Published: 08 September 2024

In our modern world, people spend hours on end staring at computer screens, smartphones, tablets, e-readers, and books that require their eyes to maintain close focus. For most people (all except those who are nearsighted and aren’t wearing their glasses), their eyes’ natural focus point is far in the distance. In order to move that focus point from far to near, there is an eye muscle that needs to contract to allow the lens of the eye to change its shape and bring up-close objects into focus. This process is called accommodation. When we accommodate to view close objects, that eye muscle has to maintain a level of contraction to keep focused on the near object. And that muscle eventually gets tired if we continuously stare at the near object. When it does, it may start to relax a bit and that can cause vision to intermittently blur because the lens shape changes back to its distance focal point and the near object becomes less clear. Continuing to push the eyes to focus on near objects once the focus starts to blur will began to produce a tired or strained feeling in addition to the blur. This happens very frequently to people who spend long hours reading or looking at their device screens. An additional problem that occurs when we stare at objects is that our eyes’ natural blink rate declines. The average person blinks about 10 times per minute (it varies significantly by individual) but when we are staring at something our blink rate drops by about 60% (4 times per minute on average). This causes the cornea (the front surface of the eye) to dry out faster. The cornea needs to stay moist in order to see clearly, otherwise little dry spots start appearing in the tear film and the view gets foggy. Think about your view through a dirty car windshield and how much that view improves when you turn the washers on. So what should you do if your job, hobby, or passion requires you to stare at a close object all day? Follow the 20-20-20 rule. Every 20 minutes, take 20 seconds and look 20 feet into the distance. This lets the eye muscle relax for 20 seconds, and that is generally enough for it to have enough energy to go back to staring up close for another 20 minutes with much less blurring and fatigue. It also will help if you blink slowly several times while you are doing this to help re-moisten the eye surface. Don’t feel like you can give up those 20 seconds every 20 minutes? Well if you don’t, there is evidence that your overall productivity will decline as you start suffering from fatigue and blurring. So take the short break and the rest of your day will go much smoother. Article contributed by Dr. Brian Wnorowski, M.D.

Published: 24 August 2024

If you are seeing the 3 F's, you might have a retinal tear or detachment and you should have an eye exam quickly. The 3 F's are: Flashes - flashing lights. Floaters - dozens of dark spots that persist in the center of your vision. Field cut – a curtain or shadow that usually starts in peripheral vision that may move to involve the center of vision. The retina is the nerve tissue that lines the inside back wall of the eye and if there is a break in the retina, fluid can track underneath the retina and separate it from the eye wall. Depending on the location and degree of retinal detachment, there can be very serious vision loss. If you have a new onset of any of the three symptoms above, you need to get in for an appointment fairly quickly (very quickly if there are two or more symptoms). If you have just new flashes or new floaters you should be seen in the next few days. If you have both new flashes and new floaters or any field cut, you should be seen in the next 24 hours. When you go to the office for an exam, your eyes will be dilated. A dilated eye exam is needed to examine the retina and the periphery. This may entail a scleral depression exam where gentle pressure is applied to the outside of the eye to examine the peripheral retina. Some people have a hard time driving after dilation--since the dilating drops may last up to 6 hours, you may want to have someone drive you to and from your appointment. If the exam shows a retina tear, treatment would be a laser procedure to encircle the tear. If a retinal tear is not treated in a timely manner, then it will progress into a retinal detachment. There are four treatment options for retinal detachment: Laser. A small retinal detachment can be walled off with a barrier laser to prevent further spread of the fluid and the retinal detachment. Pneumatic retinopexy. This is an office-based procedure that requires injecting a gas bubble inside the eye. The patient then needs to position his or her head for the gas bubble to reposition the retina back along the inside wall of the eye. A freezing or laser procedure is then performed around the retinal break. This procedure has about 70% to 80% success rate, but not everyone is a good candidate for a pneumatic retinopexy. Scleral buckle. This is a surgery that needs to be performed in the operating room. This procedure involves placing a silicone band around the outside of the eye to bring the eye wall closer to the retina. The retinal tear is then treated with a freezing procedure. Vitrectomy. In this surgery, the gel - the vitreous inside the eye - is removed and the fluid underneath the retina is drained. The retinal tear is then treated with either a laser or freezing procedure. At the completion of the surgery, a gas bubble fills the eye to hold the retina in place. The gas bubble will slowly dissipate over several weeks. Sometimes a scleral buckle is combined with a vitrectomy surgery. Prognosis The final vision after retinal detachment repair is usually dependent on whether the center of the retina - called the macula - is involved. If the macula is detached, then there is usually some decrease in final vision after reattachment. Therefore, a good predictor is initial presenting vision. We recommend that anyone with symptoms of retinal detachments (flashes, floaters, or field cuts) have a dilated eye exam. The sooner the diagnosis is made, the better the treatment outcome. Article contributed by Dr. Jane Pan