Ординатура / Офтальмология / Английские материалы / The Eye Care Sourcebook_Lavine_2001
.pdfF O R E W O R D
Similarly, cataracts are strongly influenced by factors in our daily lives— things we can control. Too much sunlight wrinkles the skin, of course, but it also contributes to cataracts, as does smoking. And a measure of protection comes from diets rich in fruits and vegetables, because the vitamin C and other nutrients they contain pass into the lens and knock out the free radicals that would otherwise contribute to opacities. While ophthalmologists will gladly replace clouded lenses with new ones, they prefer to let patients keep their original equipment.
In this carefully written and detailed volume, Jay Lavine, M.D., tells you everything you need to know about caring for those most delicate instruments, your eyes. Dr. Lavine has made medical science so tangible and exciting, you’ll want to read this book cover to cover. I strongly encourage you also to keep this book as a reference for the years to come. When the doctor uses strange terms, like uveitis or pterygium, the translation into plain English is at your fingertips, along with everything you need to know. Also included are crucial everyday topics—how to correct poor vision, remove a foreign body, or tackle vision-related headaches—and the latest, often surprising, tips, which can save you from going down many a blind alley.
Many professionals look to Dr. Lavine for advice on tough cases. Now readers from all walks of life can profit from his wisdom and experience.
Neal Barnard, M.D. Author of Food for Life, The Power of Your Plate, and Eat Right, Live Longer
X
Introduction
THE EYE IS THE WINDOW TO THE BODY. WHERE ELSE IN THE body can we actually see a nerve that is an extension of the brain? Or internal blood vessels whose health often mirrors the health of
blood vessels in other organs? Many bodily diseases cause changes in the blood vessels, nerves, and other tissues of the eyes. Even minor changes, which might well go unnoticed in other organs, often reveal themselves in the eye by their effects on vision. Other changes may not cause symptoms but may still be detected by a competent and conscientious physician.
The eye is the organ of sight, our most important sense. If we lose our sight, a part of us dies. We should therefore try to do everything possible to maintain this precious gift. With that in mind, the emphasis in this book is on prevention, the highest form of healing. All legitimate modalities of healing, including drugs and surgery, have their place, and we should feel fortunate that medical advances have facilitated the treatment of disease. But all drugs have side effects, and even successful surgery does not usually leave us the same as we were before we became ill. Furthermore, not all diseases are curable or even treatable. It seems intuitively obvious that it is preferable to prevent illness than to become sick and then have to be treated.
This sourcebook is intended to be a self-defense manual for today’s health care environment. As patients travel down Medical Lane, the road sometimes seems more like a tunnel of love, with ghouls popping up in all directions. On one side are the fee-for-service doctors recommending surgery. Should patients
XI
Copyright 2001 by Jay B. Levine. Click Here for Terms of Use.
I N T R O D U C T I O N
believe them? On the other side the HMOs are saying that nothing more needs to be done. Should patients believe them? Out of nowhere, the specter of alternative medicine approaches, like the emperor with his new clothes, promising to get at the root of your problem. Is this promise real? How about the medical information on the Internet and in the mass media? Are the “experts” they’re interviewing really expert? Clearly, a guide is needed to find the right path.
We live in the Disinformation Age. Doctors and hospitals hawk their wares like street vendors. Drug companies advertise their prescription drugs directly to the consumer,hoping that patients will dictate their own treatment rather than rely on the expertise of their physicians.All of these players in the medical arena know that if people hear something enough, they start to believe it. One of my goals in writing this sourcebook is to remind the educated reader that self-education and regard for reputation, ethics, and legitimate authority still constitute the best approach to obtaining quality eye care and taking care of one’s own eyes.
It would be nice if we could learn all we needed to know about our eye condition from a visit to the doctor,but such is not the case,especially in this day and age of reduced doctor time per patient visit. To be sure,medical practice involves much more than just drugs and surgery. Any modality that can prevent, treat, or cure illness is in the domain of the physician.Nevertheless,the reality is that lifestyle change, especially in the area of nutrition, is too often ignored by medical practitioners.
You won’t find any miracle cures on these pages,but you will learn about most major eye problems and how to treat them in the safest, gentlest, and most effective way possible.You will discover which foods can help prevent macular degeneration, the most common cause of poor vision among the elderly, and which nutritional approaches may have unwanted side effects. You will learn how to avoid unnecessary cataract surgery; how to obtain long-lasting relief from itchy, burning eyes; and how to reduce the need for laser treatment if you are diabetic.
Myths will be shattered. Did you know that many people with glaucoma have normal eye pressures and that exercise can lower eye pressures? Is refractive surgery as safe and free from complications as you may have been led to believe? Were you aware that dry eyes, a common cause of reading problems, don’t usually feel dry?
The information on all of the various eye problems is grouped according to the part of the eye affected. In recognition of the increasingly important role of nutrition in the practice of medicine, I have included a primer on nutrition. You will often find that the foods that are best for your eyes are also the foods that benefit the rest of your organs as well.
XII
C H A P T E R O N E
Myths About Vision
and the Eyes
THERE ARE MANY COMMON MYTHS ABOUT VISION AND THE EYES.
This chapter discusses some of the most well known of them.
It Is Desirable to Detect Cataract As Soon As It Appears
There is no advantage to diagnosing cataract in its earliest stages. A cataract can be safely removed at any time and, in fact, should generally not be removed until it makes you unable to function in your everyday activities. Cataract is only a cloudiness of the lens; it is not a growth or tumor.
Cataracts Are Removed by Laser
Cataract is a condition in which the lens of the eye becomes cloudy. Cataract surgery entails removal of the lens. The only way to remove the lens is by performing conventional surgery. Laser is only used for secondary cataract, a clouding of a formerly clear membrane that remains in the eye after cataract surgery.
Eye Pressure Checks Diagnose Glaucoma
High pressure in the eye is the main risk factor for glaucoma, but 25 percent of people with glaucoma have normal eye pressures, and many people with
1
Copyright 2001 by Jay B. Levine. Click Here for Terms of Use.
T H E E Y E C A R E S O U R C E B O O K
elevated pressures do not have glaucoma. Other procedures must be performed to diagnose glaucoma.
Contact Lenses Help Keep Eyes from Changing
Contact lenses allow you to see clearly, just as glasses do. If your eyes are going to change, they do so whether you wear contact lenses or not.
Exercises Can Improve Your Vision
Special eye exercises have never been shown to change refractive errors, such as nearsightedness or astigmatism. Exercises may occasionally be of value in strengthening weak eye muscles, such as those that turn the eyes inward when you are reading.
Wearing Your Glasses Too Much Makes You Dependent on Them
Glasses only help you to see better while you are wearing them. They do not change the eyes. They may make you more psychologically dependent on them because you get used to seeing better while wearing them.
People Who Need Glasses Have Weak Eyes
People who need to wear glasses do so to allow the light to focus properly on their retinas. The need for glasses has little to do with the health of the eye, and it certainly does not mean that the eyes are “weak.”
Reading in the Dark Harms Your Eyes
It may strain your eyes to read in the dark, but it won’t cause any damage to your eyes or make you need to wear glasses sooner than you would otherwise.
Using Your Eyes Too Much Weakens Them
Eyes do not wear out from being used. They may feel strained from overuse, but such strain does not cause any permanent harm or permanent change in vision.
Children Often Outgrow Crossed Eyes
Eyes occasionally wander during the first six months of life. Constant crossing of an eye will not be outgrown and may reflect a serious problem. In such a case, examination by an ophthalmologist is mandatory.
2
M Y T H S A B O U T V I S I O N A N D T H E E Y E S
Taking Vitamin Supplements Is the Best Way to Good Nutrition
Good nutrition results from eating a wide variety of vegetables, fruits, grains, and nuts. Besides the vitamins and minerals we need, plant foods contain phytochemicals, special substances that promote good health, including resistance to degenerative eye diseases. Supplements do not contain all of these important phytochemicals.
A Low-Carbohydrate,High-Protein Diet Helps with Weight Loss and Prevents Diabetes
This kind of fad diet is unsafe and unwise. Cutting back on calories helps you lose weight. As for diabetes, countries in which people typically eat a highfiber, high–complex carbohydrate (starch) diet show the lowest incidence of the disease. In diabetics, a lower protein diet may help prevent kidney and eye complications.
Eating Whatever You Want in Moderation Is the Key to Good Nutrition and Healthy Eyes
Eating a variety of foods in moderation is the key to good health. But that does not mean that you should eat whatever you want. If foods A and B both supply required nutrients, but consumption of food B has some health risks associated with it, then why consume food B at all? Concentrate on health-promoting foods and enjoy them.
Most Eye Diseases Cannot Be Prevented
Recent research has revealed that a number of eye problems, including cataracts and age-related macular degeneration, may be prevented, primarily by nutritional means. A dark, leafy green vegetable a day may keep the ophthalmologist away.
3
This page intentionally left blank.
C H A P T E R T W O
What Should You Do If . . . ?
THIS CHAPTER DISCUSSES A NUMBER OF “WHAT IF” EYE CARE
scenarios.
You Get Some Acid, Oven Cleaner, or Other Chemical in Your Eyes?
Run, don’t walk, to the nearest faucet and start splashing water in your eyes. Theoretically, an eyewash might be slightly better, but plain old water does the job just fine. The longer the chemical is in contact with your eyes, the more damage it does. Therefore, time is of the essence. Continue to flood your eyes with water for at least fifteen minutes. It can take a good while to completely flush out all the remaining chemicals. If your eyes then feel irritated or burn, or they seem blurry, or if it was a strong acid or base that got in your eye, seek medical attention right away from either an ophthalmologist or an emergency room.
You Suddenly Lose Vision in One Eye?
If your vision has completely blacked out in one eye and remains that way, seek emergency medical attention immediately. One major cause of sudden blindness in an eye is a central retinal artery occlusion. This is equivalent to a stroke in the eye. The emergency measures employed to treat an occlusion such as this
5
Copyright 2001 by Jay B. Levine. Click Here for Terms of Use.
T H E E Y E C A R E S O U R C E B O O K
are controversial, but if they are to have any effect, they must be begun as soon as possible. Without its blood supply, the retina can die very quickly.
Vision that is only partially lost or that takes hours to days to be lost can be due to a number of conditions but should still be checked out on an urgent basis. The optic nerve may have lost its blood supply from a shutdown of small blood vessels. Retinal detachment can cause loss of vision, but it generally begins in the periphery and gradually works its way across the field of vision.
If you lose your vision but it then returns within thirty to forty-five minutes, you may have suffered a transient ischemic attack (TIA), a warning sign that a stroke may occur in the near future. Usually the loss of vision occurs as a dimming of vision over a number of seconds, although occasionally it may appear as though a shade were slowly being drawn across the eye. A possible TIA requires urgent evaluation, because if you have a TIA you may need medication to reduce your tendency to form blood clots.
If your vision just becomes blurry but doesn’t black out, try blinking a few times or rinsing the eye with some water. Sometimes excess mucus from the glands in the eyelids may spread over your cornea and cloud your vision for a short while. If the blurring is accompanied by funny patterns in your vision and a headache begins after the blurring subsides, you may have suffered your first migraine, assuming you are a child or young adult. If the blurring does not go away, have it checked out as soon as possible.
You Get a Foreign Body in Your Eye?
Do not rub the eye. Rubbing can cause the foreign body to become more deeply embedded or to scratch the cornea. Blink your eyes several times to try to wash the foreign body out. If that does not work, grasp your upper eyelashes between your thumb and forefinger and then pull the upper eyelid down over the lower eyelid, allowing it to contact the lower lid. This often dislodges a small foreign body adhering to the inside of the upper lid. If that doesn’t work, try rinsing the eye with some water or eyewash. Repeat these steps as necessary. If you continue to feel as if a foreign body is in your eye, you should seek medical attention. Sometimes a foreign body sensation in the eye is not due to a foreign body at all but may instead be the first symptom of a developing eye infection (conjunctivitis).
6
W H A T S H O U L D Y O U D O I F . . . ?
You Can’t Get Your Contact Lens Out?
First, don’t panic. Although a contact lens can fall out of your eye, it can’t travel behind your eye and get lost that way. The conjunctiva ends in a cul-de-sac as it reflects from the eyeball to the inside of the eyelid, so nothing can get past it. If you have a rigid contact lens and you know for sure that it is on your cornea, you can use a little contact lens remover (plunger) if you have one. But be careful. People sometimes think they still have a contact lens in their eye, but it has long since fallen out. They have a feeling of something in the eye simply because the eye has become irritated. Many a person has tried using a plunger in such a situation and ended up abrading the cornea because no lens was present.
Sometimes a contact lens travels up under the upper eyelid and gets caught there. Irrigating the eye with some saline or contact lens wetting solution may help free the lens. If you can’t get it out, then your ophthalmologist or optometrist has to do it for you. But don’t be surprised if you’re told that there’s nothing there! This problem is much more common, of course, in new contact lens wearers.
You See Floating Spots and Flashing Lights?
Black dots, lines, and cobwebs are called floaters. They may appear when the vitreous humor detaches itself from the retina. A white light flashing off to one side, more prominent in the dark, can be a symptom of traction on the retina by the vitreous. If you begin seeing floaters, white light flashes, or both, see an ophthalmologist as soon as possible, certainly within twenty-four hours. A retinal tear, which is an easily treatable lesion, might be present. Untreated retinal tears may lead to a retinal detachment, a much more serious problem requiring major surgery.
Your Eyelid Keeps Twitching?
The medical term for this common symptom is lid myokymia. It may occur when you’re feeling tired, a condition that produces a little nervous stimulation that causes the eyelid muscle to twitch. A slightly dry eye or a little eyelid-associated irritation can also provoke lid myokymia. Consuming caffeine-containing beverages is another major risk factor, as illustrated by this anecdote.
7