What doctors wish patients knew about improving eye health

Good vision is essential for our daily lives, yet many people take their eye health for granted. That’s why it is important to be aware of the steps that can be taken to maintain healthy eyes and prevent vision problems. From lifestyle changes to regular checkups, an ophthalmologist shares what to know about eye health and how to prevent eye diseases.

About 12 million people in the U.S. 40 years or older have vision impairment. Meanwhile, nearly 7% of children have a diagnosed eye and vision condition. And while an estimated 93 million adults in the U.S. are at high risk for serious vision loss, only half visited an eye doctor in the past 12 months, according to the Centers for Disease Control and Prevention’s fast facts about vision loss.

The AMA’s What Doctors Wish Patients Knew™ series provides physicians with a platform to share what they want patients to understand about today’s health care headlines.

For this installment, David H. Aizuss, MD, an ophthalmologist in Calabasas, California, and assistant clinical professor of ophthalmology at the UCLA Geffen School of Medicine, Stein Eye Institute, discusses what patients need to know about improving their eye health. Dr. Aizuss is also a member of the AMA Board of Trustees.

One thing that can cause damage to a person’s eyesight “is putting things in your eye that you should not be putting in your eye,” Dr. Aizuss said. Also, “rubbing your eyes can weaken the structure of the eye, which can result in something called keratoconus where you get an abnormal bulging of the clear front surface of your eye.”

“Another thing that can damage your eyes is staring directly into the sun or using lasers and pointing them at one’s eyes,” he said. “Infections that don’t get dealt with appropriately can also damage your eyes. And chronic inflammation in the eyes can damage your eyes permanently.”

“Other things that can damage your eyes are wearing contact lenses and not disinfecting them on an appropriate schedule,” Dr. Aizuss said. “Or wearing contact lenses and properly disinfecting your lenses, but failing to wash the contact lens case out at least once a week with soap and water and letting it air dry.”

“I just saw a patient today with a corneal ulcer who failed to clean their case ever, and I explained to them that when you put your contact lenses into a dirty case, even when you’re putting in your disinfection solution,” he said. “It’s not a sterilizing solution. Those solutions decrease bacterial count levels, but if you’re already starting with a dirty case with bacteria, you can’t reduce them to a level low enough that it’s not risky for your eyes.”

Actress Tori Spelling was recently in the news because she left her contacts in for 20 days and now has an ulcer, which is “a perfect example of why you need to take out your contacts,” said Dr. Aizuss. “And that’s why I recommend daily disposable lenses.”

“My children wear daily disposable lenses because every day they’re putting a fresh lens in their eye—they don’t have to monkey around with contact-lens solutions,” he said. “If you compare the cost of a daily disposable lens to the cost of a monthly disposable lens and all the solutions, it often comes out pretty similar and the safety is much greater.

“All you have to do is have one doctor’s visit for contact lens overwearing or poor lens care—and whatever savings you might have, you’ve immediately lost,” Dr. Aizuss added.

“Patients with diabetes are at much greater risk and need to have annual eye checkups regardless of age,” Dr. Aizuss said. That’s “because you can get diabetic eye disease, leaky blood vessels in the retina, which when caught early can be dealt with to prevent later problems.”

“Other people at risk: If you you’ve got certain connective-tissue diseases like rheumatoid arthritis, ankylosing spondylitis, systemic lupus,” he said. “There are a variety of things that can impact the ocular system, so those patients should be seen on a periodic basis.”

Additionally, “if you take certain medications—like oral Plaquenil for various connective tissue diseases or even oral steroids—it can have negative impacts on the eye and those individuals should be seen on a regular basis,” Dr. Aizuss said.

“High blood sugar is correlated with progressive diabetic eye disease,” Dr. Aizuss said. “So, it’s very important that you maintain a good diet and your blood sugar is controlled—whether with oral medicines or insulin.

“And that you’re followed on a regular basis by your primary care physician, preferably,” he added. The primary care physician is following you for your comprehensive diabetes care, but they can’t do an eye evaluation, which is needed annually.

“Blood pressure can actually damage the little blood vessels in the back of the eye,” Dr. Aizuss explained, noting “it can cause narrowing of the arterioles and it can cause a variety of problems that can affect the eye if your blood pressure is not controlled.

“If your high cholesterol is not controlled, it can damage vessels all over your body, including the vessels in your eye,” he added.  

Keep in mind that “healthy eating can help with eye health,” Dr. Aizuss said. “For example, macular degeneration is the leading cause of vision loss in adult Americans.

“We know that a major risk factor for macular degeneration is smoking, so the first thing is you shouldn’t smoke,” he added. “But we also know that eating lots of green leafy vegetables and plenty of fish in your diet is a benefit to help prevent the development of macular degeneration.”

That’s “because those things contain vitamins and fish oil—things that we know help with ocular health,” Dr. Aizuss said.

“It is cool to wear your shades, because it helps prevent sun-induced damage to your eyes,” Dr. Aizuss said. “And I tell most patients that most of the damage done to our eyes from the sun and to the lens of the eye is done when we’re kids, before we’re adults.

“But you don’t, unfortunately, see kids running around outside wearing sunglasses. In fact, my children had sunglasses from when they were very young, but they never wore them, including prescription sunglasses,” he added, noting “the sun can damage the outside of the eye. It can cause growth of abnormal tissue on the surface of the eye.”

“There’s something called surfer’s eye, which is another name for pterygium, and is a fleshy vascular growth on the surface of the eye that is caused by sun damage,” Dr. Aizuss explained. “So, sunglasses help prevent that.”

When choosing sunglasses to wear, “you want something that protects you, so choose a UV 400,” he said.

“Blue light glasses are completely unnecessary,” Dr. Aizuss said, noting “there was a study done about two years ago that was published in the American Journal of Ophthalmology that showed that BluBlockers have no real benefit.”

“Now there are some people who may feel more comfortable wearing them, but it’s not demonstrated in the medical literature,” he said. “Most patients will find that they blink less frequently when they stare at screens and there is something called computer vision syndrome where patients get dry eyes and their eyes feel tired.

“And most of this is because we don’t blink as often and we’re focusing at near,” Dr. Aizuss added, noting he wears special computer glasses where the top part is set for the distance from the computer screen as opposed to regular glasses.

When it comes to working on the computer or other devices, “I recommend that every 20 to 30 minutes you take your eyes off the computer,” said Dr. Aizuss. “And focus on something in the distance that lets your eye muscles relax.”

“It makes people much more comfortable and helps prevent headaches and all the other things that come with computer vision syndrome,” he said.

“If patients are having tired, fatigued eyes or they’re burning from the prolonged work at a computer, keep a bottle of brand-name artificial tears next to your computer screens,” Dr. Aizuss said. “Patients can put a drop in every hour to two or four hours to give them some comfort.

“And the reason I say brand-name artificial tears is there’s been a lot of publicity lately because there were a small number of artificial tears removed from the market because they were contaminated with a very aggressive form of bacteria called Pseudomonas aeruginosa, which can cause severe corneal ulcers and blindness,” he added. “The tears that have been withdrawn from the market are not typical brand-name drugs. They’re either private label or they’re unknown names.”

“It’s not worth saving a dollar or two on some sort of generic tear where you don’t know where it came from,” Dr. Aizuss said.

“There’ve been a number of studies lately that demonstrate that children who play outside are much less likely to get nearsighted than those who stay inside reading books and playing on their iPads and their computers,” Dr. Aizuss noted. “So, we definitely encourage parents to have their kids outdoors playing, which seems to be happening less and less nowadays because children lead very scheduled lives.

“And a lot of those scheduled activities are not necessarily always sports,” he added, noting “it’s just another thing to try and bring back the childhood that many of us may have known that our children don’t get exposed to.”

“The only thing with makeup is sometimes patients don’t take it off every night and they have to take it off because if they don’t, you can get what’s called blepharitis, which is skin bacteria,” Dr. Aizuss said, adding “they colonize the margin of your eyelids and irritate your eyes.”

“Some people put foundation on very close to the edge of their lid and it’s powdery stuff that gets in the eye and affects their tear film and it can irritate you and make your eyes dry,” he explained. “Mascara can also get in the eye and sometimes it gets stuck under the upper lid and scratches the eye, so I’m often giving patients lectures about wearing less makeup.”

“I’m seeing a lot of styes. We’re seeing more than we ever did, partially related to mask wear because the moist air helps clog up the meibomian glands,” Dr. Aizuss explained. “The other reason that we see that a lot is we see them more commonly in women than men from eye makeup, but sweat causes them too.

“So, when people exercise, that can cause a lot of them and as long as you wash your face thoroughly it should prevent styes,” he added, noting “there’s the occasional patient who we have to put on a program of lid hygiene, which is a hot compress once or twice a day along with a lid scrub.”

For a lid scrub, “just take a Q-tip, dip it in warm water, close your eyes and go back and forth on the edge of your lids where the eyelashes grow, and that helps prevent inflammation of the eyelid margins and helps prevent styes from developing,” Dr. Aizuss said.

Washing eyes with baby shampoo “was what we used to tell people. There are many people who still recommend diluted baby shampoo. I do not,” Dr. Aizuss said. That’s “because when it gets into the eye—even though it’s diluted—it disrupts the tear film and is irritating.”

“So, I would rather see people just use warm water. There are commercially available lid scrubs that are also good,” he said. “But baby shampoo can be used as long as it’s diluted—usually one teaspoon of shampoo to five teaspoons of water.”

“Everyone should have an eye exam prior to age 5 by an ophthalmologist or a pediatric ophthalmologist,” said Dr. Aizuss. “They should have another exam prior to junior high school in elementary school, and they should have another eye exam prior to leaving for college.

“For kids, if you're wearing glasses or have a known eye issue, then you probably need to be checked more frequently in that age group,” he added. Then “when you’re an adult, probably every two to three years is fine up to age 65 when you should be seen annually.”

Notably, such eye-health exams by ophthalmologists should be distinguished from vision screening done by optometrists.

If the purpose of a visit is “primarily to get a new pair of glasses or contact lenses,” Dr. Aizuss said, then visiting an optometrist “may be appropriate.”

But, he cautioned, “the problem is that there are significant differences in education level and ability to recognize disease because there's a much greater exposure to disease and abnormal eyes in ophthalmology training than there ever is in optometry training.”

“Ideally, especially if you have a young child, you're better off being seen by an ophthalmologist because there are serious issues that need to be dealt with before age 7,” Dr. Aizuss said, adding that “if you're an older adult, you are much better off being seen by an ophthalmologist and in between there's more opportunities to go to either.”