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When I turned 40, I glanced in the mirror one morning and discovered a message. It read: “Get it back!”

The “it,” of course, was my youth. And as I confronted myself in the mirror, I couldn’t help but recall the days when I didn’t have to wear glasses. Oh, I was a looker! I made ’em howl back then. Now, I’m Clark Kent.

I decided right then and there that I wanted to lose the glasses. So, with eyes wide open, I embarked on a program to improve my vision. Some guys get a red convertible to cope with their midlife crisis; I got a vision-improvement kit.

For four months I did eye exercises. The result was a slight upgrade in my vision (I no longer need glasses for close work) and a major boost in my mental outlook. Instead of kidding myself that I look better without glasses, I’m now grateful for my specs: My glasses do a pretty good job in hiding the effects of aging. At least that’s what I tell myself.

The experience opened my eyes to just how valuable vision is, and how important it is to protect our peepers as we age. A 2002 Prevent Blindness America survey found that blindness ranked third (after cancer and heart disease) as people’s major fear. Our sight is precious to us, and for good reason. “Over 80 percent of what you learn comes in through your eyes,” says Jeffrey Anshel, OD, author of Smart Medicine for Your Eyes. But even if we know how important our vision is, we often have a funny way of showing it. We strain our eyes by spending hours on end reading or watching television, often without a rest. We rub our eyes until they are bloodshot. We avoid eye doctors. “Studies show that most people have their cars tuned up more often than they have their eyes examined,” says Anshel, who has a private practice in Encinitas, Calif.

If you are serious about wanting to keep your vision in tip-top shape, your first step is to protect your eyes from serious injury (scratches, cuts, chemical burns, and blunt trauma). Wear safety goggles or eye shields when undertaking potentially dangerous tasks or activities, including racquet sports, car maintenance, carpentry and biking.

But being careful during physical activities isn’t the only step you should take to protect your eyes. Good nutrition, regular checkups and, yes, exercise are all important factors in maintaining or improving your eye health.

Vision Vigilance

Having a yearly eye exam will help put your mind at ease that disease and blindness are not sneaking up on you. Regular exams also allow doctors to diagnose and treat potential problems early. Many diseases can cause vision loss, but these four are the most common:

Cataracts: Increasing cloudiness of the normally transparent lens, located behind the pupil. Cataracts form primarily because of excessive exposure to ultraviolet light and may cause vision-disrupting glare or halo effects. Robert Abel Jr., MD, writes in The Eye Care Revolution that because of cataract formation, an 80-year-old can require three times as much light as a 20-year-old to see clearly.

Glaucoma: Vision loss related to compression of the retina and optic nerve. Excessive pressure within the eye may be caused by clogged eye-drainage canals. Although cataracts are more common, glaucoma is more likely to lead to blindness. What’s more, glaucoma, unlike cataracts, rarely has symptoms that a typical patient might notice. Stress, high blood pressure and steroids – taken as eye drops, nose drops or inhalants – can contribute to glaucoma.

Macular degeneration: Often called AMD or ARMD (for age-related macular degeneration), this condition causes progressive and irreversible damage to the macula, the area of the retina that is used for direct, fine and reading vision. The macula is one of the body’s most metabolically active areas, says Abel. It occupies just 2 percent of the retina’s visual field but contains about one-fourth of all the cones (photoreceptor cells) in the eye. AMD is the leading cause of vision loss and blindness in Americans age 65 and older.

Diabetic retinopathy: Involves hemorrhaging blood vessels in the retina. The disease typically occurs about a decade after the onset of diabetes.

Eye Kindness

Even the healthiest of eyes are delicate and deserve gentle treatment. Our eyes were not made to withstand hours of paperwork and monitor-reading. The close-up work of the information age causes burning eyes, watering, blurring, double vision and headaches. It also contributes to nearsightedness.

Researchers working with native Alaskans in the 1930s found that few of them suffered from nearsightedness. Over the next 40 years, as the native population moved away from an outdoor lifestyle, that changed. “By the 1970s,” according to Abel, “30 percent of Eskimo children – who had lived much more of their lives inside than their elders – had become nearsighted.”

Thanks to computers, we’ve become locked into a viewing distance of 20 to 30 inches. “Viewing at that distance for hours and hours is stressful on the eyes,” Anshel advises. “So, blink, breathe and break. Follow the 20-20-20 rule: Every 20 minutes, take 20 seconds and look 20 feet away.”

Taking breaks, ironically, may actually improve your productivity. According to a study conducted by Cornell University researchers, typists who had a habit of taking regular breaks averaged 13 percent more accuracy than coworkers who never took breaks. Over the course of the five-week test, the typists who took periodic breaks also proved to be 1 percent more productive than their workaholic peers. Granted, it’s a small difference, but, hey, it didn’t hurt!

To reduce on-the-job eyestrain, it helps to wear glasses that are task-specific. Computer glasses have lenses split for reading (with a focal length of around 16 inches) and computer work (assuming the monitor is 20 to 30 inches away). They do not help with distance viewing, however. Anshel says trifocals, which in theory cover reading, intermediate and distance viewing, have only a narrow band for computer work. To reduce eye and neck fatigue, some experts advise patients to wear contacts or “progressive” lenses with no lines.

Make sure screen brightness matches that of the screen’s immediate environment (in other words, don’t turn your screen up to glaring bright when you are in a dark ? room). Both overly bright and overly dark screens can cause eyestrain, but when in doubt, choose a dimmer backdrop over a brighter one, Anshel suggests.

Beware of reflected glare and glare from room lights or bright windows. Use an antiglare filter and shade windows in your immediate work area, even if it means temporarily leaning or taping a piece of cardboard up against the offending part of the pane.

Finally, when typing from printed copy, keep it and the screen the same distance from your eyes. The ideal distance is 17 to 26 inches. And lower your monitor a few inches. Looking slightly down allows more of the eye surface to be covered by the eyelid. Also, your eyes unconsciously blink more and produce more lubrication when the lids are lowered.

Monitor Medication

Many medications can negatively affect your vision, so double-check with a doctor or pharmacist about the safety of the drugs you take. Some cases of macular degeneration, for example, are not age-related; they are side effects of drugs such as Aralen (an antimalaria drug) and Thorazine (an antipsychotic drug that is also used to treat nausea, vomiting and hiccups).

Also, ask your pharmacist if any of the drugs you take are photosensitizing drugs. “More than 1,000 medications are photosensitizers,” says Abel, whose private practice is located in Wilmington, Del. “They sensitize the skin and the lens to sunlight, which can speed up formation of cataracts.” Certain antibiotics and many blood pressure and heart medications are photosensitizers.

Steroids and statins can also spell trouble for the eyes. Long-term use of steroid drops can cause cataracts and glaucoma. And statins, the popular cholesterol-lowering drugs, “can definitely speed up cataracts,” Abel says.

Many other drugs have a potential for ocular side effects:

  • Accutane, for acne, can cause light sensitivity and eye dryness.
  • Benadryl, for motion sickness and allergies, can cause visual field constriction and retinal hemorrhaging.
  • Ergomar, for treating migraines, can change vision and visual field.
  • Ortho-Novum, used for birth control, can cause optic neuritis, blind spots and light halos.
  • Pepcid, for ulcers, can contribute to retinal bleeding and light sensitivity.
  • Prozac, an antidepressant, can cause light sensitivity and double vision.
  • Restoril, for insomnia and anxiety, can disturb accommodation (the ability to adjust focus near and far).
  • Rogaine, for blood pressure and hair growth, can cause increased eye pressure and decreased vision.
  • Tylenol, for fever and mild pain, can cause disturbed color vision and double vision.
  • Viagra in excess can cause bluish vision and light sensitivity. When Viagra went to market in 1998, the American Academy of Ophthalmology warned doctors to monitor patients with retinitis pigmentosa (a progressive congenital disease, also called tunnel vision). The incidence of such side effects is relatively rare in most cases, but if you have any concern, it’s wise to consult your doctor. This is particularly true if you are taking any of these drugs in combination.

Nourish Your Body

Your brain and eyes comprise only 2 percent of your entire body weight but consume about 25 percent of your daily nutritional intake. “The visual system uses an amazing amount of energy,” says Anshel. “The retina is very elaborate, with 120 million rods and 7 million cones per eye.” Rods and cones interconnect and converge to form a network of nerve fibers. About 1 million of them make up each optic nerve that carries visual impulses to the brain at 423 mph.

Certain foods and supplements are excellent for vision. Omega-3 fatty acids, found in cold-water fish (salmon, tuna, cod) and flaxseed, maintain the health of cell membranes, including those of the retina.

A type of omega-3 fatty acid called DHA (docosahexaenoic acid) makes up half of the fats in the brain and retina, says Abel. Omega-3 fatty acids help lower the risk of AMD, but omega-6 fatty acids, prevalent in the American diet and many vegetable oils, are associated with an increased risk.

Antioxidants help fight cataracts by reducing ultra-violet-light damage to the lens. Lycopene (found in tomatoes) is a helpful antioxidant, as are vitamins C, E and A (or beta-carotene, A’s precursor). Vitamins C and A are bountiful in citrus fruits, melons, carrots and green leafy vegetables. You can find E in beets, broccoli, leafy greens, whole grains and nuts. An eight-year study of 50,000 women showed 50 percent less cataract formation in those eating five servings of spinach a week.

Glutathione, another antioxidant, also prevents cataracts. In fact, lenses with cataracts contain one-fifteenth the normal amount of glutathione and one-tenth the normal level of vitamin C. Glutathione is in asparagus, avocado, broccoli, garlic, onions, spinach, tomatoes, watermelon, eggs and walnuts. Abel advises taking alpha lipoic acid, N-acetyl cysteine and selenium, which contribute to glutathione production. Abel notes that metabolizing and excreting acetaminophen (Tylenol) depletes glutathione. “Tylenol is probably not the best long-term pain reliever for anyone concerned with eye health,” he says.

Flavonoids, found in berries and grapes, are powerful antioxidants that improve night vision and help prevent AMD. Wine, especially red wine, is rich in flavonoids. Quercetin is a flavonoid supplement, as is bilberry, which is available as a berry or supplement. The mineral zinc, as well as the antioxidants lutein and zeaxanthin, also help lower the risk for AMD or slow down its progression.

Supplement Your Sight

In 1990, Andrew Rudawsky, PT, ATC, had a corneal transplant as a result of infections related to wearing contacts. “I was nearly blind in my right eye,” he says.

Abel performed the operation and prescribed a supplement that includes DHA, lutein and other antioxidants. “It has made such a huge difference,” says Rudawsky, who is codirector of Christiana Care PT Plus, in Wilmington, Del. “I spend roughly $50 a month for the supplement, but every year my vision improves. There’s more clarity, and I rarely have irritations, redness or dry eye.”

Rudawsky is part of a growing group of people investing in vision supplements. Todd Whitthorne, president and COO of Cooper Concepts, Inc., and Kenneth Cooper, MD, founder of the Cooper Aerobics Center in Dallas, host a weekly radio show on health. “Whenever we talk about eye health and vision, the phone lines explode,” Whitthorne says. “It’s apparent that AMD is a major issue – and an emotional issue. People with this disease are desperate. They all say the same thing: ‘What can I do? How do I stop this? I don’t want to go blind.'”

Vision supplements are recommended by many vision specialists. But it’s important to look beyond promotional labels and investigate the ingredients in such supplements. In some cases, a good multivitamin may be an equally good bet. For example, Cooper Concepts offers a multivitamin and mineral supplement, which contains 6 milligrams (mg) of lutein, several times more than most leading drugstore brands carrying “vision” specialty labels. Their skin and eye formula, released last January, has 10 mg of lutein. Is that enough to boost vision? Experts claim anywhere between 4 and 40 mg of lutein are needed, although this is still “an inexact science,” Whitthorne says.

“Many consumers are familiar with supplement ingredients,” he says. “They know lutein is good for the eyes; lycopene is good for the prostate. But I’m convinced most people don’t know the difference between a microgram, a milligram and a telegram. The amount makes a difference, and most formulas fall shy of the recommended amount of lutein.”

Supplement quality is also an issue. An ingredient may appear on the label, but not in the bottle, at least not in stated amounts. A study of supplements out of the University of Maryland School of Pharmacy analyzed 32 products claiming to contain chondroitin. “Of the 32 tested,” Whitthorne says, “only five met label claims.”

In the case of lutein, it’s possible that your diet may provide enough already. “But you’d have to eat an awful lot of spinach, collard greens, kale and eggs,” Whitthorne says. “If they eat healthily, Americans get maybe 2 mg of lutein daily from diet. Studies show that 10 mg of lutein helps reduce the progression of AMD. But I don’t think most people get 10 mg in their diet.”

Still, aside from taking his company’s own lutein-rich multi, Whitthorne says he has no plans for taking ? any additional vision supplements. “I eat lots of fruits and vegetables and a ton of spinach, which gives me 2 to 3 mg of lutein daily. I take the Cooper Complete multi, which contains 6 mg of lutein. So I’m probably getting 8 to 10 mg daily.”

Many single-nutrient supplements, like lutein and bilberry, are also available at health-food stores. They’re safe, says Abel, but single-nutrient supplements can be expensive. The bottom line, says Abel, is this: “You can’t take every supplement around. You want a multivitamin that at least gives you vitamins A, C and E, as well as lutein, which benefits retina function and protects the lens. Also, omega-3 fatty acids are important to both eye and general health.” Follow the suggestions of your eye doctor or other healthcare provider, he advises.

Exercise Your Eyes

In the early 20th century, ophthalmologist W. H. Bates, MD, introduced the Bates Method for Improving Eyesight. He sought to restore natural habits of seeing, which are lost through strain, tension and misuse of the eyes. Bates presented relaxation exercises to (in theory) help the eyes and mind work together.

Since then, newer programs have added all sorts of exercises and enhancements, including acupressure. Some exercises aim to strengthen the six extraocular muscles that enable the eyeballs to move and track properly. Other exercises require you to watch an object as you “trombone” it toward and away from your face. This works the ciliary muscle, which attaches to the lens and causes it to change shape as you focus on various objects.

While none of the exercises I tried were difficult, I found that the relaxing-and-energizing exercises were far and away the most pleasant. One of my favorites is called palming. You close your eyes and gently cover them with your palms, breathing slowly and deeply. Another is hydrotherapy. You dip a washcloth in warm water and hold it against your closed eyes for 30 seconds. Repeat using a washcloth dipped in cold water. Repeat warm-cold-warm-cold for several minutes.

The upside of these types of programs is they make people appreciate their vision and believe in vision improvement. The downside is they are often too general and too simple to do much to improve vision. Many customers pay $300 or more for a program, work the exercises a few weeks and quit when they don’t get desired results. Programs by optometrists are customized and tend to give better results, but they can cost thousands of dollars for exams and months of therapy.

Anshel claims he was able to push back purchasing reading glasses until age 50 because he regularly performed eye-exercise techniques that helped his accommodation capabilities. These techniques, he asserts, work muscles inside the eye, keeping the lens flexible and more able to adjust to different focal lengths.

But it is unnecessary to strengthen muscles outside the eye (extraocular muscles), says Anshel, because they are “about 200 times stronger than they need to be to move the eyeball. It’s not that these muscles are weak; mostly it’s the coordination of them that’s causing problems. They need to be well coordinated to ward off crossed eyes, binocular-vision problems and certain disorders. But much of that coordination capacity resides in the brain. If you do general exercises that just spin the eyeballs in circles, it’s unlikely to help. Ultimately,” says Anshel, “you need to know what problem you have before doing techniques to resolve it.”

Perhaps you are fortunate enough not to have any vision problems – at least for now. If so, just keep in mind that you’re probably even more likely than most to take vision for granted. Your eyes have been there for you all these years, making the intricate and miraculous conversion of light to sight seem like no big deal. But if your vision ever does start to go, you can be certain that you will miss it dearly.

So take care of your sight. Take steps to nurture it when you can. Appreciate all that you see now – and see to it that your vision lasts a lifetime.

Constant Contacts

Can leaving contacts in too long or wearing them constantly damage your eyes? “Absolutely,” says Jeffrey Anshel, OD, author of Smart Medicine for Your Eyes. “The main problems are an increased risk of infection and an inadequate supply of water and oxygen to the eyeball, leading to tissue damage.” Over time, the eyes can even take on a ring-shaped lens imprint (a condition that generally reverses itself when the eyes are given a rest from lenses).

Anshel points out, however, that what qualifies as overwear can vary – not just from lens to lens, but person to person, even season to season. During allergy season, for example, protein and lipid deposits on lenses may build up faster. That’s why it’s important to follow the guidelines your optometrist provides, and to return for regular checkups.

“We look at the eye microscopically to see how the lens is working on the eye and how the eye is responding over time. If we see a problem, we might adjust your schedule or your fit, or recommend a different type of lens. This is why purchasing contact lenses over the Internet isn’t a good idea and why regular checkups are so important.”

The recommended wearing schedules for different types of lenses varies considerably, from daily-wear lenses that must be removed and cleaned each evening to disposable extended-wear contacts that can be worn for weeks at a time, day and night. The upshot: Always change your contacts according to your eye doctor’s instructions and alert him or her if you are experiencing dry eyes, irritation or any other problem.

The good news is in the last few years, a new superpermeable silicone-based contact lens material has become available. It allows significantly more oxygen to pass through the lens to the eye and has been approved for 30-day extended wear by the FDA. It’s available in CIBA Vision’s Night & Day and PureVision by Bausch & Lomb, but PureVision is not currently sold in the United States because of a patent dispute.

“This material lets in so much oxygen through the lens that even with the lid closed at night, your eyes are getting enough oxygen,” Anshel says. “Plus, the material is deposit resistant; it resists the buildup of proteins [present in tears] that irritate the eyes.”

Anshel says even those patients who generally sleep in their contacts may benefit from taking them out overnight once a week. This gives the eyes a healthy break. When sleeping with contacts in, use lubricating drops before going to sleep and again when you wake up, he suggests. Just make sure the drops you choose are a formulation designed for lubricating contact lenses, not anti- redness drops that contain chemical blood-vessel constrictors like tetrahydrozoline.

“Those ‘get-the-red-out’ products are the worst things you can possibly use in your eyes,” asserts Anshel. Used on a regular basis, he explains, such drops tend to cause a “rebound phenomenon.” Initially, the constriction of the blood vessels makes the eyes appear whiter. But artificially shrinking the blood vessels that carry oxygen to the eye can force your blood vessels to adapt by growing bigger, making your eyes redder over time.

Shape Shift
In the past few years, the FDA has granted approval for new overnight contact-lens technologies that reshape the cornea for better daytime vision. Known as corneal refractive therapy (CRT), this approach uses lenses that gently flatten the cornea in a way that refocuses more light on the retina, even after the lenses are removed.

You put the specially designed lenses in before going to sleep and they remold the cornea overnight. In the morning you take out the lenses and see more clearly – in many cases, all day. “The only challenging part is that you need to put the lenses on every night in order to maintain the result,” says Jeffrey Anshel, OD. “But otherwise, this is a perfect solution for many nearsighted people, especially kids in their early teens, or anyone who is very active and hates wearing glasses.”

CRT won’t work with severe nearsightedness (myopia) but shows good results with mild cases, including myopia with astigmatism. “I’ve had patients go from 20/200 vision, a bad case, to 20/40 vision – which is pretty good – in one day,” Anshel says. “And by the end of the week they are 20/20.” Costs for the required exam and special lenses range from $1,500 to $2,000. The Corneal Refractive Therapy contact lens by Paragon Vision Sciences is the first CRT lens to receive approval by the FDA for overnight wear. For more on CRT, see www.allaboutvision.com/contacts/orthok.htm.

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