Review Category : Dr. Mark Siegel, MD FAAO

Maintain eye health with diabetes

By Mark S. Siegel

Diabetes is a disease that affects the body’s ability to produce or use insulin effectively to control blood sugar (glucose) levels. Although glucose is an important source of energy for the body’s cells, too much glucose in the blood for a long time can cause damage in many parts of the body, including the heart, kidneys, blood vessels and the small blood vessels in the eyes.

When the blood vessels in the eye’s retina (the light sensitive tissue lining the back of the eye) swell, leak or close off completely — or if abnormal new blood vessels grow on the surface of the retina — it is called diabetic retinopathy.

People who are at greater risk of developing diabetic retinopathy are those who have diabetes or poor blood sugar control, women who are pregnant, and people with high blood pressure, high blood lipids or both. Also, people who are from certain ethnic groups, such as African-Americans, Hispanics and Native Americans, are more likely to develop diabetic retinopathy. In fact, a new study confirms that diabetes is a top risk factor for vision loss among Hispanics.

Something to remember: diabetes can cause vision in your eyes to change even if you do not have retinopathy. If your blood sugar levels change quickly, it can affect the shape of your eye’s lens, causing blurry vision, which goes back to normal after your blood sugar stabilizes. Therefore, it’s important not to change your glasses prescription unless your blood sugar levels are normal.

Did you know there is also a link between diabetes and cataracts? Permanent blurring of vision due to cataracts can also result from changes to the lens due to excess blood sugar. Cataract surgery may be necessary to remove lenses that are clouded by the effects of diabetes and replace them with clear intraocular lenses (IOLs) to restore clear vision.

Maintaining good control of your blood sugar helps reduce episodes of temporary blurred vision and prevent the permanent clouding of the lens that would require surgery to correct.

Mark Siegel,  MD, FAAO, Medical Director, Sea Island Ophthalmology, www.seaislandophthalmology.com

 
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Study: Hip fractures less likely after cataract surgery

By Dr. Mark S. Siegel

After practicing ophthalmology for nearly 15 years and performing thousands of cataract surgeries, I’ve recognized additional benefits beyond better vision and spectacle independence: patients improve their ability to ambulate; cognitive function and mood are improved in patients with dementia and depression; and overall quality of life improves.

When older people have cataract surgery to improve their vision, they also lower their risk of falling and breaking a hip, according to a national study. People in their 80s and those who have serious illnesses such as heart disease are most likely to benefit — the research shows that these patients had about 30 percent fewer hip fractures in the year after they had cataract surgery. The study, published in the August edition of the Journal of the American Medical Association, compared the rate of hip fractures in more than 400,000 Medicare patients who had cataract surgery with a matched group of patients who did not have their cataracts removed.

Older people are more likely to fall and break their hips or other bones, and recovering from such injuries is often difficult for them. Earlier studies have found that vision loss is a key reason for seniors’ higher risk of falling. When cataracts and other aging eye problems decrease older people’s visual sharpness and depth perception, they also lose the ability to maintain balance, stability and mobility.

People should never be regarded as “too old” to have their cataracts removed. Other studies show that after cataract surgery, older people tend to sleep better, be less depressed, and lead more active, enjoyable lives.

Overall, the greatest decrease in hip fracture risk was seen in patients aged 80 to 84 who had cataract surgery. Another notable group was patients with severe cataracts, for whom risk was reduced by 23 percent. Although U.S. health statistics show that women are more susceptible to hip fractures than men, this study found no significant gender-linked differences in fracture risk.

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Sleeping in contact lenses is a risky endeavor

By Mark S. Siegel

If you’re a contact lens wearer, chances are you’ve snoozed with your contacts in at least a time or two. Maybe you only do it once in awhile, when you fall asleep in front of the TV or forget to bring disinfecting solution on an overnight trip. Or maybe it’s more of a regular practice, and you leave them in for days (and nights) at a time.

Either way, it’s not a good idea.

When you sleep with your contact lenses in, you’re depriving your corneas of oxygen. This is analogous to wearing a plastic bag over your head when you sleep which is not ideal for oxygen exchange. The cornea receives oxygen from the air when you are awake, but when you are asleep, it gets nourishment and lubrication from tears and a gelatinous fluid inside the eye called the aqueous humor. If there’s a contact lens in your eye when you’re sleeping, then the contact lens acts as a barrier between the closed eyelid and the cornea, and it’s fairly tight over the surface of the cornea. When you’re awake, the contact lens is actually supposed to move a bit — about a millimeter of movement with every blink — in order to allow the cornea to get oxygen. But when you’re sleeping with your contacts in, the contact lens is unable to move because your eyes aren’t blinking. The end result is an oxygen-starved cornea, which becomes more susceptible to infection.

Bacteria or parasites can infect any microscopic abrasions of the cornea, which can be caused by contact with the back surface of the contact lenses. These bacterial microorganisms are part of our normal eyelid flora or can be introduced from the contact lenses themselves (a contact lens can have some bacteria on it because it’s not clean or it’s been resting on the eyes for so long), or from water, even when it’s safe for drinking. A parasite found in water called acanthamoeba, for example, can cause serious eye infections. Corneal ulcers, which are localized infections of the cornea, may cause permanent scarring resulting in loss of vision or even blindness.

In fact, a 2012 study in the journal Ophthalmology showed that the risk for keratitis — inflammation of the cornea — increased 6.5 times with just occasional overnight lens use among people who used contact lenses intended for removal at the end of the day.

While there are some contact lenses that have been FDA-approved for “extended wear,” meaning you can wear them for multiple days at a time, the FDA still recommends people using these lenses remove them and not wear them overnight at least one time a week. However, it’s simply not a good idea to wear these lenses overnight, if you can help it, because there is still an increased risk for infection.

Moreover, multiple studies have shown that people who wear extended-wear lenses (soft hydrogel lenses) have a 10 to 15 times higher risk of developing ulcerative keratitis, compared with daily-wear contact lens users. Overnight wear, regardless of contact lens type, increases the likelihood of corneal infection, which may result in permanent vision loss or even blindness and should be avoided.

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The benefits of exercise and alcohol

By Dr. Mark S. Siegel

In 2020, the number of people in the United States with visual impairment – sight loss often caused by eye disease, trauma, or a congenital or degenerative condition that cannot be corrected with glasses or contact lenses – is projected to increase to at least four million. This is a 70 percent increase from 2000 and is due to the growing aging population and prevalence of age-related eye diseases.

To help determine ways to decrease the incidence of visual impairment, researchers at the University of Wisconsin examined the relationships between the incidence of visual impairment and three modifiable lifestyle behaviors: smoking, drinking alcohol and staying physically active. The research was conducted as part of the Beaver Dam Eye Study, a long-term population-based cohort study from 1988 to 2013 of nearly 5,000 adults aged 43 to 84 years.

The researchers found that regular physical activity and an alcoholic beverage every now and then is associated with a lower risk of visual impairment. The data showed that over 20 years, visual impairment developed in 5.4 percent of the population and varied based on lifestyle behaviors. For example, people who were physically active had a 58 percent decrease in the odds of developing visual impairment compared to people who were not physically active.

The researchers also found that people who drank alcohol occasionally (defined as those who have consumed alcohol in the past year, but reported fewer than one serving in an average week) had a 49 percent decrease in the odds of developing visual impairment compared to people who had consumed no alcohol in the past year.

As with most epidemiologic research, the researchers caution that a limitation to their study is that the findings may be due, in part, to unmeasured factors related to both lifestyle behaviors and development of visual impairment. The data does not prove that these lifestyle behaviors are directly responsible for increased risk. The researchers still believe the research shows good promise for indicating ways that people can lessen their risk of visual impairment through lifestyle changes.

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Leave fireworks to professionals this Fourth of July

By Dr. Mark S. Siegel

I recall a few extraordinary patients during my ophthalmology residency who have left an indelible memory. One such patient was a 13 year old who was playing with an M-80 explosive device that he placed in a soup can. The subsequent explosion sent shards of metal that were absorbed by his face and one of his eyes. The metal perforated his cornea and lens and lodged in the back wall of his eye in his retina. After multiple surgeries, he can see a hand waved in front of his face.

I really hate to be a buzz kill before this Fourth of July holiday — what should be a time when wonderful memories are made with family and loved ones.

Unfortunately, more than 9,000 fireworks injuries happen each year on average in the United States, with roughly 1 in 8 fireworks injuries harming the eyes, according to the most recent fireworks injury report from the U.S. Consumer Product Safety Commission. Common fireworks eye injuries include burns, lacerations, abrasions, retinal detachment, optic nerve damage and ruptured eyeballs.

Those injured are not necessarily handling the explosives themselves. In fact, nearly half of people injured by fireworks are bystanders, according to an international study. Children are frequent victims: 30 percent who sustained a fireworks injury near the Fourth of July holiday are ages 15 and under, according to the commission report.

Even sparklers can burn more than 1,000 degrees hotter than the boiling point of water. So, fireworks should not be thought of as toys, but devices that can cause third-degree burns. This is why people must be vigilant and take precautions to avoid the risk of serious eye injury.

Fireworks Safety Tips

The best way to avoid a potentially blinding fireworks injury is by attending a professional public fireworks show rather than purchasing fireworks for home use.

For those who attend professional fireworks displays and/or live in communities surrounding the shows:

• Respect safety barriers at fireworks shows and view fireworks from at least 500 feet away.

• Do not touch unexploded fireworks; instead, immediately contact local fire or police departments to help.

For those who decide to purchase consumer fireworks because they live in states where they are legal, such as South Carolina, follow the following safety tips to prevent eye injuries:

• Never let children play with fireworks of any type, even sparklers.

• Adults handling fireworks should always wear protective eyewear that meets the parameters set by the American National Standards Institute and ensure that all bystanders are also wearing eye protection.

• Leave the lighting of professional-grade fireworks to trained pyro technicians.

Remember, if an eye injury from fireworks occurs, seek medical attention immediately.

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June is Cataract Awareness Month

By Mark Siegel, MD, FAAO

Throughout the month of June, Sea Island Ophthalmology would like to help people become more aware of the serious eye disease of cataracts. There are about 22 million Americans aged 40 and older who suffer with cataracts, and more than half the people over age 65 have some degree of cataract development. Cataracts are now the leading cause of blindness among adults over 55 years of age.

Moreover, a study out of the University of Texas Medical Branch in Galveston indicates that seniors suffering from poor vision have shown evidence of a premature mental decline.

Additionally, a study found that patients who received cataract surgery had a significantly reduced rate of hip fractures from falls.

The results of these studies clearly bring to light the importance of routine eye care for older adults, who are at increased risk of eye conditions that cause severe visual impairment such as cataracts.

The good news is that vision loss caused by cataracts can be easily treated. Cataract surgery is now one of the most commonly performed procedures in the United States and has a 99 percent success rate. This is why ophthalmologists recommend scheduling a yearly eye exam for all those who might be at risk.

The Symptoms

Cataracts can cause a variety of symptoms or signs. One common symptom is often compared to looking through a dirty car windshield or a smeared camera lens. Other symptoms may include:

• Blurred vision

• Difficulties reading or driving at night

• Difficulty with glare (such as a bright sun or automobile headlights)

• Dull color vision

• Increased nearsightedness (with frequent changes in eyeglass prescriptions)

• Occasional double vision in one eye.

The Diagnosis

Cataracts can be detected during a thorough eye examination. The doctor can see the affected lens in your eye while performing a variety of tests using specialized viewing instruments.

By selecting the appropriate tests, the doctor will be able to determine how much a cataract might be affecting your vision. The doctor will also perform a thorough examination of the eye to ensure any vision loss is not due to other eye problems, such as diabetes, glaucoma, or macular degeneration.

The Treatment

Some cataracts never progress to the point where they require treatment, while others progress more rapidly. Cataracts commonly affect both eyes, but it is not uncommon for a cataract in one eye to advance more rapidly than one in the other. Surgery is generally recommended for those who experience detectable vision loss.

If you or a loved one has been diagnosed with cataracts, please request an appointment for your cataract surgery consultation.

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Protect your eyes from the sun

By Mark Siegel

As you rub on sunscreen to protect your skin this summer, don’t forget to protect your eyes as well. Summertime means more time spent outdoors, and studies show that exposure to bright sunlight may increase the risk of developing cataracts, age-related macular degeneration (AMD) and growths on the eye, including cancer.

May is UV (ultraviolet light) Safety Awareness Month and Sea Island Ophthalmology wants to remind everyone of the importance of protecting our eyes from the sun’s haarmful rays by wearing proper protection. It also wants to remind the public of the importance of protecting eyes from indoor UV light when using tanning beds.

UV radiation, whether from natural sunlight or indoor artificial rays, can damage the eye’s surface tissues as well as the cornea and lens. Unfortunately, many people are unaware of the dangers UV light can pose. By wearing UV blocking sunglasses, you can enjoy the summer safely while lowering your risk for potentially blinding eye diseases and tumors. It is important to start wearing proper eye protection at an early age to protect the eyes from years of ultraviolet exposure.

Our eyes are at risk from the sun year-round. However, the longer the exposure to bright light as happens frequently during the summer, the greater the risk is. Excessive exposure to UV light reflected off sand, water or pavement can damage the eyes’ front surface. In addition to cataracts and AMD, sun exposure can lead to lesions and tumors that may be cosmetically unappealing and require surgical removal. Pinguecula, tiny yellow bumps on the eye, are common from too much UV exposure. They begin on the white part of the eye and may eventually disrupt your vision.

Damage to the eyes from UV light is not limited to the outdoors; it is also a concern with indoor tanning beds. Tanning beds can produce UV levels up to 100 times what you would get from the sun, which can cause very serious damage to the external and internal structures of the eye and eyelids. Corneal burns, cataracts, and, in rare instances, retinal damage can occur. It is critical that you wear the properly designed goggles for use in tanning booths.

Follow these tips to protect your eyes from the sun:

Don’t focus on color or darkness of sunglass lenses: Select sunglasses that block UV rays. The ability to block UV light is not dependent on the price tag or how dark the sunglass lenses are.

Check for 100 percent UV protection: Make sure your sunglasses block 100 percent of UV-A rays and UV-B rays.

Choose wrap-around styles: Ideally, your sunglasses should wrap all the way around to your temples, so the sun’s rays can’t enter from the side.

Wear a hat: In addition to your sunglasses, wear a broad-brimmed hat to protect your eyes.

Don’t rely on contact lenses: Even if you wear contact lenses with UV protection, remember your sunglasses.

Don’t be fooled by clouds: The sun’s rays can pass through haze and thin clouds. Sun damage to eyes can occur anytime during the year.

Protect your eyes during peak sun times: Sunglasses should be worn whenever outside, and it’s especially important to wear sunglasses in the early afternoon and at higher altitudes.

Never look directly at the sun: Looking directly at the sun at any time, including during an eclipse, can lead to solar retinopathy, damage to the eye’s retina from solar radiation.

Don’t forget the kids: Everyone is at risk, including children. Protect their eyes with hats and sunglasses. In addition, try to keep children out of the sun between 10 a.m. and 2 p.m., when the sun’s UV rays are the strongest.

Mark Siegel, MD, FAOO, Medical Director,
Sea Island Ophthalmology, www.seaislandophthalmology.com

 
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Exercise and lifestyle can affect visual impairment

By Mark S. Siegel, MD

In 2020, the number of people in the United States with visual impairment — sight loss often caused by eye disease, trauma, or a congenital or degenerative condition that cannot be corrected with glasses or contact lenses — is projected to increase to at least four million. This is a 70 percent increase from 2000 and is due to the growing aging population and prevalence of age-related eye diseases.

To help determine ways to decrease the incidence of visual impairment, researchers at the University of Wisconsin examined the relationships between the incidence of visual impairment and three modifiable lifestyle behaviors: smoking, drinking alcohol and staying physically active. The research was conducted as part of the Beaver Dam Eye Study, a long-term population-based cohort study from 1988 to 2013 of nearly 5,000 adults aged 43 to 84 years.

The researchers found that regular physical activity and an alcoholic beverage every now and then is associated with a lower risk of visual impairment. The data showed that over 20 years, visual impairment developed in 5.4 percent of the population and varied based on lifestyle behaviors. For example, people who were physically active had a 58 percent decrease in the odds of developing visual impairment compared to people who were not physically active.

The researchers also found that people who drank alcohol occasionally (defined as those who have consumed alcohol in the past year, but reported fewer than one serving in an average week) had a 49 percent decrease in the odds of developing visual impairment compared to people who had consumed no alcohol in the past year.

As with most epidemiologic research, the researchers caution that a limitation to their study is that the findings may be due, in part, to unmeasured factors related to both lifestyle behaviors and development of visual impairment. The data does not prove that these lifestyle behaviors are directly responsible for increased risk. The researchers still believe the research shows good promise for indicating ways that people can lessen their risk of visual impairment through lifestyle changes.

Dr. Siegel is medical director of Sea Island Ophthalmology, board certified, American Board of Ophthalmology, www.seaislandophthalmology.com. 525-1500.

 
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Prevent injuries with 10 eye safety tips during Workplace Eye Wellness Month

By Mark S. Siegel

More than 700,000 work-related eye injuries occur each year. March is Workplace Eye Wellness Month — a good time to refocus attention on your eye protection program. Get the facts here, plus 10 tips for injury prevention.

As the National Safety Council points out, “All it takes is a tiny sliver of metal, particle of dust, or splash of chemical to cause significant and permanent eye damage.”

OSHA’s eye and face protection standard requires employers to “ensure that each affected employee uses appropriate eye or face protection when exposed to eye or face hazards from flying particles, molten metal, liquid chemicals, acids, or caustic liquids, chemical gases or vapors, or potentially injurious light radiation.”

Share these injury-prevention tips with managers and supervisors.

1. Look carefully at plant operations, work areas, access routes, and equipment. Study injury patterns to see where accidents are occurring.

2. Conduct regular vision testing, as uncorrected vision can cause accidents.

3. Select protective eyewear based on specific duties or hazards.

4. Establish a mandatory eye protection program in all operation areas.

5. Have eyewear fitted by a professional.

6. Establish first-aid procedures for eye injuries, and make eyewash stations available, especially where chemicals are in use.

7. Make eye safety part of your employee training and new hire orientation.

8. Make sure managers and executives set an example by wearing protective eyewear wherever it’s worn by other employees.

9. Regularly review and revise your policies, and set a goal of zero eye injuries.

10. Display a copy of your policy where employees can see it.

It’s also a good time to remind employees of off-the-job eye hazards like do-it-yourself work on cars and homes, cooking accidents, sports injuries, yard work, and chemical splashes from cleaners and fertilizers.

So please protect your eyes — you only get two of them.

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Can cataract surgery help you live longer?

By Mark Siegel, MD, FAAO

A recent study indicated that people who suffer from vision loss related to cataracts that proceed with cataract surgery lower their long-term mortality risk by 40 percent compared to people that choose not to have surgery.  The data used for the research study came from the Blue Mountains Eye Study, a group that researches vision and common eye diseases in an older Australian population.

The study that was published in the Journal of the American Academy of Ophthalmology studied a total of 354 patients over the age of 49 who suffered from visual impairment that was caused by cataracts. This study took place over a 15-year time span and evaluated patients who elected to have cataract surgery and patients who did not have surgery to correct cataract-related vision impairment. The study took adjustments into account such as age and gender as well as mortality risk factors such as hypertension, diabetes, smoking, co-morbid disease and cardiovascular disease to name a few.

The correlation between living longer and the correction of cataract related vision loss is not clearly understood, but several plausible factors may include improvement in physical and emotional well-being, optimism, the ability to live independently, as well as greater ability to comply with prescription medications.

Cataracts are typically slow to change over time, and their effects on vision can subtly progress to the point that the cataract might have unnoticed negative impacts on visual functioning, mood, and as a result, personal independence.

Cataracts occur when the eye’s natural lens becomes cloudy over time. Cataracts are a leading cause of vision impairment and will affect more than 50 percent of Americans by the time they are 80 years old. Cataracts can develop at different rates for everyone, but once they begin to develop, they will only gradually worsen and become more opaque over time. The best way to correct visual impairment caused by cataracts is to undergo cataract surgery where an ophthalmologist removes the natural lens of the eye and replaces it with an artificial intraocular lens. If you notice difficulty in completing everyday tasks due to vision problems, you should contact an eye care professional to discuss cataract surgery to improve the quality of your life.

Many people who suffer from cataracts complain of issues driving, especially at night, problems seeing color and detail clearly, and difficulty performing day-to-day functions at home and work. If cataracts go a long period of time untreated, people often lose their independence, ability to work and their quality of life may begin to suffer.

I have many patients who say they’re “too old” for cataract surgery. After undergoing cataract surgery, one is able to realize the colors and clarity of vision that were missing from their world. No one is “too old” for better vision and possibly a longer life as a result!

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