In the midst of the busy holiday season, don’t forget to take care of your eyes. If you’ve put off having your eyes examined or buying new glasses, sunglasses or contact lenses, be sure to do it before Dec 31st to avoid losing benefits. Schedule your appointment or stop in to see our new collection of Silhouette drilled rimless frames, Juicy Couture frames with interchangeable temples to change up your look or our popular new Hugo Boss Orange line. We have special eye wear packages starting at $99. Expenses for eye exams, contacts lenses and prescription eye wear (including sunglasses, sports goggles and safety glasses) are eligible for reimbursement under flexible spending accounts. Please note that the office will be closed for the holidays from Fri, Dec 23 through Mon, Dec 26th and Mon, Jan 2nd.
Driving is one of the most cherished activities of seniors. It enhances self esteem, promotes social interaction and enhances independence, all of which improve quality of life. Driving skill is dependent on functional ability more than age so it’s important to get regular physicals and eye examinations to help prevent or identify and treat problems that can adversely affect driving at any age.
While older drivers have the lowest rate of crashes per year of any age group, when you look at crashes per mile driven, the accident rate for drivers over age 65 approaches that of teenager drivers. The fatality rate for drivers aged 85 and older is 9 times higher than the rate for drivers 25 to 69. This is partially because older drivers tend to be more frail making them more prone to injury and less able to recover from injuries sustained in an automobile crash. As the number of older drivers continues to grow, drivers 65 and older are expected to account for 16 percent of all crashes and 25 percent of all fatal crashes.
Driving is a complex skill that demands good vision, motor and mental skills. In addition to changes that occur naturally with aging, many chronic illnesses and medications can negatively impact driving. Drivers need good visual acuity to read road signs and the instrument panel; good peripheral vision to be aware of traffic and potential hazards; visual perception skills to recognize and interpret warning signs. They need adequate movement and strength to turn their head and eyes to scan traffic, turn the steering wheel and step on the brakes. They need to be alert; able to recognize warning signs; react to sudden changes; multi-task and remember where they are going.
Contrast sensitivity decreases with age and with eye diseases such as cataracts, macular degeneration and glaucoma, making it harder to distinguish objects (like cars or pedestrians) from the background. The decrease is most pronounced at night or in stormy weather. Older drivers also experience more glare and adjust more slowly to brightness changes like headlights and the ability to judge speed of oncoming cars.
There are some practical things that older drivers can do to significantly improve their safety. Stay active to maintain strength and flexibility. Make sure your car is senior friendly: easy to get in and out, large displays on dashboard, mirrors on both sides and power controls. Avoid driving at night or during storms. Take familiar routes and avoid heavy traffic. Be especially careful at intersections and avoid making left hand turns whenever possible. Do NOT bring a “copilot” to help navigate or read roads signs and traffic signals. This is a very dangerous practice. Split second decisions are required in critical situations and it takes too long for a driver to react to a co-pilot.
The AARP has a Safety Driver Program to update your driving skills and learn defensive driving techniques. They now have both a classroom or an online course format. Some insurance companies will give a discount on your insurance premium for completion of the program.
Some red flags to watch out for are: recent crashes, near-misses, lots of dings on the car, traffic tickets, getting lost, poor night vision, forgetfulness, and confusion, friends or family refusing to drive with you. The Hartford Insurance Company has a more extensive list of Warning Signs for Older Drivers that may indicate unsafe driving ability.
If you or a caretaker recognize some of these signs be sure to have a physical exam and/or eye exam to rule out and treat any undiagnosed medical problems. If the problems persist, a Driver Rehabilitation Specialist (DRS) can assess driving skills, recommend rehabilitation as needed and suggest possible modifications needed to allow safe driving. The Association for Driver Rehabilitation Specialists (ADED) has an online directory you can search for a DRS near you.
There are also some free online assessment tools available:
The University of Michigan SAFER Driving Program is an online assessment survey where you rate your experience over a wide variety of circumstances that may impact driving ability. After completing the survey questions, it provides a list of potential health concerns, which critical driving skills may be affected and it makes personalized recommendations for safer driving.
AAA Roadwise Review is another online self-assessment that takes about 30 min and helps identify skills that need improvement.
If you find that driving is no longer safe, you are not alone. It is estimated that the average male will live 6 yr without driving and female 10 years. There are many resources that can help with the transition and provide tips to maintain as much independence as possible. Even if paid transportation is necessary, it is often less expensive than driving when the total cost of car ownership including maintenance, insurance, taxes and licenses and gas are taken into consideration .
Helpguide.org has an comprehensive article on senior driving: Senior Driving Safety Tips, Warning Signs and Knowing When to Stop
The Hartford has a downloadable pdf guide “We Need to Talk: Family Conversations with Older Drivers” that has information on how to determine when a family member should no longer be driving, how to get them to stop driving, help in making alternative transportation plans and a list of resources.
American Medical Association Older Driver’s Guide Educational Guides and Resources Patient and Caregiver including a safe driver checklist, Successful Aging Tips, Tips for Safe Driving, How to Assist the Older Driver, Getting By Without Driving and other resources.
Contrary to popular belief, optometrists don’t dilate patient’s pupils because we enjoy listening to our patients complain. We dilate the pupils in order to obtain the best possible view of the retina, optic nerve and blood vessels inside the eye. It also allows a better assessment of the lens for signs of cataracts.
Think of examining the eye like a trying to look through a hole in the front of a ping pong ball to see a design painted on the inside. Making the hole bigger makes it a lot easier to look inside and see farther out. That’s especially true when the ping pong ball is wiggling around! Unfortunately, when you shine a light in the eye, the pupils get smaller, making it even harder to get a good view to assess the health of the eye. If you were trying to see details of the back of the eye, which eye in the photo above would you prefer to examine?
Signs of both ocular and systemic diseases can be seen in the back of the eye. For example, glaucoma causes changes in the appearance of the optic nerve. Yellow deposits called drusen or dark specs of pigment accumulate in the macula in macular degeneration. Small holes or tears in the retina can lead to a retinal detachment. Diabetes and hypertension can cause hemorrhages in the retina and/or changes in the appearance of the retinal vessels. Primary cancers such as choroidal melanomas and retinoblastomas can be seen there as well as metastases from the breast, lung and other organs. And the list goes on and on.
How often you need to be dilated and the type of drops used depend on several factors. Age, pupil size and reactivity, iris color, medical conditions, risk factors, signs and symptoms, the level of patient co-operation and previous response to dilation should all be taken into consideration. With the equipment and lenses available today, we may be able to get an adequate view without dilation or use milder drops that wear off quicker and won’t affect your focusing as much. However, dilation always maximizes our view. Even patients with unusually large pupils may require dilation in some situations.
Many offices are now marketing the Optos optomap laser scanning image as a premium option, often as a high tech “alternative” to dilation. An image made with laser light has a sexy wow factor for patients but, in my opinion, the optomap is not an adequate substitute for dilation. It certainly should not be done in lieu of physical examination of the retina by the doctor.
Optos claims that it has a field of view of “up to 200 degrees” and “conventional devices” are only 30 degrees. A good quality, 200 degree image requires a skilled technician and a cooperative patient with decent sized pupils (even laser energy has to go through the pupil to make an image) and no corneal or lens problems. And that 200 degrees only covers the horizontal direction. Unfortunately, pathology doesn’t just occur in the horizontal meridian. I have an optometrist friend that has significant scarring in the inferior retina from surgery for a retinal detachment that did not show up in an optomap of her retina.
I’m also not sure what “conventional device” they are talking about. Even the basic instruments I used in optometry school 30 years ago gave up to a 60 degree (full circle) single view in a fully dilated patient. The edge of the retina could be seen by having the patient look in different directions. Current technology gives even wider views with smaller pupils. It also provides greater magnification than the optomap and a stereo view, both of which are critical in identifying subtle changes in the retina or optic nerve.
I’m not against taking images of the eye. They allow us to document the eye for future comparison and they are a great tool for patient education. One of the biggest benefits of retinal imaging is that it allows a faster, more thorough examination of the eye with better comfort for the patient. The macula and optic nerve are in the posterior pole of the eye where patients are most sensitive to light. In some patients it’s tough to get more than a quick peek of this critical area between blinks and their watering eyes cause a lot of reflections that block the view. With retinal photography, we can quickly capture an image that can be viewed on the monitor for as long as desired. We can zoom in on any areas of interest for better detail and a variety of filters can be applied to the image to highlight specific details. No examination with lenses can provide the same field of view and magnification in one view.
However, I would argue that an optomap is inferior to a digital retinal photo in most cases. While the Optos can get farther in the periphery under optimal conditions, the bulk of pathology is found in the posterior pole where the macula and optic nerve are located. Also, most problems in the periphery either need to be treated or they don’t. So while you want to be able to see pathology in the periphery, a photograph isn’t as helpful in management and treatment. The optomap image is very distorted and much lower resolution compared to a digital retinal photo. Retinal photos can also be taken in offset pairs to provide a 3D view of the posterior pole and multiple images can be combined with software to expand the field of view included in a photo.
If your goal in paying extra for an optomap is to get a neat, high tech laser scanning image of your retina, then the optomap may be for you. But don’t think that it will provide the same quality of view that is achieved by dilation and examination by the doctor using modern equipment and lenses and, I dare say, even examination without dilation in many instances.
If your goal is a high quality, cost-effective health assessment of your eyes, have them dilated as needed for an overall stereo view of the eye. Have high resolution retinal photos of the posterior pole if you want the detail, analysis, documentation and wow factor that they provide.
Dilation is not always necessary at every exam but, regardless of the equipment used, it usually allows for a better health assessment of your eyes. Isn’t that why you’re having your eyes examined in the first place?
Check out these examples of optomap images I received from the previous doctors of some of my patients compared to the retinal photos I took and decide for yourself.
- Optomap image of patient #1. That yellow/white disc with blood vessels coming out of it is the optic nerve. The darker patch just left of that is the macula. They are in the posterior pole of the eye. You can see that there is a wide view of the temporal retina (to the left) but very little view of the superior, nasal and inferior retina. Even with the wider temporal view, you can barely see the retinal defect peeking through the eyelashes at 8:00.
- Retinal photo of the peripheral defect in patient #1. This is a retinal photo of the same defect seen between the lashes at 8:00 in the optomap image above. Peripheral images are harder to capture in a retinal camera but have better detail when you can get them. The hazy white zone is from reflection of the flash off the iris when the patient is looking off center.
The Washington’s blog has put together an incredible collection of videos of new 3-D printing technologies that are being used to reproduce an amazing variety of items from tools with moving parts to functioning human organs. Much of the research involving organ reproduction is being done at Wake Forest University, here in NC. They “printed” a two chamber mouse heart that beats using a standard ink jet printer with an ink cartridge filled with cells instead of ink! The mind boggles at the possibilities for this technology.
While you’re busy shopping for book bags, notebooks and calculators, don’t forget to have your child’s eyes examined. Studies show that 80 percent of learning is done visually. We also know that more than 20 percent of kindergarten children have vision problems. That number climbs to between 30 and 40 percent by 12th grade. Yet VSP’s Children’sVision Awareness Study found that almost half of children age 12 and under have never had a professional eye exam.
Parents of the majority of those children said they did not bring their children in for a comprehensive eye exam because they “had already been examined” in school or at the doctor’s office. My blog post last year explains why a vision screening is not enough. Even screenings performed by eye professionals miss many vision problems and conditions such as amblyopia are much more difficult to treat if not caught by age 5 or 6.
While vision problems may not be the only reason for learning difficulties, at a minimum, they are an unnecessary distraction. And you can’t depend on children to complain when they are having trouble seeing. Since they don’t know anything different, they don’t realize that there is anything wrong with their vision.
Call 919-439-7995 and schedule an eye exam today to ensure that your child starts the school year with clear and comfortable vision.