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SUNDAY STAR, 6 MARCH 2016

special

HEALTHY EYES

Towards better visionBy THERESA BELLE

WHEN it comes to caring for youreyes, you cannot start soonenough. This is especiallyimportant considering the declinein eye health among young people,which has been attributed toincreased use of technologicaldevices.

Lynn Foo, optometrist with theMalaysia Glaucoma Society (MGS),says she sees more and more casesof myopia (short-sightedness)among children who are exposedto gadgets as young as three orfour years old.

“Urbanisation plays a role in thechanging landscape of eye health –in the past, children wereencouraged to run around andplay outside but now many arecontent with staying indoors facingscreens for extended periods oftime,” she explains.

Not only does light from thesescreens dry up your eyes, it alsocontributes to the gradualdegeneration of the eyes andstrains eye muscles, whichweakens them over time.

Dr Liau Kok Liang, residentconsultant ophthalmologist atMahkota Medical Centre, advisesparents to train their children inprotective and hygienic measures,including limiting use of gadgetsand maintaining a safe distance

when using them as well asreading and doing homework at acomfortable distance from printedmaterial.

Millennials facing smartphone,television or computer screensfor hours on end today were thechildren who were told to keeptheir distance from the televisionwhen they were young.

Studies have proven that thiswarning is not to be taken lightlydue to the long-lasting impact oflight exposure.

Data released by eye healthgroup Optegra reveals that thosedoing office and clerical work areat highest risk of poor eye healthcompared to those in other sectors,which is unsurprising considering

the eyes are continually strained ina modern office environment.

Protection is keyLight can be both bad and good

for the eyes, depending on its typeand level of exposure. For example,we are advised to read underbright light but at the same time,

told to use sunglasses that offer thebest protection from ultraviolet(UV) rays.

“The pupils naturally dilate toallow light to enter the eyes.Without proper protection againstharmful rays, lenses are easilydamaged with excess exposure tolight,” says Foo.

A large part of preventive care isincluding the right nutrition inyour daily diet. According to theAssociation of MalaysianOptometrists, vitamin E isimportant for the retina, whilelong-term consumption of vitaminC helps prevent cataracts.

Antioxidants lutein andzeaxanthin, which can be found incorn, spinach and celery, help filterharmful blue light and quenchhazardous free radicals in themacula (oval yellowish area nearcentre of the retina, which is theregion of greatest visual acuity),which also prevents cataracts.Keeping a balanced diet with fish,meat, grains, fruits and vegetablesis the best option.

Maintaining healthy lifestylehabits in general protects the eye

because when the body is fit anddisease-free, the risk ofserious eye complicationsis reduced.

Systemic diseases

such as diabetes are closely linkedwith optical health – this is whydiabetic patients must undergoregular checks for diabeticretinopathy, which occurs whenretinal blood vessels are damagedby high sugar levels and can leadto blindness.

Besides that, it is important tokeep eyes clean to avoid infection.For example, contact lenses mustbe properly cleaned and stored ina sterile solution and should not beworn for longer periods of timethan prescribed.

Foo also warns against thedangerous trend of usinguncertified lenses – although theymay be cheap and easily accessible,contact lenses sold in nightmarkets and the like often comefrom unauthorised suppliers.Contact lenses use must beprescribed and monitored by anoptometrist.

Awareness, proactivitySteven Chan never had

problems with his eyesight beforehe was diagnosed with glaucomain 2002.

The condition is characterised byincreased intraocular pressure(occuring in the eyeball), whichdamages optic nerves to causegradual blindness – this pressurecaused Chan to suffer sudden,terrible headaches.

Within the next five years,he underwent nine surgeriesto address this condition.Unfortunately, combined with theeffects of diabetic retinopathy,Chan lost his eyesight in 2007.

After this life-changing event,he founded MGS in 2009 to addressthe lack of public knowledge andaction on this eye disease.

This was followed by theformation of Save Our SightMalaysia (SOSM) in 2010, a non-governmental organisation thatcares for and supports patientswith all types of eye disorders, andthe Malaysian chapter of Dialoguein the Dark, an international social

enterprise that lets peopleexperience living in

absolute darkness

while led by blind guides.MGS and SOSM have worked

with various agencies to bringeye check facilities and servicesto those in rural communities athigh risk of developing eyecomplications.

According to Chan, these effortsshare the aim of raising awarenesson eye care and checks, especiallyamong the young and the sick.

“There are 3.2 million diabeticsin the country, of which 8% to 10%will lose their eyesight within thenext decade,” he explains, addingthat the public healthcare systemdoes not place sufficient emphasison eye health, which is why somany people still take these vitalorgans for granted.

Ministry of Health Data from2014 places the ratio ofoptometrists to the population at1:22,450. This ratio, together withmeagre optometry offerings inpublic healthcare, means thatMalaysians are left to seekguidance and protection throughtheir own initiative.

Since eye diseases do nottypically present symptoms early,

you may not be able to clearlyidentify a complication.

Health professionals recommendattending eye checks at least onceevery two years or once a year ifyou have eye problems to takecharge of your eyesight before it is

too late.

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healthy eyesSUNDAY STAR,

 6 MARCH 2016

Treatingeye trauma

AUMATIC eye injuries are moremmon than people think;idents happen at work or evening play.

The most common one seen bycialists is a corneal foreign body

ury, where a moving foreigndy (most often a tiny piece oftal) becomes lodged in thenea (the transparent layer thatms the front of the eye).

This injury is often seen amongople who work with potentiallyngerous machinery, such asel-cutting machines, weldinguipment or even grass cutters,d who neglect to wear protective

gear.Corneal foreign body injurieso occur during motor vehicleidents, such as when a brokenss flies into the person’s eye, andong children where the corneaierced with a pencil, formple.

A corneal foreign body canually be removed under localaesthesia by using a needle andit lamp microscope. Theients are then prescribed withibiotic eye drops to preventection in the eyes,” says Dr Liauk Liang, resident consultanththalmologist at Mahkotadical Centre.

Dr Liau explains that a morengerous injury occurs when the

is cut by a sharp foreign bodyvelling at high speeds, causing athickness corneal laceration –

ere the sharp object cutsough the whole cornea to nexters of the eye. The injuryrsens if the foreign body hits the

s of the eye.This can cause a traumaticaract, which can lead to loss ofon. There is also a chance ofteria entering the eye andsing infection,” he explains.

Other injuries include where ant object (such as a shuttlecockin cases of assault, a fist) hitseye, causing blood to pool ineye, leading to blurred vision.

Dr Liau says that most of theseuries can be treated with orald topical medication. However,he injury is severe, it can lead to

traumatic glaucoma, which iswhere there is persistent highpressure in the eyeball. Thisrequires long-term treatment andsurgical intervention in somecases.

Sometimes, a forceful impact caneven lead to the eyeball rupturing.“This type of traumatic injury ismore difficult to treat and in mostcases leads to complete vision loss,”

says Dr Liau.Another serious eye injury is

called intra-ocular foreign body,where the foreign body haspenetrated the eyeball and restson the internal part of the eyeball.

Treatment for this injuryrequires the use of a vitrectomymachine to remove the foreignbody and suture (sew close) thelaceration.

Imaging technology such as a CT(computed tomography) scan mayalso be used so that the surgeoncan determine exactly what the

injury entails.“The eye is very small compared

with other organs, so a 2mm objectlodged in the eye is consideredquite big. Therefore, surgery onthe eye requires microscopicprecision,” says Dr Liau.

These treatments areadministered by specialists athospitals in Malaysia, includingMahkota Medical Centre. It is best

to go to hospital when such injuriesoccur instead of to your normalgeneral practitioner.

Dr Liau stresses the importanceof taking care of your eye health.“Your eyes are not like yourbones – they do not regrow thesame way. If you have a severeinjury, you may never recoverfull vision in that eye. Loss ofvision is usually permanent,” heexplains.

This means that you will loseyour ability to perform certaintasks as your three-dimensional

The easiest way toprevent injury isto wear protectiveeyewear such asgoggles. We onlyhave two eyes; theloss of even oneis traumatic and

detrimental. There isno way to replace aneye or your vision.Dr Liau Kok Liang

Knowwhat

to do

WHEN a traumatic eye injuryoccurs, it is essential that youknow what to do.

Traumatic eye injuriesinclude when a foreign body (atiny piece of metal or glass)penetrates the cornea; whenthe eye is struck by a bluntobject, causing blood to pool in

the eye; when a forceful blowto the eye causes the eyeball torupture; or when chemicals(acids or alkalis) enter the eye.

Before going to hospital, hereis what you should do:

Chemical injuryl Wash the eye with clean

running water for at least fiveminutes. This means placingthe eye directly under the tapand letting the water run overand off the eye to wash awaythe chemical.l Go to the hospital

emergency room immediatelyafter.

Penetrating/blunt force

injuryl Place a solid material, such

as a piece of plastic or even asmall cup over the eye socketto protect the eyeball.l Gently hold the material/

cup to the face or gently securewith gauze or tape.l If no solid material is

available, a thin piece of gauzeor cloth should be placed very

gently over the socket.l Do not apply gauze

directly to the eye or pressdown on the eyeball as thiscould cause further injury,such as the inner contents ofthe eye spilling out.l Go to the hospital

emergency room immediately.

It is best to go directly to thehospital emergency roominstead of your normal generalpractitioner, as the GP will nothave the equipment or skill toperform the treatment orsurgery required.

At the emergency room, anophthalmologist will be called

in to assess and treat theinjury.

vision is compromised. This maylead to you losing the ability towork and to loss of income.

“The easiest way to preventinjury is to wear protectiveeyewear such as goggles. This goesnot just for those working withmachinery in a factory but also theeveryday person who does workaround the house or is cutting

grass in the garden,” he advises.“We only have two eyes; the

loss of even one is traumatic anddetrimental. There is no way toreplace an eye or your vision. It istherefore very important to ensuresafety and prevent eye injury.”

n For more information, contactMahkota Medical Centre.

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SUNDAY STAR, 6 MARCH 2016

healthy eyes 3

Laser surgery in your 50sTECHNOLOGICAL advances inlaser eye surgery have broughtcontinuous improvement in safetyand efficacy.

Through the years, LASIK (lasereye surgery) has become amainstream procedure for thecorrection of refractive errors.

Most people experience a declinein the quality of their vision whenthey hit their 40s. With a very largepopulation of baby boomers nowin their 40s and above, the demandfor corrective eye surgery has beenon the rise.

In fact, there are increasingnumbers of patients above theage of 50 enquiring about LASIK.

Many may wonder whetherthere is an age limit for LASIK. Astudy carried out by Dr DimitriAzar and colleagues at Universityof Illinois, Chicago, that involvedperforming eye surgery on patientsaged 40 to 69 concluded that therewere no significant statisticaldifferences in final visual acuitybetween the different age groupsof those aged 40 to 69.

Hence, I believe that there is notnecessarily an age limit for one toperform LASIK. Rather, it dependson the state of the eyes of thepatient rather than his age.

However, each candidate

seeking refractive surgery mustundergo a thorough eyeexamination and be consideredon a case-by-case basis.

Those in this age group shouldtake these precautions intoconsideration before undergoingLASIK:l The natural lens inside the eye

has to be clear and the patientmust understand that LASIK willnot prevent a cataract fromdeveloping in the future.l Changes in vision or

prescription may indicate an earlyonset of a cataract. Patients whoare already developing a cataractand undergo LASIK may find their

vision deteriorating in a few years.The main cause of this is not thatthe laser eye surgery is notpermanent; rather, it is caused bythe cataract.l Be aware of any signs of age-

related eye diseases or a familyhistory of diabetes, glaucoma orcorneal disorders.

Another thing to consider is dryeyes. This is more common inthose aged above 50 due to changesin their body as well as side effectsof certain medications.

Dry eyes are a common sideeffect of LASIK, especially during

the recovery period. During theLASIK procedure, a significantamount of corneal nerves, whichhelp reduce dry eyes, is cut.

However, with a technologycalled SMILE (small incisionlenticule extraction) the cornealnerves are preserved and thechance of developing dry eyes issignificantly lessened.

LASIK is contraindicated if apatient is on Amiodarone (a drugthat helps keep the heart beating,normally used by patients withheart disorders).

Using Amiodarone afterundergoing LASIK may causecoloured haloes around lights,photosensitivity, blurred vision,dry eyes and lens opacities.

So prior to undergoing any lasereye surgery, ensure that yourdoctor knows of your medicalhistory and prescription drugs.

Treating presbyopia

Presbyopia is a loss of elasticityin the lens resulting in the eyelosing its flexibility to adjust itsfocus, which affects a person’sability to see fine details up close.It normally develops at age 40 and

above.In LASIK, the laser treats the

cornea to correct myopia,hyperopia and astigmatism but itcannot stop the natural lens insidethe eye from ageing.

Hence, undergoing LASIK inyour 20s will mean that you willeventually need to wear readingglasses at age 40 and above to seeclose-up details.

In LASIK, presbyopia iscommonly addressed through amethod called monovision, whereone eye is corrected for distancevision and the other eye for nearvision. So, when both eyes are

open, the brain will adaptaccordingly and the patient cansee clearly both far and near.

Monovision may only workeffectively in some patients so theyshould discuss their occupation,hobbies and other lifestyle issueswith their doctor to determine ifthe procedure is right for them.

It is not suited to people whorequire sharp distance vision,precise depth perception or precisenear vision in their day-to-dayactivities.

Some patients can adapt welland fast, but some may take longer.There is also the option of a full eyecorrection to restore a balanced

distance vision.Most people can expect a good

outcome if they maintain realisticexpectations. If you seek laser eyesurgery to correct your visionproblems, talk to your surgeonabout the benefits and risks ofsurgery involved at your age.

Make sure that you are fullyinformed of the advantages anddisadvantages of the procedure aswell as understand the aftercaretips. – By Dr Yen Siew Siang

n Dr Yen Siew Siang is a seniorophthalmologist & laser refractivesurgeon at Optimax Eye Specialist.

Dr Yen Siew Siang.

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