Sunday, October 15, 2006

Everything You Need To Know About Having Happy & Healthy Eyes

Even after almost 40 years, Van Morrison is still in love with that brown-eyed girl. And Coldplay's Chris Martin routinely rocks out on "Green Eyes" (even though it's about a former girlfriend, pre-Gwyneth). Obviously, the eyes do have it, whether they're Spanish eyes, brown eyes that have turned blue (somebody explain that one to me), or Bette Davis eyes. Ah, but my eyes? Sometimes they just don't live up to the hype. In fact, if the eyes are the windows to the soul, as Dante so poetically put it, then my soul is tired and bloodshot, not to mention nearsighted and in need of bifocals. If, like me, nobody's going to write a song about your peepers until they get some TLC, read on.

Next time you see your mother, tell her that reading in low light is not going to wreck your eyesight. Mitchell Friedlaender, MD, of Scripps Clinic in La Jolla, California, says so. "You can't harm your vision by overusing your eyes," he says. But everything else your morn told you--to eat your veggies, take your vitamins, and get plenty of sleep--will do your eyes a world of good, he says. (And who wants to jeopardize their good looks because of eyestrain, anyway?)

In fact, researchers now think healthy food and lifestyle choices (whether it's quitting smoking, drinking alcohol in moderation, or eating lots of colorful fruits and vegetables that have eye-healthy antioxidants) improve the odds that your eyes will look their best and brightest. Those good choices can also help you avoid or delay eye problems that sometimes occur later in life, including age-related macular degeneration (AMD), glaucoma, and cataracts.

How important is eating right? A National Eye Institute study showed that a specific combination of vitamins, minerals, and antioxidants reduced AMD risk by 25 percent for some people. The combo: 400 IU of vitamin E, 15 milligrams of beta-carotene, 80 mg zinc, and 2 mg copper. Giacomina Massaro-Giordano, MD, of the University of Pennsylvania School of Medicine's Scheie Eye Institute, also recommends carotenoids (like lutein and zeaxanthin) and antioxidants such as vitamins A, C, and E, which help protect the retina from the damaging effects of the sun. For the veggie-averse, a supplement might be the answer, but check first with your primary care physician.

Regular eye checkups are essential to good eye and whole-body health, says ophthalmologist Susan Stenson, MD, clinical professor at New York University School of Medicine. Many health conditions (high blood pressure and diabetes, for example) have a major impact on your eyes, she says. "By treating the disease," she adds, "you're protecting your eyes."

Fight computer fatigue
Position your computer screen directly in front of you and slightly below eye level.
Don't put the computer in front of a window or bright light source.
Avoid working on a computer in a dark room. The light should be on, but should not be brighter than the computer screen.
Use an antiglare screen to eliminate glare and reflections.
Have a shaded lamp nearby when reading papers, and make sure it doesn't throw light onto the screen.
Increase the text font size to avoid eye-strain and squinting. Black text on a white background is easiest on your eyes.
Consider buying a pair of weaker reading glasses just for use with your computer. Reading-strength glasses are probably too strong for the distance between your eyes and the screen. Or ask your eye doctor about computer glasses, which are made specifically for long hours in front of a monitor.
Typical age when you need reading glasses. The culprit: presbyopia.
The three O's
Eye docs and eyeglass dispensers seem to be everywhere. But are they all created equal? Here's the scoop.

OPTICIANS typically fill and dispense prescriptions for glasses and contact lenses. Not all states require that an optician have a license, though, so look for certification from the American Board of Opticianry or the National Contact Lens Examiners.

OPTOMETRISTS examine, diagnose, and treat eye diseases and disorders, and fit and dispense corrective eyewear. In some states they can treat glaucoma and eye infections. They've completed college and optometry school, are certified by a national board of examiners, and must have state licenses.

OPHTHALMOLOGISTS are MDs qualified to diagnose and treat all eye conditions and diseases, including procedures such as cataract removal and laser surgery. They've completed college, medical school, and a residency, and many have specialty training as well.

Not pretty in pink
Dry, itchy, uncomfortable eyes can look bad and feel worse. Here are some of the most common ailments, plus a rare one that's been in the news.

Legend for Chart:

A - Symptoms
B - What it could be
C - Cause
D - Treatment





Pink tinge to whites
of eyes, burning,
discharge, dryness,
itching, light sensitivity,
pain or discomfort,
tearing, swelling

Conjunctivitis, an
inflammation of
the conjunctiva, the
mucous membrane
that lines the visible
part of the eye
and the inner eyelid

Infection or allergy

See a doc; antibiotic
drops are
usually prescribed
for bacterial
conjunctivitis. And
don't rub your eyes(!)

Dry, gritty, sticky

Dry eye, a lack of
lubrication and

Can range from
squinting at the
computer (the more
you squint, the
less you blink) to
age, systemic
disease, or medication
side effects

Many dry-eye complaints
are temporary
and easily
relieved with
over-the-counter eye
drops. Chronic
dryness may
require a doc visit.

Tearing, red, itching


Allergens, such as
pollen, cat dander,
dust, or mold

Oral allergy meds
may help, or either
OTC or Rx eyedrops.

Redness, excessive
tearing or discharge,
rapid onset
of blurred vision,
pain in and around
the eyes


If you're a contact
lens wearer, you
could have microbial
fungal keratitis,
but this is very rare

Anytime you have
eye pain, call a doctor.
If you're wearing
contact lenses,
remove them.

In the blink of an eye
You blink an average of 15 to 20 times per minute, each time lubricating and cleaning your eyes. If you're really engrossed in something (like the latest best seller), you blink less often. If you're tired or somebody asks you a question you aren't ready for, your blinking is likely to become more rapid.

3 things to keep out of your eyes

Yes, you've been desperate and wet a contact lens with spit once or twice. But that was back in junior high when you didn't know better. Now you do. Carry a purse-size bottle of rewetting solution with you.

The shelf life for eye-area cosmetics is shorter than that of other products because of the risk of eye infections. Replace mascara and eyeliner every 3 months, and all other eye makeup and creams every 6 months. If you have an eye infection, stop using all eye products, discard those you were using, and see your eye doctor. And never share eye makeup or try samples at the cosmetic counter.

Better geeky than sorry: Wear safety glasses when you're using cleaners or spray painting. If a chemical gets in your eye, wash it out with cool running water (keep your good eye upstream). If wearing contacts, remove them, rinse again, and head to the doc.

Protect your peepers
The bad news

Only 16 percent of adults wear sunglasses when they head out in the sun for an extended time.

The good news
When it comes to the evils of ultraviolet rays (sunlight that ages skin and makes skin cancer more likely), some eye doctors are starting to preach protection almost as loudly as dermatologists do. "Your eyelids can get sunburned just like skin elsewhere on the body," says ophthalmologist Susan Stenson, MD. "And both the cornea and retina can experience burn from unprotected high-intensity UV exposure." If you're a contact lens wearer, you are getting some UV protection, but it can't match the protection of sunglasses. And exposure to UV rays can accelerate age-related macular degeneration, glaucoma, and cataracts. At right is a collection of sun specs that combine protection and style.

For more details on the sunglasses shown here, see our Buyer's Guide on page 210.

Frames in a darker color, like the deep-brown tortoise on these Revo shades ($239), are better at blocking UV rays.

Amber-colored lenses like the ones on these Ray-Ban sunglasses ($80) are very good at shielding your eyes from the sun.

Oversize sunglasses, like this pair from Two Eyes ($55), are certainly fashionable--and they're great protectors, too.

Shades needn't be expensive to be effective. Case in point: these Isaac Mizrahi for Target sunglasses ($19.99).

Classic aviators like these from Shades of Juicy by Juicy Couture ($220) flatter many face shapes.

Help prevent crow's-feet with UV-blocking wraparound frames like these from Donna Karan ($299).

Look sporty, be smart
Why wear protective sports glasses? Approximately 40,000 sports-related eye injuries occur in the United States each year. So reach for shatterproof lenses such as polycarbonate, which can withstand a ball traveling at 90 mites per hour. The frames should protect the sides of your eyes, too. Some glasses have sweat strips, antifogging lenses, and other special features.

For racquetball and squash, nVue from Wilson ($60) offers three interchangeable lenses and ventilation that prevents fogging.

If you need prescription swimming goggles, the Sable 922 by See Worthy ($120) offers three sizes of nosebridges and a no-slip buckle head-strap.

Spec-tacular! Glasses have come a long way since Ben Franklin crafted bifocals from two pieces of glass (today progressive bifocals and trifocals don't even have a line). Fashions have changed, too, although as you can see here, what goes "out" soon comes back "in" again.

In the '70s, women's-rights activist Gloria Steinem made aviator glasses her signature--proof that a woman could look smart and sexy.

Tired of glasses or contacts? Not to worry. New ways of banishing corrective lenses seem to be popping up all the time.

First there was laser refractive surgery, which is still the most popular technique. The original form of this procedure is PRK, which was approved by the U.S. Food and Drug Administration in 1995 and is still used in some situations. Today the most popular version of laser refractive surgery is LASIK, which involves reshaping your cornea with a keratome machine and ultraviolet light. It has been done on nearly 5 million people, both nearsighted and farsighted, in the United States. After a brief recovery period, most nearsighted patients can ditch their glasses or contacts forever--or at least until they need reading glasses or bifocals for the fine print. Now there are a couple of new techniques that can solve that problem (called presbyopia), too. A new monovision version of LASIK corrects one eye for long-distance vision and the other for close-up sight.

There's also conductive keratoplasty (CK) for the middle-aged squint. It's a blade-free process that uses radio waves to reshape the cornea. A word of warning: The procedure may wear off over time.

If the idea of anything cutting your eye freaks you out, there's new hope for you. Bladeless distant-vision surgery uses "extremely short little bursts of light, putting localized pressure on the cornea," says Roger F. Steinert, MD, president of the American Society of Cataract and Refractive Surgery. The light bursts produce bubbles that slice the cornea, much as a blade would.

These surgeries are not for everyone, and careful prescreening with a qualified surgeon is a must. Andrew Caster, MD, FACS, author of The Eye Laser Miracle: The Complete Guide to Better Vision, recommends that you make sure the surgeon is board-certified and experienced with the procedure.

DON'T: Throw a raw steak On an injured eye
It may have worked for John Wayne after a punch-up, but that was just movie magic. There's absolutely nothing in raw meat that helps heal a black eye.

DO: Patch the injured eye, and head to the doc
Whatever the injury--a scratch, blow, bungee cord in the eye (it's more common than you think)--it could cause retinal detachment. Cover the eye and get to the ER or doc.

Rules of contact(s)
The recent eye-infection scare got contact lens wearers worried about tainted cleaning solutions and outbreaks of fungal keratitis. Truth is, contact lenses are very safe, and problems--particularly dangerous ones--are rare. In fact, there are over 30 million contact lens wearers in the United States, and only about 100 cases of fungal keratitis were reported during the outbreak. More common are infections caused by plain ol' bad habits. That's why if you wear contact lenses, you should always:

• Wash and dry your hands before handling lenses.

• Do a "rub and rinse" before storing lenses each night to minimize germs, even if you're using a no-rub lens cleaner.

• Keep your contact lens case clean and replace it every 3 to 6 months. Use fresh solution each night.

• Remove the lenses and see a doc if your eyes become red or irritated, or if your vision changes.

Windsor-style glasses with round wire rims were intro'd in the 1880s, but have been worn in more recent years by John Lennon and Whoopi Goldberg.

Cat-eye glasses aren't just for Tracey Ullman's wacky characters. They're all the rage. Buy a vintage pair, and put in your own Rx.

Plastic frames never go out of style: from horn rims (think Annie Hall) to sidewinders (Austin Powers), to today's popular small-framed "nerd" glasses.

H has details on how to donate used eyeglasses or sign up to donate your eyes to an eye bank.

Sunglass must-have: The "100 percent UV protection" label, which means they block the ultraviolet rays that do the most skin and eyed

Look for: Large or wraparound frames that protect the skin on your eyelids and the sides of your eyes.

No-brainer protection: If you don't like changing glasses when you go in and out, get photo-chromic lenses that darken when exposed to UV rays (they work better than the,

We like: Classic shades that never go out of style, like these by Robert Marc. For more sunglasses.

By: Strickland, Pam, Health

Lobbyists win code-review battles; physicians still face cuts in 2007

Despite some victories in preserving and improving 11 Medicare payment codes, ophthalmologists will sec some significant changes in 2007 unless Congress intervenes to stop acrossthe-board cuts.

The payment code analysis, mandated by the Centers for Medicare and Mcdicaid Services (CMS) and called the Five-Year Review, determines whether physicians are appropriately compensated for their work. Specialty medical societies were asked to offer what they thought were misvalued procedures, and CMS devised its own list of codes to be reviewed. After much lobbying by the American Academy of Ophthahiiology{AAO), American Society of Cataract and Refractive Surgery (ASCRS), and other medical societies, CMS has agreed to make more moderate changes to the codes used by ophthalmologists. The revised codes, called Work Relative Value Units (RVUs), will be effective Jan. 1.

"We did a lot better than others thought we would," said Cathy Cohen, AAO vice president for governmental affairs. "We were able to convince them to increase the work value for a number of codes." The AAO surveyed and presented data for 25 codes that could be adjusted, and won increases for 11 codes, according to Cohen. Values for another 11 codes challenged by CMS were maintained at current levels, and minor decreases were ordered for the physician work value portion of three codes: cataract with IOL (66984), photodynamic therapy for choroidal neovascularization (67221), and correction of trichlasis epilation by forceps (67820).

Meanwhile, nearly all codes relating to office visits—^evaluation and management— saw significant improvements, including increases by as much as 37%. "We succeeded on every code we proposed as undervalued," Cohen said. "We have a good track record." The team of physicians representing ophthalmology was particularly challenged in defending the code value for performing cataract surgery with an IOL, because survey data showed the procedure now takes less time than it did 5 years ago. In its alert, ASCRS noted that the intraservice physician time required for cataract surgery has decreased from 50 to 30 minutes.

However, the group said the decrease in time spent reflects a decrease of only low-intensity work (suturing). The code was considered particularly critical given the volume of these cases for most ophthalmologists. Ophthalmology Times' telephone call to ASCRS' Nancey McCann was not returned by press time. Stephen A. Kamenetsky, MD, AAO's official presenter at the Relative Value Update Committee (RUC), stressed that cataract surgery deserves higher payment because the technical difficulty of the procedure— through a small incision with a foldable or injectable lens and a self-sealing corneal incision— has increased even though the time required to perform it has decreased.

"The time that was eliminated was related to the lower-intensity work of ere-ation of a large wound and its subsequent closure, and was more than compensated for by the increase in skill required for the newer cataract operation," he said, adding that the RUC accepted that reasoning. "This confirmed the AAO position that time alone is a poor measure of physician work and that using it as a proxy for work to determine payment will stifie innovation for all specialties." Advocacy groups were also concerned about key retina codes that they feared would be slashed under the review. However, wo were successful in getting decisions about those codes deferred for at least a year until CMS'Current Procedural Terminology committee can evaluate them, Cohen said.

Dr. Kamenetsky said these codes—for vitrectomy and other common retina procedures— are under review because they no longer describe today's procedures. The AAO will submit revised and updated codes later this year, he said. "We believe that the values obtained will accurately refiect the physician work for these codes and will result in fair reimbursement for retinal specialists," he said.

In spite of these positive results. Congress and CMS continue to try to rein in spending. For example, even though ophthalmology won work value increases on many codes, under the Omnibus Budget Reconciliation Act of 1989, the payment for some codes will be reduced to preserve "budget neutrality." "Unless Congress increases the amount of money in the pool, any increases the RUC recommends has to be paid for within the pool," Coben said. Congress also has established a muchcriticized volume target formula—the Sustainable Growth Rate (SGR). Under this formula. Medicare payments will be cut 5.1% beginning in January.

In addition. Congress has pledged a 1.1% per year cut (for each of the next 4 years) related to practice expense (PE) policy changes. "They offered a very similar PE proposal a year ago and the academy pulled together a coalition and was successful in derailing it," Cohen explained. "They put it on hold and spent a year re-looking at it, and came up with basically the same proposal. We're the most significantly affected, and that's why we're convinced there's something wrong."

Still, lobbyists representing ophthalmology are encouraged by the code victories and are working on alternate ways to provide fair compensation for physicians. "The challenge is: How do we pay for it?" Cohen posed

By: Webb, Jennifer A.. Ophthalmology Times