Every visit with a patient is an opportunity to teach them about the different aspects of eye health. By encouraging regular eye examinations, I can reinforce basic wellness tips to help keep my patients’ eyes healthy and reduce the possibility of vision loss.
The Anatomy of the Eye
It can be difficult to explain to patients that different parts of their eyes require different types of nutritional support. By breaking down the anatomy to distinguish the front of the eye (the ocular surface including eyelids and Meibomian glands) and those at the back of the eye (the macula and retina), I can simplify treatment explanations for patients.
When I talk to patients about taking care of the ocular surface, I often emphasize how omega fatty acids help to reduce inflammation and focus on recommending a specific supplement rather than overwhelming them with too many options. Most patients aren’t aware of the risks of Meibomian gland dysfunction or ocular rosacea until I explain the role of these conditions in dry eye disease and introduce them to a daily eyelid hygiene regimen.
In discussing the anatomy of the back of the eye, the conversation often turns to cataracts, glaucoma, age-related macular degeneration and how the retina processes light. These discussions include lessons about the effects of UV light and smoking, which can contribute to back of the eye conditions (related to macula and retina)1.
Myopia is also a hot topic. Since the early 1970s, the prevalence of myopia has increased from 25 to 40 percent for Americans between the ages of 12 and 542. Explaining the dangers of myopia may lead to discussions about lifestyle behaviors that pose risks to eyesight, such as screen use, lack of natural light, fully correcting refractive error and the importance of regular eye examinations3.
Recommending Supplements
I suggest that my colleagues recommend or “prescribe” a specific type of omega fatty acid supplement4, as they would with other eye medications, to care for both the front and back of the eye. I am also a big fan of lutein and zeaxanthin for patients with age-related macular degeneration. When recommending supplements, I am extremely aware of the risks of overprescribing, especially fat-soluble vitamins. Working with a patient’s entire medical team is important to make sure multiple products are not being taken that counteract each other.
An important part of each visit is talking to my patients about their overall nutrition and recommending a diet of certain foods that are specifically helpful for eye health5. While some patients already have a good diet full of fish, fruits and vegetables, others need guidelines. I often suggest foods that are rich in antioxidants, like spinach and kale, and encourage them to eat grapefruit, strawberries and brussels sprouts for Vitamin C. I also take care to highlight the importance of limiting the amounts of fried and fatty food they ingest. Some caffeine intake has been shown to be beneficial for dry eye. Alternatively excessive caffeine intake can contribute to dry eye. Thus, I discuss the importance of staying well hydrated. All of these nutritional guidelines can help patients maintain optimal eye health and overall health in general.
Contact Lens Education
One of the scariest trends I see when treating patients is the misuse of contact lenses. Because of advancements in technology, there are new companies that offer online sales of contact lenses through telemedicine. While this can be a more convenient option for patients, it overlooks the importance of an eye examination including dilation. It is important to evaluate the contact lens fit on the eye itself and how to apply and remove contact lenses properly.
Non-compliance with proper contact lens use has become a much larger problem in recent years. For example, I often see non-compliance with contact lens solutions. Additionally, I sometimes see patients using a contact lens for a whole month, even though it is recommended by the FDA for one-day use. Some of the risks of this behavior include bacterial infections or corneal ulcers, which could potentially lead to blindness, the need for a corneal transplant or even the loss of an eye. These are scary, sight-threatening risks. If patients purchase their contact lenses online, they aren’t getting the proper education on how to handle and clean their lenses. They also lack information about potential risks to their eyesight from improper care. Also, sight or light-threatening conditions such as ocular melanoma cannot be diagnosed by an online vision examination.
Risks at Every Age
Risk factors exist for patients of all ages. In particular, digital device use is highly prevalent in our society today. Dry eye is on the rise because patients don’t blink as often as necessary while using their devices, and therefore, their tear film is affected and is not smooth and even. We’ve started to see Meibomian gland drop out in children as young as 8 years old, which is unprecedented. I make a point of emphasizing the importance of taking care of the ocular surface during screen use by teaching all of my patients to take breaks while using their devices—from computers to phones to iPads. A 20 second break every 20 minutes to look at something 20 feet away is essential.
Educating patients on the proper way to care for their eyes during each stage of life can help them maintain eye health. These are simple things that all patients can do to protect their eyesight throughout their lives.
Eye Health for All Ages
- Kids, teens and adults: sunglasses; sport protection/safety goggles; and learning the 20-20-20 rule early.
- Teens and adults: proper use and removal of face, eye creams and makeup.
- 20s: sleep; proper contact lens use; and eating a healthy diet.
- 30s and 40s: watching for vision and hormonal changes caused by pregnancy and nursing; taking breaks during digital device use; and corrective lenses for the onset of presbyopia.
- 50s and older: nutritional supplementation to protect against ocular surface disorders caused by hormonal changes during menopause; eating a diet full of omega fatty acids; and taking supplements for other conditions, such as AMD, as needed.
For everyone, it is highly important to wear sunglasses, take breaks when on digital devices and eat a healthy diet and exercise. Beyond these simple pieces of advice, I tailor treatments to each individual and focus on behaviors such as smoking or poor diet that can potentially lead to vision loss. As doctors, we can’t necessarily control our patients’ behavior after they leave our office. Arming them with the information they need to care for their eyes to avoid vision loss is an essential part of every visit.
Dr. Melissa Barnett is a Principal Optometrist at the UC Davis Eye Center in Sacramento. She is internationally recognized key opinion leader, specializing in anterior segment disease and specialty contact lenses.
Citations:
- Klein, B. E. K., & Klein, R. (2007). “Lifestyle Exposures and Eye Diseases in Adults.” American Journal of Ophthalmology, 144(6), 961–969.
- Ziaziaris, S. (2015, Jan 25)“Study: Number of myopia sufferers to reach 4 billion by 2050.” Sydney Morning Herald.
- “The Nearsighted Epidemic is Real. ” (2016, Jan 3)Science Alert
- Bhargava, R., Kumar, P., Kumar, M., Mehra, N., & Mishra, A. (2013). “A randomized controlled trial of omega-3 fatty acids in dry eye syndrome.” International Journal of Ophthalmology, 6(6), 811–816.
- Richer, S., & Newman, S. “Caring for Your Vision: Diet & Nutrition.” ” American Optometric Association.
