressure inside the eye. Elevated internal eye pressure can cause glaucoma, which is vision loss due to damage to the sensitive optic nerve in the back of the eye.

One common method used for tonometry is the “air puff” test – where an automated instrument discharges a small burst of air to the surface of your eye. Based on your eye’s resistance to the puff of air, the machine calculates the pressure inside your eye – called your intraocular pressure (IOP).

Though the air puff test can be startling, nothing but air touches your eye during this measurement and there’s no risk of eye injury from the procedure.

Another popular way to measure eye pressure is with an instrument called an applanation tonometer, which is usually attached to a slit lamp. For this test, a yellow eye drop is placed on your eyes. Your eyes will feel slightly heavy when the drops start working. This is not a dilating drop — it is a numbing agent combined with a fluorescent yellow dye.

During applanation tonometry (also called Goldmann applanation tonometry or GAT), your eye doctor will have you stare straight ahead in the slit lamp while he or she gently rests the bright-blue glowing probe of the tonometer on the front of your eye and manually measures the intraocular pressure.

Like the air puff test, applanation tonometry is painless and takes just a few seconds.

Since glaucoma has no symptoms prior to permanent vision loss, having routine comprehensive eye exams that include tonometry is essential for ensuring the long-term health of your eyes.

Pupil dilation

Your comprehensive exam usually will include the use of dilating drops. These medicated eye drops enlargen your pupil so your doctor can get a better view of the internal structures in the back of the eye.

Dilating drops usually take about 20 minutes to fully affect your pupils. When your pupils are dilated, you will be sensitive to light, because more light is getting into your eye. You also may notice difficulty reading or focusing on close objects. These effects can last for up to several hours, depending on the strength of the drops used.

If you don’t have sunglasses to wear after the exam, be sure to ask for disposable sunglasses to wear for the drive home.

Additional testing

Depending on your particular needs, your eye doctor may perform additional tests or schedule them to be performed at a later date.

In some cases, he or she may refer you to a colleague who specializes in advanced care (for diabetic retinopathy, for example) for additional testing and/or treatment.

Why Are Eye Exams Important?

To safeguard your precious gift of sight, it’s important to have regular eye exams regardless of your age or physical health.

During a comprehensive eye exam, your eye doctor will check your eyes for common eye diseases, assess how your eyes work together as a team and determine your prescription for eyeglasses or contact lenses. He or she also will evaluate your eyes as an indicator of your overall health.

Who should get their eyes examined?

Eye examinations are an important part of health maintenance for everyone. Adults should have their eyes tested to keep their prescriptions current and to check for early signs of eye disease. For children, eye exams can play an important role in normal development.

Vision is closely linked to the learning process and it is important to have your child’s eyes examined to rule out learning-related vision problems. Many times, children will not complain of vision problems simply because they don’t know what “normal” vision looks like. If your child performs poorly at school or exhibits a reading or learning problem, be sure to schedule an eye examination to rule out an underlying visual cause.

What is the eye doctor checking for?

In addition to evaluating whether you have nearsightedness, farsightedness or astigmatism, your eye doctor will check your eyes for eye diseases and other problems that could lead to vision loss. Examples of problems your eye doctor will be looking for include:

  • Strabismus: Strabismus is misalignment of the eyes. Your eye doctor will check your eyes’ alignment to be sure that they are working together. Strabismus causes problems with depth perception and can lead to amblyopia.
  • Amblyopia: Amblyopia is reduced eyesight (usually in one eye only) due to the brain ignoring visual input from the eye or because images from that eye are significantly less clear because of unequal refractive error in the two eyes. Amblyopia often is caused by strabismus and is an adaptation by the brain to prevent double vision. Treatment of amblyopia usually involves treating the underlying cause of the condition, and then patching the “good” eye for a period of time to force the brain to start using the amblyopic eye so good vision can develop in that eye.
  • Eye Diseases: Many eye diseases, such as glaucoma and diabetic eye disease, have no obvious symptoms in their early stages. Your eye doctor will thoroughly check the health of your eyes, looking for signs of early problems. In most cases, early detection and treatment of eye diseases can help reduce your risk of permanent vision loss.
  • Other Diseases: Your eye doctor often can detect early signs of systemic conditions such as high blood pressure and high cholesterol by looking at the retinal blood vessels inside your eyes. In some cases, a comprehensive eye exam is how these conditions are first discovered.

For example, diabetes can cause small blood vessel leaks or bleeding in the eye, as well as swelling of the macula (the most sensitive part of the retina), which can lead to vision loss. It’s estimated that one-third of Americans who have diabetes don’t know it; your eye doctor may detect the disease before your primary care physician does, especially if you’re overdue for a physical.

Vision screenings and comprehensive eye exams

Vision screenings are general eye tests that are meant to help identify people who are at risk for vision problems. Screenings include brief vision tests performed by a school nurse, pediatrician or volunteers. The eye test you take when you get your driver’s license renewed is an example of a vision screening.

Vision screenings can suggest that you need an eye exam, but they are not a substitute for a comprehensive eye exam.

A comprehensive eye examination is performed by a licensed eye doctor and includes multiple tests of all aspects of your vision, including glaucoma testing. Based upon the results of your exam, your doctor will then recommend a treatment plan for your individual needs.

Only a licensed eye doctor can provide a comprehensive eye exam. Family physicians and pediatricians generally are not trained to perform complete eye exams, and studies have shown that they can miss important vision problems that require treatment.

Treatment plans following a comprehensive eye exam may include eyeglasses or contact lenses, strabismus surgery or vision therapy for eye alignment or binocular vision problems, medical treatment for eye disease or simply a recommendation that you have your eyes examined again in a specified period of time.