1. Maintaining Healthy Eyes Robert C. Arffa, M.D. Ophthalmic Specialists

2. How Often To Have an Eye Exam Many people want to know how often they should have their eyes examined. The answer depends on your age, medical background and risk factors for disease.

3. Children Screening for eye disease by trained personnel — Eye doctor, pediatrician or trained screener Ages Newborn to 3 months 6 months to 1 year 3 years (approximately) 5 years (approximately)

4. Adults Comprehensive medical eye exam by an Eye doctor Once between age 20 and 39 Age 40 to 64, every two to four years Age 65 and older, every one to two years

5. Increased Risk for Eye Disease Developmental delay Premature birth Personal or family history of eye disease

6. Increased Risk for Eye Disease African-American heritage (increased risk for glaucoma) Previous serious eye injury Use of certain medications (plaquenil) Certain diseases that affect the whole body (such as diabetes or HIV infection)

7. Dry Eye Some people do not produce enough tears or the appropriate quality of tears to keep the eye healthy and comfortable.

8. Tear Production slow, steady rate and is responsible for normal eye lubrication constantly produced by a healthy eye Another mechanism produces large quantities of tears in response to eye irritation or emotions.

9. Symptoms stinging or burning eyes Scratchiness stringy mucus in or around the eyes excessive eye irritation from smoke or wind excess tearing difficulty wearing contact lenses.

10. What Causes Dry Eye? We don’t know Tear production normally decreases as we age. Women are most often affected, especially after menopause. Sjogren's syndrome: dry eyes, dry mouth and arthritis

11. Medications that can reduce tears diuretics beta-blockers antihistamines sleeping pills medications for "nerves“ pain relievers.

12. Treatment A rtificial tears Preservative-free if you are sensitive to the preservatives in artificial tears. If you need to use artificial tears more than every two hours You can use the tears as often as necessary — once or twice a day or as often as several times an hour. Restasis

13. Conserving the Tears Punctal plugs Preventing evaporation Humidifier Wrap-around glasses

14. Glaucoma — The Sneak Thief of Sight If you're one of the 1 million Americans who have been diagnosed with glaucoma... Consider yourself lucky! vision loss from glaucoma can be prevented if it is caught and treated in time

15. Glaucoma – Sneak Thief of Sight affects 2.2 million Americans Half have no symptoms and, therefore, do not know they have the disease glaucoma is one of the leading causes of preventable blindness in the United States, and the single most common cause of blindness among African- Americans

16. Risk Factors Over age 50 African American over age 40 Family history of glaucoma Past serious eye injury Other health conditions, such as diabetes

17. Detection of Glaucoma The only way to detect glaucoma is by examination by an eye doctor Intraocular pressure Optic nerve Field of vision

18. Examination for Glaucoma Applanation tonometry

19. Examination for Glaucoma Optic nerve

20. Examination for Glaucoma Visual Field

21. Treatment of Glaucoma Eyedrops Surgery Laser Provide alternate outflow mechanism Almost always can preserve sight

22. What are floaters? small specks or clouds moving in your field of vision often see them when looking at a plain background, like a blank wall or blue sky Floaters can have different shapes: little dots, circles, lines, clouds or cobwebs.

23. Floaters Floaters are actually tiny clumps of gel or cells inside the vitreous, the clear jelly-like fluid that fills the inside of your eye

24. Flashing lights twinkling lights lightning streaks present even if you close your eyes can appear off and on for several weeks or months

25. What causes floaters? As you age the vitreous gel may start to thicken or shrink, forming clumps or strands inside the eye Also, the vitreous gel pulls away from the back wall of the eye, causing a posterior vitreous detachment

26. What causes flashing lights? Flashes are the vitreous tugging on the retina

27. Posterior vitreous detachment is more common : If you are nearsighted If you have undergone cataract operations If you have had inflammation inside the eye

28. Can floaters be serious? The retina can tear if the shrinking vitreous gel pulls away from the wall of the eye A torn retina is always a serious problem, since it can lead to a retinal detachment

29. You should see your ophthalmologist as soon as possible if: even one new floater appears suddenly you see sudden flashes of light If you notice other symptoms, like the loss of side vision

30. Floaters - course Floaters can get in the way of clear vision, which may be quite annoying, especially if you are trying to read You can try moving your eyes, looking up and then down to move the floaters out of the way Many of them will fade over time and become less bothersome

31. Migraine flashes of light that appear as jagged lines or "heat waves" in both eyes, often lasting 10-20 minutes can occur without a headache

32. The Age-Related Eye Disease Study (AREDS) conducted at 11 major medical center research facilities around the country looked at the effects of zinc and antioxidants on cataracts and age- related macular degeneration (AMD)

33. What Were the Results? High doses of antioxidants and zinc can reduce the risk of vision loss from advanced AMD patients with intermediate AMD or advanced AMD in one eye but not the other

34. What Were the Results? Supplements do not provide significant benefit to patients with minimal AMD These nutritional supplements do not prevent the initial development of AMD, nor do they improve vision already lost to AMD Nutritional supplements do not seem to prevent cataracts or to keep them from getting worse over time

35. Should I Take Nutritional Supplements? If you have intermediate (or advanced) AMD in one eye only

36. Supplement Dosages Vitamin C 500 mg Vitamin E 400 IU Beta-carotene 15 mg (approximately 25,000 IU) Zinc 80 mg, as zinc oxide Copper 2 mg, as cupric oxide (copper should be taken with zinc, because high-dose zinc is associated with copper deficiency.)

37. Cautions It is very important to talk with your physician before taking large-dose supplements and to follow his or her dosage recommendations carefully. Some supplements may interfere with each other or other medications. Smokers and ex-smokers probably should not take beta-carotene, as studies have shown a link between beta-carotene use and lung cancer among smokers.

38. Custom LASIK Excimer laser correction of Myopia (nearsightedness) Hyperopia (farsightedness) Astigmatism

39. Excimer laser Precise evaporation of corneal tissue to reshape the surface Changes the focusing power of the cornea

40. LASIK procedure Create a partial thickness flap in the corne

41. LASIK procedure Lift and retract the flap

42. LASIK – laser ablation

43. LASIK Procedure

44. Customized procedure