Eye Care Basics

Eye Care Basics

By Danny Hum

Copyright Danny Hum 2017, All Rights Reserved

Published by Danny Hum, Distributed by Smashwords

Smashwords Edition, License Notes

Thank you for buying an authorized copy of this ebook. This ebook is licensed for your personal enjoyment only. This ebook may not be re-sold or given away to other people. If you would like to share this ebook with another person, please purchase an additional copy for each recipient. If you’re reading this ebook and did not purchase it, or it was not purchased for your use only, then please return to your favorite ebook retailer and purchase your own copy. Thank you for respecting the hard work of this author.

Scripture Quotations

Scriptures are from the King James Version of the Holy Bible—unless otherwise noted.

Also by Author

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Table of Contents

Introduction

Chapter 1: Our Complex Eyes

Chapter 2: Defining 20/20 Vision

Chapter 3: Myopia, Hyperopia, Astigmatism

Chapter 4: Unequal, Lazy, Blind

Chapter 5: Presbyopia Time

Chapter 6: Contact Lenses

Chapter 7: Myopia Control

Chapter 8: Laser Eye Surgery

Chapter 9: Cataracts

Chapter 10: Glaucoma

Chapter 11: Flashes, Floaters, Detachments

Chapter 12: Macular Degeneration

Chapter 13: Diabetes, Hypertension

Chapter 14: Watery Dry Eyes

Chapter 15: Blood, Bumps, Bugs

Chapter 16: Eyelid Problems

Chapter 17: Headache Dizzy

Chapter 18: Seeing Not See

Chapter 19: Vision Genetics

Chapter 20: It’s Complicated…

About the Author

Introduction

Am I going blind? That’s what my last doctor told me.

Statements from their doctor that they need surgery right now, or that they may go blind, may cause some folks to make decisions which may not be in their own best interests. And just the mention of a need for glasses may cause some to panic.

This book’s goal is to provide some basic understandings of the eyes’ design and function, insight into some eye problems which may need correction or treatment, as well as some problems which may not need correction or treatment during certain times in life. The topics discussed in this book are only basic overviews of some of the more common situations from my years in practice.

This book is not designed or intended to provide for self-diagnosis or self-treatment of any condition discussed. You must contact your own trusted doctor for any diagnoses, answers, or treatments regarding your personal situations. Furthermore, because everyone is different to some extent, there will be exceptions to what is presented herein. I thus invoke what one lecturer stated, For everything I say here today, there is an exception.

Hence, a disclaimer is indicated here. The information offered is with the understanding that it does not contain or offer legal, financial, medical, or other personal or professional advice. Individuals requiring such advice or services must consult with his or her own trusted competent professionals. The author, publisher, or distributor makes no representations about the suitability, nor assumes any responsibilities for any real or alleged damages arising from the use, of the information contained herein. The information is provided as is without any warranty of any kind whether expressed or implied.

Patient descriptions may have been changed and kept very generic to protect their identities (not that they were guilty of anything at all, mind you).

(Table of Contents)

Chapter 1: Our Complex Eyes

You need cataract surgery right now, or you’ll go blind!

You will go blind in 20 years.

Do you really think doctors would say such things to their patients? Or, am I making this up…?

Truly, many people may not know much about their normal eye functions and changes with time. They may not know the difference between cataracts and glaucoma, or the difference between a serious eye problem and normal gradual age changes. Thus, recommendations or comments from their doctor such as noted above may cause them to make decisions not in their own best interests.

Having a better understanding of our eyes’ basic functions and normal changes, we may be able to make better decisions about our eye care, out of knowledge and not out of fear. To that end, I share a few interesting situations I’ve come across over the years as an optometrist. Some are funny and some are shocking, liken to each of us finding equivalent inside information within his or her field of work.

To understand why eye issues occur, we shall first look at some basic eye structures and functions. All the diagrams and figures are not to scale.

Eye and Camera

Why is the eye often compared to a camera? And which came first, the camera or the eye? Without a doubt, the design of the camera is based upon the design of the eye. Both the camera and the eye have a focusing system to render a sharp image, light control system to yield proper exposure, and a recording system to store images.

In this book the eye may often be compared to the film camera and film. However, it may be said that the digital camera is also similar in that the light sensors which convert images into a digital format is much like the retina, in that it is reused repeatedly like the retina without needing to be changed like camera film. For side-by-side comparisons, we draw and chart some basic parts of the eye and the camera.

Figure 1-1: The human eye and camera.

From the diagram and chart, we can understand the equivalent basic parts of the human eye and film camera. Respectively, there is the front lens element of the cornea or front camera lens; the light control diaphragm and aperture, the focus controlling lenses, the vitreous cavity or space between lens and film, the housing of the sclera or the camera body, the image detectors being the retina or film, and viewing and storage in the brain or on the print and the negative.

Figure 1-2: Eye and camera compared.

With the eye’s basic design in mind, let’s discuss some aspects and functions of each part or component of the eye, beginning at the front with the cornea.

Cornea

The cornea has five general layers. Two of these layers we shall just mention, Bowman’s and Descemet’s membranes, serve as connective tissue barriers or junctions between the other layers.

The top layer of the cornea is called the epithelium (similarly, the top layer of your skin is called the epidermis). With its abundant innervations we sense minor to major irritations or pain from scratching the eye, abrading the eye, or getting foreign matter (like dust or eyelashes) into the eye. Generally, minor injuries to the epithelium will heal quickly and leave no scars.

Figure 1-3: Corneal cross-section.

The majority of the corneal structure is composed of the central stroma. The stroma is a uniquely clear tissue made of regular and parallel collagen fiber layers (as opposed to the opaque sclera, which we shall soon discuss). However, unlike the epithelium, disease or injury to the stroma may disrupt its regular collagen arrangement, resulting in an opaque scar or mark on the cornea. And depending upon the severity of the disease or injury the resultant mark or scar may range anywhere in appearance from faint to dense.

The back layer of the cornea is the endothelium. It is mainly responsible for controlling the hydration of the cornea. Damage to the endothelium by disease, injury, or even eye surgery, may decrease the function of the endothelium resulting in increased (hydration) fluid in the corneal stroma. But excess fluid produces an edematous or swollen cornea with resultant clouding of the cornea and reduced vision due to the disruption of the regular parallel arrangement of the corneal stroma’s collagen fibers.

Aqueous and Anterior Chamber

The aqueous humor is the main fluid flowing inside the eye. The aqueous is involved in providing oxygen and nutrients to the back of the cornea, the endothelium. This is an important point for contact lens wearers to keep in mind, especially those who overwear or sleep in their contact lenses.

The anterior chamber is the fluid space between the back of the cornea and the iris. The aqueous fluid is produced by the ciliary body and its processes (structures) behind the iris. The majority of the aqueous flows forward through the pupil and into the anterior chamber. The aqueous then mainly flows out the edges of the anterior chamber through the main drainage portal called the canal of Schlemm. The junction between the anterior chamber and the canal of Schlemm is a sieve-like structure called the trabecular meshwork (a structure of interest in many aspects of glaucoma). Draining from the eye, the aqueous fluid enters into the venous portion of the circulatory system flowing to the heart.

Figure 1-4: Aqueous flow.

The delicate balance between aqueous production into the eye and aqueous outflow from the eye is of primary importance in patients with eye pressure problems (namely, glaucoma).

Iris and Pupil

The iris and the pupil control the amount of light entering the eye, like the diaphragm and the aperture of a camera. The lower the ambient lighting, as being indoors or at night time, the pupils are more open or dilated. In bright lights, the pupils will constrict. When the doctor dilates a patient’s eyes, medicine is used to pharmacologically act on the iris to temporarily widen the pupils.

As with the aperture of the camera, smaller pupils will yield a greater depth of field. Hence, folks who may need reading glasses may say that they do not need their reading glasses outdoors in the bright sunlight. In the bright sunlight, they may have tiny pupils rendering them great depth of field to see fairly well for distance and for reading.

Conversely, when the lighting is reduced at night or indoors, the iris dilates and opens the pupil like a camera opening the aperture. Thus, with dimmer lighting, the depth of field is narrower, more people complain of not being able to see as well.

Indeed, there comes a time when the depth of field created by a small pupil size may not suffice to give you good distance and reading vision. That is the time when our number of birthdays hits home, which we will discuss further in the chapter on presbyopia.

Crystalline Lens

The crystalline lens of the eye is often referred to simply as the lens. Until we reach about 40 birthdays, the lens is readily able to change its shape. The changing of the lens shape to adjust its focus is accomplished by the ciliary body’s action on fibers (called zonules) attached to the lens capsule (a clear tissue lens sac holding the actual lens). The lens focuses the light entering the eye onto the retina as the lens of a camera may change focal length to focus an image.

Hence, the ability of the lens to focus is important as we view a wide location of images, from far distance road signs to up close fine print. But the lens’ focusing ability slowly decreases with time.

The slowly decreasing focus ability of the lens is due to growth and aging. The lens is constantly growing. New lens material is constantly being added, creating layers, likened to an onion having layers upon layers. The inner layers are as old as you are. And age and other factors will bring about lens changes, as we shall discuss in the chapter on cataracts.

Vitreous

The vitreous is a gel-like material in the middle vitreous cavity (portion) of the eyeball. The vitreous has a fibrous matrix, giving it some structural shape. The vitreous plays an important role in the development of the eye.

In our younger years, the vitreous is relatively clear and free of distracting debris, having a consistency likened to cold jelly. With age that consistency normally and gradually becomes more liquefied.

This normal change of the vitreous may create several problems. One problem is that with its gradual liquefaction, debris such as dead cells, fibers, and cellular products may float and move more easily within the vitreous. We see them as distracting or annoying floaters in our vision, shadowy flies that are not real.

The body has constant cell production and demise. As you wash each day, any surface dead skin cells get washed away. In contrast, any debris or matter cannot readily leave the eye resulting in a gradual accumulation of debris or matter. Thus, the presence of floaters becomes more apparent as we age.

Another problem is that the vitreous is attached to the retina at various points. And as the vitreous moves around more freely, it will tug on its attachments to the retina. And any strain or stress on these attachments may cause you to notice flashes or unusual visual symptoms. We shall discuss these matters again in the chapter on flashes, floaters, and retinal detachment.

Retina

The retina is the complex imaging tissue of the eye, able to detect light, color, and motion. The retina consists of about ten layers of living cells, each layer handling specialized functions. And their specialized biological and neural functions and interactions are far more complex and intricate than color photographic film or the light sensor in a digital camera.

Let’s refresh our memory about camera film. As the photography world has gone digital, what was film? Basically, film was a thin light-capturing medium for recording images of the world placed in the back of the camera cavity where the camera lens would focus the images.

Black and white film had one light-sensitive layer for capturing images’ range of light in gray tones or gray scale. And color film had three light-sensitive layers for capturing the brilliant world of color. The three layers of color film would use a process of color separation, wherein each layer was sensitive to a specific range of the light spectrum. This is similar to the old color television cathode ray tubes (again, before the flat-screen digital displays) where there were three different color spectrum-responsive phosphor coatings.

Amazingly, all this is similar to the eye with its three separate color range-sensitive retinal cones. The red spectrum-sensitive cones, the green spectrum-sensitive cones, and the blue spectrum-sensitive cones. And the retina also has the black-white light-sensitive rods which are designed for low light situations. With separate light-range sensitivities, defects may occur in one or more of these groups of cells. We shall discuss this a little more in the chapter on vision genetics.

Truly, the retina may have a total light-sensitive range far greater than any given film, and maybe any current light sensor. When the retina captures the light energy photons they are translated into electrical signals. These electrical signals are further processed in the other retinal layers and forwarded to the brain for the ultimate interpretation of these signals and storage of the images.

Choroid

Underlying the retina is the choroid, the main blood vessel network supplying nutrients to the retina. It resides between the retina and the sclera. Of course, any diseases