May is "Healthy Vision Month," so we decided it was a great opportunity to speak with Keith Skolnick, an ophthalmologist who practices in South Florida. He was generous with his time and shared his wisdom concerning eye health with me as I asked some probing questions. –Jeanne
How often should we see an ophthalmologist?
For people aged 65 years and older, the recommendation is every one-two years. For those younger than 65, it depends on their risk factors and family history for various diseases. Your ophthalmologist will make specific recommendations for appropriate follow-up.
Screen Use
In the current environment of excessive digital device usage, do you have any recommendations for safer usage?
Normally, we blink about every two-three seconds. While staring at screens (various digital devices, watching TV, reading), you may blink every 10 seconds, or even less frequently. This is a set-up for evaporative tear loss. Using digital devices exacerbates dry eyes, but it doesn’t necessarily cause dry eyes. The evaporative tear loss is called computer vision syndrome (CVS).
Recommendation to help prevent CVS—the 20-20-20 Rule:
Look away from your device every 20 minutes or so for at least 20 seconds, look in the distance only, beyond 20 feet.
Digital devices emit blue light. Blue light is a low-wavelength light (in the 400 range), which is closest in wavelength to UV lights. These light spectrums can be damaging to the body. They can damage DNA, and injure the retina. It can potentially cause macular degeneration, which is the leading cause of blindness. It isn't known yet exactly how damaging all-day exposure to blue light from computer usage is. Blue light exposure is used to regulate our circadian rhythms and sleep cycles. For that reason, we recommend minimizing exposure to blue light during the late-night hours.
Recommendation:
Change the settings on your phones, iPads and computers to Night Shift or a blue-light filter between 10 pm–7 am. This will tone down all the blue wavelengths to a more beige setting on your screens.
Other device-related concerns:
Reduce your screen brightness to a comfortable level.
Increase your screen font size to the most comfortable level for reading. As we get older, we will likely need to keep increasing the size.
The optimal distance the device should be from the reader is user-dependent. As long as the material is in clear focus, then whatever screen distance the user prefers should be fine.
Should we avoid UV light exposure? Do you have any recommendations regarding sunglasses?
UV light is damaging to our body through damage to our DNA. Our eyes will naturally block out most UV light, especially if you have dark eyes. Those with lighter eye color may be more sensitive to the light. All sunglasses block out at least 99% of UV light, so you do not have to spend a lot of money on eyewear for UV protection. Also, the color of the tint of glasses does not matter that much. The glass in our cars also blocks out most of the UV light; however, maybe one-two percent gets through.
Recommendation:
ALWAYS were sunglasses and a hat—even if you have dark eyes and are less sensitive to the light. NEVER look up at the sun, especially during an eclipse. This can cause burning of the retina and permanent eye damage.
Should we be concerned if we have symptoms of dry eyes? What is the best treatment for dry eyes? Dry eyes are often a symptom of another problem. Initially, if you experience dry eyes, you can try an over-the-counter lubricating drop like Artificial Tears. If this does not help, then you should have an eye exam so an accurate diagnosis can be made. Of note, many people with autoimmune diseases have a high prevalence of dry eyes. Does increasing one’s hydration help? There are no evidence-based studies that suggest that hydration improves dry eyes.
Are there any dangers to our eyes if we are cigarette smokers?
There is a clear link that cigarette smokers have an increased risk of macular degeneration. In the Age-Related Eye Disease Study (AREDS), researchers determined that certain supplements (including vitamin A) can help slow down the progression of macular degeneration. However, in additional studies, researchers found that smokers (and previous smokers) who took vitamin A supplements had a higher incidence of lung cancer. Therefore, the formulations of supplements for the prevention of macular degeneration no longer contain vitamin A in them.
Are there any foods and/or supplements that you recommend for better eye health? I always recommend food over supplements. However, I also realize that only a small percentage of the population actually eat these recommended foods in abundance. Therefore, I also recommend taking various supplements. Personally, I try to eat healthily; yet, to be assured that I am getting all the nutrients I need, I also take supplements.
Foods that are recommended for eye health include:
Omega 3-rich foods: Fresh cold water fish (salmon, mackerel, anchovies, herring and sardines), walnuts, hemp, chia and flax seeds. These are all beneficial for eye health, retinal health, macular degeneration and general overall health.
Carotenoids (lutein, zeaxanthin): Food sources of these carotenoids include dark berries, dark leafy greens such as kale and spinach, summer squash and eggs. Carotenoids are nutrients for the retina and act as a protective substance against UV-light induced damage.
Supplements for eye health: Note: It is crucial to pay attention to the quality of supplements, which may be difficult to determine There are some brand suggestions listed below.
Omega 3 fatty acids: The best forms are from wild-caught cold-water fish. The natural triglyceride (TG) form is better than the ethyl ester (EE) form. It should contain more EPA than DHA. It should also include vitamin E (tocopherols) as an antioxidant to prevent a fishy smell or taste. Some brands that I recommend are Nordic Naturals, Carlson, Physician Recommended Nutriceuticals (PRN), Ascenta and Progressive Nutritional Therapies.
AREDS 2 Formula: In the AREDS 1 and 2 studies, various vitamins and minerals were helpful to slow the progression of macular degeneration. These include vitamins C, E, zinc, copper, lutein and zeaxanthin. The formula is made by Bausch and Lomb PreserVision. Note: omega-3 fatty acids are not included in the AREDS formulation.
Bilberry: This supplement may be beneficial for optic nerve health and, therefore, may be helpful for glaucoma patients. However, the evidence is not conclusive.
Are there any foods to avoid? For general health, try to limit sugar intake and avoid high amounts of saturated fats and foods high in sodium. These recommendations also can apply to better eye health. Diabetics need to take additional precautions. The eye is an end organ affected by diabetes. In diabetic patients, cataracts develop earlier, bleeding in the eye occurs and there is a greater incidence of retinopathy. Therefore, diabetic patients should try to keep their blood sugars in a stable range.
Resources
Information for Healthy Vision. National Eye Institute, National Institutes of Health. nei.nih.gov/healthyeyes/eyehealthtips
Top 10 Tips to Save Your Vision. American Academy of Ophthalmology. aao.org/eye-health/tips-prevention/top-10-tips-to-save-your-vision-2
Keith Skolnick, MD
Keith A. Skolnick, MD is a board-certified ophthalmologist specializing in laser cataract surgery He treats myriad ocular disorders, such as cataracts, glaucoma, eye emergencies, dry eyes, allergies, infections and inflammatory conditions. He received his undergraduate degree from the University of Michigan and studied medicine at the University of South Florida. He completed his medical and surgical residency in ophthalmology at Loyola University of Chicago and spent a large portion of his training at the Edward Hines, Jr. VA Hospital.
He teaches both students and residents as a clinical instructor for NOVA Southeastern University’s School of Optometry and Medical School. He has published articles in several peer-reviewed journals and is an investigator for a number of FDA-approved clinical studies. He frequently lectures to other doctors and the community about recent advances in ophthalmology and has been featured many times on local television news health segments and newspapers.
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