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Women & healthy vision.

Sunlight. Airplanes. Wind. Smoking. Computers. Poor diet. Family background. This list of items may seem unrelated, but they all have one thing in common: They can negatively affect the health of your eyes. Yet with one exception--your family background--their potential impact on your vision can be modified if you're willing to make the effort.

And effort, where vision health is concerned, is a good idea. Of the approximately 3.4 million visually impaired Americans, about two-thirds are women; additionally, two-thirds of the one million Americans who are blind are women, says Ilene Gipson, PhD, a senior scientist at the Schepens Eye Research Institute, affiliated with Harvard Medical School in Boston. (1)

In fact, nearly all eye-related diseases and conditions, including dry eye syndrome, (2) age-related macular degeneration (AMD), (3) glaucoma and cataracts, (4) are slightly or considerably more prevalent in women. One eye disease--glaucoma--is also significantly more prevalent in African Americans over age 40 and everyone over 60. (5)

Part of the reason women suffer more than their fair share of eye-related conditions is simply related to time: Women live longer than men, and nearly all eye conditions become more prevalent as we age. As for other reasons? "We do not know all the factors, but research is ongoing," says Dr. Gipson.

Another reason has to do with the negative effects of inflammation on eye health, a byproduct of the immune system. Since women make up 75 percent of Americans living with autoimmune diseases such as multiple sclerosis, lupus, rheumatoid arthritis and Sjogren's syndrome, all of which can significantly affect the eyes, this may play a role in the eye-related gender gap. (7)

What is known, however, is that 75 percent of visual impairment can be prevented or corrected, primarily with lifestyle changes, says Dr. Gipson. (2) Armed with that knowledge and shocked by the high incidence of vision impairment in women around the world, she and colleagues at the Schepens Eye Research Institute and other medical institutions formed the Women's Eye Health Task Force, dedicated to providing education and out-reach to stem the growing number of women with impaired vision.

Your Health & Your Eyes

The most common cause of vision loss in people over 65 in this country is age-related macular degeneration, or AMD. It affects an estimated 1.6 million Americans, most of them women. (8) It primarily affects the part of the retina responsible for sharp central vision, gradually destroying it until you're left with just your peripheral vision (the outer part of your field of vision). One theory suggests it may be related to an inappropriate immune response that triggers inflammation. (9)

Patti Jacobs, 56, doesn't really care what the cause is. She just wants researchers to come up with a cure. Ms. Jacobs, a public relations consultant in Boston, MA, was diagnosed with an early, genetically related form of the disease in her thirties. Because her form of the disease progresses slowly, she still retains some central vision, although she can no longer drive or even recognize friends unless they're standing right in front of her.

There's nothing medically available to help with the disease, but Ms. Jacobs does what she can to slow its progress. For instance, she takes a vitamin supplement developed especially for eye health. It contains high doses of vitamins C and E, beta-carotene and zinc, all of which have been shown to slow the progression of AMD, as well as significantly reduce the risk in high-risk people. (10)

And she remains upbeat. She's structured her life to accommodate her disability, including starting her own business so she could work at her own pace, using special equipment that enlarges print and adjusting her computer screen so she can see images more clearly. "I'm just lucky I'm living at a time when there is all this technology," she says. Additionally, she's thankful for researchers investigating approaches such as stem cell transplants as possible treatments or cures for AMD.

Sunlight--An Eye Enemy

To all the negative effects of global warming, add one more: An increased rate of cataracts. Cataracts occur when soluble protein in the lens of your eye (the transparent structure just behind the iris) clumps together, making your lens cloudy. About one in every six people 40 and older have cataracts, half of those 80 and older. (1), (2) Sunlight is a contributor to the development of cataracts. Any reduction in the Earth's protective layer of ozone could increase the amount of certain ultraviolet rays (UV) that reach the eye, significantly increasing the incidence of cataracts in the U.S. (12)

But cataracts aren't the only eye condition caused, in part, by sunlight. Early onset of presbyopia, retinal lesions, sunburn of the cornea (called photokeratitis) and, possibly, the risk of AMD, have also been linked to long-term sun exposure. (11)

Although there aren't any sunscreens developed for eyes (yet!), if you wear contact lenses you're in luck. Today, many brands of contact lenses block harmful UV rays. (13) "If we were able to get everyone who wears contacts from age 20 to age 60 to wear lenses with UV protection, we'd see a difference in their rate of cataracts after years of use," says clinical trial consultant Robin L. Chalmers, OD.

If you're not a contact lens wearer, however, your best bet is to buy wrap-around sunglasses that transmit no more than one percent UVB and UVA rays. Make sure they're large enough so you don't have light bleeding through the edges of the lenses and forget fancy colors; they can interfere with your ability to recognize traffic signals. Instead, stick with gray or amber lenses. (14)

Even if you wear contact lenses, don't toss the sunglasses. The two together are better than either alone and adding a wide-brimmed hat is better yet. Contacts, for instance, still leave certain areas of the eyes uncovered, as well as the eyelids and surrounding areas of the face. (15)

Aging and Your Eyes

If you're over 40, chances are your eyes have suddenly jumped front and center in terms of the attention they demand. No longer can you stare at the computer screen for 15 hours and still feel comfortable, with or without your contacts. If you're nearsighted, you may find yourself whipping your glasses off and squinting as if you were in front of stage lights to read small print. And when it comes to reading books and magazines, well ... if your arms would only grow another 10 inches you'd be fine.

"The normal eye loses its focusing ability as it (and you) ages," explains Jeffrey Anshel, OD, an optometrist based in Carlsbad, CA. It's called presbyopia, and the question isn't if you'll get it, but when. This is one eye condition you can't prevent.

Presbyopia likely results as the lens is less able to move in your eye to help focus. Without the flexibility to expand forward, it becomes difficult for the lens to focus close up. (16)

The good news is that we're far from the days when the only solution was a pair of bifocals or dime-store reading glasses. Today you can find soft and gas permeable contact lenses designed to correct presbyopia, or you can undergo laser surgery.

The most common method of contact lens correction for presbyopia is called "monovision," in which one lens is fitted for close-up vision and the other for distance vision. Sometimes just one lens is needed. If you do a lot of close-up work (like needle-point) or drive a lot, especially at night, this may not be the best option for you. (17)

You have other options, however. These include bifocal (for close and distance seeing) or multifocal (for close, intermediate and distance viewing) contact lenses. Be patient with these lenses, however; it may take your brain (and thus your eyes) a week or two to adjust to them.

Rae Skinner, 56, switched to bifocal contact lenses as her presbyopia hit. "It was great," the Portland, OR, woman says. "And the reason it was great was that instead of going into a restaurant and not being able to read the menu, or having to take out reading glasses, I could easily read what was there."

You might also talk to your eye care professional about surgery. More ophthalmologists are performing laser surgery called "conductive keratoplasty" to try and correct presbyopia. If you have a cataract removed, you can receive intraocular contacts, or contacts implanted in front of the lens, designed to correct presbyopia. Intraocular contacts to correct presbyopia that can be used without cataract surgery are under investigation. (18)

But, warns Dr. Chalmers, keep in mind that your presbyopia continues to change as you age. A surgical remedy corrects the condition at one point in time. "That's the really wonderful thing about a contact lens," she says. "You can change the prescription, and you can take it out if the vision doesn't suit you. You can't do that with surgical treatments. I think people forget that."

Contact Lenses and Dry Environments

Although contacts might be more flexible than surgery, aging eyes along with environmental elements can conspire to make your once-barely-noticeable contacts feel irritating. Perhaps that's why some research shows that just five percent of people 50 and older who need vision-correcting glasses or contact lenses choose contacts. (17)

"As we age, our tear film and the surface of our eyes change," explains Dr. Chalmers. Oil-producing glands called meibomian glands shrink a little, so you wind up with less oil on the front surface of the tear film. That means the tear film on the eye evaporates more quickly. Plus, certain medications that we may use more often as we age, such as allergy medications, can be drying.

Contact lens manufacturers have taken note, using new forms of silicone hydrogel to produce lenses that let more oxygen reach the eye and require less liquid to feel comfortable. Several studies find lenses made with these new materials are more comfortable than other forms, significantly reducing dryness. (19-21)

If you spend most of your time in dry environments--airplanes, office buildings, cars, trucks or certain climates--ask your eye care professional about which contact lens products might work best for you, if you wear them.

Whether or not you wear contact lenses, there are things you can do on your own to relieve dry eye discomfort, say eye professionals. Aim air conditioning and heating vents in your car at your feet, not your face, and if you use a computer a lot, make sure you blink frequently. (For more on eyes and computer use, see "Eye-Safe Computing" on this page.) And stay out of smoke-filled rooms. Not only will the smoke dry your eyes, but cigarette smoking can also damage your eyes, contributing to AMD and cataracts. (22) You may want to keep extra wetting drops for your contacts on hand or wear your glasses if your eyes become dry.

Resources

American Academy of Ophthalmology

415-561-8500

www.aao.org

Professional organization of ophthalmologists; offers information about eye health, as well as professional journals and an ophthalmologist directory service.

American Academy of Optometry

301-984-1441

www.aaopt.org

Professional organization for researchers and academic optometrists; offers links to several vision-related resources.

American Optometric Association

1-800-365-2219

www.aoa.org

Professional organization of optometrists; includes an optometrist locator service and information on eye conditions and concerns.

Lighthouse International

1-800-829-0500

www.lighthouse.org

Provides information on eye health, vision impairment and vision rehabilitation, including resources for those who care for a visually impaired friend or relative.

National Eye Institute

301-496-5248

www.nei.nih.gov

Government agency that provides patients, professionals and the general public with information on eye diseases and disorders. Includes research results and educational programs.

Prevent Blindness America

1-800-331-2020

www.preventblindness.org

A volunteer organization that provides information on eye diseases and conditions, as well as tips on eye safety, children's eye health and links to news and resources.

Women's Eye Health Task Force

www.womenseyehealth.org

Provides information about women's eye health and about eye diseases more common in women and what causes them.

References

(1) Abou-Gareeb I, Lewallen S, Bassett K, Courtright P. Gender and blindness: a meta-analysis of population-based prevalence surveys. Ophthalmic Epidemiol. 2001 Feb;8(1):39-56.

(2) The Statistics, Women's Eye Health Task Force. http://www.eri.harvard.edu.

(3) Smith W, Mitchell P, Wang JJ. Gender, oestrogen, hormone replacement and age-related macular degeneration: results from the Blue Mountains Eye Study. Aust N ZJ Ophthalmol. May 1997;25 Suppl 1:513-15.

(4) Klein BE, Klein R, Lee KE. Incidence of age-related cataract: the Beaver Dam Eye Study. Arch Ophthalmol. Feb 1998;116(2):219-225.

(5) National Eye Institute. Glaucoma: what you should know. Apr 2005; Available at: http://www.nei.nih.gov/health.

(6) Snow KK, Seddon JM. Age-related eye diseases: impact of hormone replacement therapy, and reproductive and other risk factors. Int J Fertil Women's Med. Sep-Oct 2000;45(5):301-313.

(7) Women's Eye Health Task Force. Statistics in Industrialized Countries. Available at: http://www.womenseyehealth.org.

(8) Quillen DA. Common causes of vision loss in elderly patients. Am Fam Physician. Jul 1999;60(1):99-108.

(9) Kijlstra A, La Heij E, Hendrikse F. Immunological factors in the pathogenesis and treatment of age-related macular degeneration. Ocul Immunol Inflamm. Feb 2005;13(1):3-11.

(10) A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS report no. 8. Arch Ophthalmol. Oct 2001; 119(10):1417-1436.

(11) National Eye Institute. Vision Problems in the U.S.: Prevalence of Adult Vision Impairment and Age-Related Eye Disease in America. 2002.

(12) West SK, Longstreth JD, Munoz BE, Pitcher HM, Duncan DD. Model of risk of cortical cataract in the US population with exposure to increased ultraviolet radiation due to stratospheric ozone depletion. Am J Epidemiol. Dec 1 2005; 162(11):1080-1088.

(13) Giasson CJ, Quesnel NM, Boisjoly H. The ABCs of ultraviolet-blocking contact lenses: an ocular panacea for ozone loss? Int Ophthalmol Clin. Winter 2005;45(1):117-139.

(14) Sheedy JE, Edlich RF. Ultraviolet eye radiation: the problem and solutions. J Long Term Eff Med Implants. 2004;14(1):67-71.

(15) Schnider CM. UV-Blocking Contact Lenses Play Unique Role in Protecting Patients' Eyes. Refractive Eyecare. 2005.

(16) Mayo Clinic. Presbyopia. Available at: http://www.mayoclinic.com.

(17) Rakow PL. Presbyopic correction with contact lenses. Ophthalmol Clin North Am. Sep 2003; 16(3):365-381.

(18) Olson RJ, Werner L; Mamalis N, Cionni R. New intraocular lens technology. Am J Ophthalmol. Oct 2005;140(4):709-716.

(19) Riley C, Chalmers RL, Pence N. The impact of lens choice in the relief of contact lens related symptoms and ocular surface findings. Cont Lens Anterior Eye. Mar 2005;28(1):13-19.

(20) Chalmers RL, Dillehay S, Long B, et al. Impact of previous extended and daily wear schedules on signs and symptoms with high Dk lotrafilcon A lenses. Optom Vis Sci. Jun 2005;82(6):549-554.

(21) Lemp MA, Caffery B, Lebow K, et al. Omafilcon A (Proclear) soft contact lenses in a dry eye population. Clao J. Jan 1999;25(1):40-47.

(22) Thornton J, Edwards R, Mitchell P, Harrison RA, Buchan I, Kelly SP. Smoking and age-related macular degeneration: a review of association. Eye. Sep 2005;19(9):935-944.

(23) Jawa A KJ, Fonseca VA. Diabetic nephropathy and retinopathy. Med Clin North Am. Jul 2004; 88(4):1001-1036.

(24) Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation for Diabetic Macular Edema. ETDRS Report Number 1. Arch Ophthalmol. 1985;103:1796-1806.

(25) Fong DS AL, Ferris FL 3rd, Klein R. Diabetic retinopathy. Diabetes Care. Oct 2004; 27(10):2540-2553.

RELATED ARTICLE: Your Eyes and Diabetes

If you have diabetes, your eyes are at special risk. The leading cause of blindness in adults under 65 is diabetic retinopathy, in which small blood vessels in the eyes weaken and burst. The condition affects nearly everyone with Type 1 diabetes and 60 percent of those with Type 2 within 20 years of diagnosis. (23)

You're also more likely to develop cataracts and glaucoma, a condition in which pressure builds in the eye, eventually destroying the optic nerve and leading to vision loss.

The good news? Early diagnosis and effective blood-sugar and blood-pressure control can prevent blindness in about 90 percent of cases of diabetic retinopathy. (24) As someone with diabetes, it's best to get those screenings from a qualified ophthalmologist. You should be screened immediately upon diagnosis and at least every year thereafter. (25)

RELATED ARTICLE: UV Protection for Your Eyes: Class 1 or Class 2?

As if there weren't enough choices when it comes to contact lenses, here's one more: The level of UV protection. The U.S. Food and Drug Administration classifies contact lenses that protect against UV rays into two categories: Class 1 and Class 2. Class 1 UV-blockers provide the greatest measure of sun protection. Only Acuvue Advance and Acuvue Oasys brand contact lenses offer Class 1 UV-blocking. Other Acuvue contact lenses and some products in the Biomedics line (CooperVision) contain Class 2 UV-blocking, as do Precision UV soft contact lenses (CIBA Vision) and many rigid gas permeable (GP) lenses.

RELATED ARTICLE: Eye-Safe Computing

"While there's no scientific research that shows that using a computer is any worse on the eyes than anything else you do up close, if you ask any eye doctor if they see patients coming in with more severe problems because they're using computers, they'll say 'sure,'" says Jeffrey Anshel, OD, an optometrist based in Carlsbad, CA. He consults with corporations and trains other optometrists regarding computer-related eyestrain, which can lead to dry, itchy eyes, headaches and blurred vision.

The biggest culprit? Not enough blinking. "Studies find we blink about one-third as much as normal when we're working on a computer than when we're doing normal reading," says Dr. Anshel. So he recommends the 20:20:20 rule: Every 20 minutes take 20 seconds and close your eyes or look 20 feet away. "This breaks up the intensive viewing habits that can cause eyestrain," he says.

Also make sure your monitor is positioned properly. Rather than having it at "eye level," the ideal height is one that enables you to look over the top of the monitor when looking straight ahead.

For more information on preventing and reducing computer-related vision problems, take the "Eye Q's and View Quiz," www.computerquiz.jnjvision.com.
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Title Annotation:research; includes related articles "Your Eyes and Diabetes", "UV Protection for Your Eyes: Class 1 or Class 2", "Eye-safe Computing" and association listings
Publication:National Women's Health Report
Geographic Code:1USA
Date:Apr 1, 2006
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