Good eyesight is essential for modern life. However, our eyes change drastically over our lifetimes, and because we are living longer it’s critical to protect our eyes where possible so that our vision continues to be as good as possible as we age. While medical or surgical treatment can be very effective, prevention is better than cure.
Here are some practical pointers on how you can look after your most precious sense:
1. Have a regular eye medical assessment. Over age 40 it is possible to assess the eyes for the health not only of the eye but many other medical conditions. It is common for an ophthalmic professional to be able to detect many conditions which are otherwise silent. This includes current or future risk of glaucoma (raised pressure in the eye), which, like high blood pressure, causes silent damage.
2. Wear sunglasses to protect your eyes from harmful UV radiation. There is increasing evidence that in childhood, natural daylight is essential to regulate the normal growth of the eyes and protect from the development of short sight (myopia). However, in adult life, UV radiation is harmful. Cataracts develop due to a lifetime of light passing through the lens and from the constant change in shape as we alter our focus from distance to near.
3. Avoid smoking. Though cancer is the risk every smoker is aware of, there is a lack of understanding about the risk to the retina. Every photon of light detected in the retina causes a disk in the cones and rods to be discarded. The retina is the fastest metabolising tissue in the body and smoking causes great damage.
4. Other than smoking, nutrition is the next modifiable factor to protect the eyes. Is there any benefit in oral antioxidant, vitamin or mineral (zinc) supplementation? The retina is at risk of oxidative stress. Over 12 years, thousands of people have taken part in the AREDS and AREDS-2 studies. No one knew what the minimum effective dose or combinations of antioxidants are required. It is common for OTC manufacturers to make many claims about products’ health benefits, but long term randomised and controlled studies are rare. What is the role of dietary supplements for those who have a ‘normal’ diet? There is evidence that the AREDS combination supplements can considerably slow down progression to macular degeneration.
5. It has long been known that we are relatively lacking in omega-3 and other essential fatty acids as we poorly absorb them from our food. Omega-3 does not protect the retina from macular degeneration1 but it is very effective in treating dry eye, which is common as we get older. Contact lens wearers develop dry eye over the years, as contact lenses are associated with reduced tear production. Omega-3 supplementation has shown to dramatically improve dry eye in contact lens wearers in a recent placebo-controlled trial. Another placebo-controlled study showed benefit of omega-3 with office dry eye or ‘computer-vision syndrome’. There is now also considerable peer-reviewed evidence of dramatically improved Meibomian gland function within the eyelid and this considerably helps dry eye.
I try to avoid promoting specific brands, however, here’s an exception: I believe that, currently, the standout product is “Omega Eye”. This is available in the UK from Scope Ophthalmics at http://www.scopeophthalmics.com. This is the product I recommend for my patients with dry eye and those who are experiencing dry eye with contact lens wearing, and also after ophthalmic surgery. It takes about three months to develop its full effect, but for those who have severe Meibomian blockage and inflammation around the eyelids it takes up to six months. Treatment can also involve anti-inflammatory medication, but the mainstay of treatment is the natural product omega-3.
5. Rest your eyes! We live in a world lit by artificial lighting and our days extend into the late night. We all experience tired eyes, with dry eye due to tear evaporation and long periods reading or concentrating proving difficult. The eyes need a rest to recover, just like the rest of our body.
6. Itchy eyes are a sign of allergy or toxicity. In today’s cities there is pollution and many irritants—it is not just pollen that causes allergies. If possible, try to avoid the irritant, otherwise there are now excellent medications for blocking the eosinophil trigger cells responsible for itching, irritation and redness.
7. Artificial tears. Modern tear supplements have changed dramatically. In the UK we have moved to preservative free drops, and hyaluronate drops are a current favourite for many people. This may be pure hyaluronate or there can be some added protectants. My own hospital, Moorfields Eye Hospital in London distributes the excellent Lubristil Alternatives are Hyabak and HYLO to patients suffering from significant dry eye, one of my favourites is Clinitas soothe 0.4%. These used to be incredibly expensive but with modern manufacturing hyaluronate artificial tears have become universally available.
8. Wear ‘eyepro’. Eye protection glasses or goggles are essential. It is not cool to get an eye injury or to lose an eye because no eye protection was worn. Eye casualties are often those who didn’t wear their ‘eyepro’.
9. Know your family history. It is very common for eye diseases to be genetic. If you have parents or ancestors who have or had eye problems you should discuss this with your doctor or ophthalmologist.
10. Contact lens wearers should not get complacent. Contact lenses are convenient and great for vision but there is an ever-present risk of infection. It is common to get a particle of dust or grit under a lens and this can then scratch the cornea, breaching the natural defences, resulting in serious scarring and loss of vision.
Sight has often been described as the most precious of the senses. Look after it!
SOURCES: Cochrane Database Syst Rev 2015; Cornea, 2015; Cont Lens Anterior Eye, 2015.
