Eyecare Instructions for people using computers and computer professionals

Spending long hours in front of television or computers is part of peoples life today. Especially if you are a computer professional, there is usually no escape from it. This causes many eyes and vision related problems in future. Here are some useful eye care tips for computer users.

• After every 20 to 30 minutes of work, look at a distant away object and blink several times. This will help in better focusing
• Blink frequently. People tend to reduce blink rate while working on computer. This can lead to dry eyes. Try to blink 12 to 15 times every minute.
• Exercise you eyes at frequent intervals. Eye exercise is simple. All you need to do is just blink several times, then close your eyes and role them in clockwise and anti clockwise direction. While doing this, inhale and exhale slowly and open your eyes slowly after doing this.
• Rub your palms against each other till them become warm. Cover your eyes with your warm palms for about a minute. Palming is another great way to relax and soothe your eyes.
• Splashing water on you face during breaks can keep you refreshed. This also helps in cooling your eyes.
• A few minutes of walk during breaks will refresh your body and mind. It is also good for your eyes as walking increases blood supply to your eyes.
• Fix an anti glare screen on to your monitor or use anti glare glass while working on computers. Also position the monitor and lights in such a manner that glare from the screen is minimum.

10 Tips to Protect Your Eyes

by Marin Gazzaniga for MSN Health & Fitness

Medically Reviewed By: Bradley V. Davitt, M.D.

We go to the gym, abstain from chocolate cake and drink gallons of water all in the name of good health. But what can we do to protect those most valuable organs—our eyes? We talked to ophthalmology experts to find out what we should be doing to preserve the oft-neglected eyes.

“Eyes are delicate and precious,” says Dr. Andrew Iwach, spokesperson for the American Academy of Ophthalmology (AAO). “Just a touch of maintenance will keep them going for years.”

1. Regular checkups. When was the last time you had an eye exam? If it was at 3 years of age, chances are you’re due. The AAO recommends an eye exam before 5 years of age to check for childhood problems like amblyopia (sometimes called lazy eye) or strabismus (misaligned eyes), and then on an as-needed basis (vision problems or injuries) up to 19 years of age. One exam in your 20s, and two in your 30s can identify problems which may benefit from early treatment. While it’s normal for vision to change with age, serious eye problems like glaucoma and macular degeneration (deterioration of retina that causes loss of detail vision) can be treated if detected early. So step up the eye exams after 40 years of age to every two to four years; after age 65, every one to two years. Anyone with diabetes, a family history of eye problems or African-Americans over the age of 40 should check with their doctor about more frequent visits. (African-Americans may need more frequent checkups in middle age because of an increased risk for glaucoma.)
   
   
2. SPF for the eyes. Sunglasses don’t just prevent crows’ feet from squinting, they also block harmful ultraviolet and other rays than can play a role in the development of cataracts and macular degeneration. Fair-skinned caucasians are at the greatest risk for the latter. Be sure your sunglasses have 100 percent UV protection. “The blue wavelengths--violet and blue--hit the retina,” says Dr. Lylas Mogk, co-author of Macular Degeneration: The Complete Guide to Saving and Maximizing Your Sight. “The best filters against blue are in the amber-orange-brown range of commercial sunglasses.” You should always wear sunglasses when outside (and not just in the summer) but especially in high glare areas around snow or water. A wide-brimmed hat is great for blocking rays—even if it counteracts the cool of your aviators.
   
   
3. Eye protection. Sunglasses aren’t the only protective eyewear you should don. Obviously anyone working around construction, manufacturing—any job with machinery and flying particles—must wear eye protection. But even when you’re working around the house, you should guard your eyes. “Even while hanging a picture, plaster or a nail can fly into your eye,” warns Dr. Iwach. Any hardware store sells inexpensive clear plastic eye protection.
   
   
4. Contact care. “Contacts are a great tool, but they come with responsibility,” says Dr. Iwach. Be sure to have a pair of glasses with a recent prescription so that if you get any irritation you can change over. Wearing your contacts when your eyes are irritated can turn a simple problem (irritation) into a significant problem (a corneal ulcer). Make sure you care for the lenses properly. “I can’t believe people who pop a lens in their mouth and then put it in their eye. That is not a good idea unless you want to be seeing the eye doctor a lot,” warns Dr. Iwach. Make sure your solutions aren’t expired, keep your contacts clean—and keep them out of your mouth.
   
   
5. Eye candy. Are carrots really good for your eyes? “Carrots are rich in vitamin A, which the retina needs,” says Dr. Lylas Mogk. “But we’re not in danger of having vitamin A deficiencies.” Green leafy veggies like kale, collard and mustard greens, and spinach are good for the eyes because they contain lutein, which studies indicate can reverse symptoms of macular degeneration.  And getting plenty of omega-3 fatty acids from fish and flax can help prevent dry eyes. But avoid omega-6 fatty acids, which is tricky in the American diet. Omega-6s are in vegetable oils. “There are very few processed or packaged foods that don’t have vegetable oils,” notes Dr. Mogk. “And the omega-6s counteract the good omega-3s.”
   
   
6. Eye lube. As we age, we experience more dry eye symptoms. “The biggest reason people have dry eyes is that the tear film doesn’t have the right consistency of water, mucus and oil,” says Dr. Mogk. The oil part of your tears comes from little glands at the margin of your eyelids. As you blink, oil is supposed to coat the eyes. But if this coating is insufficient, the tear film evaporates and eyes feel dry. This triggers reflex tearing, which is why your eyes water when they get dry and irritated. Omega-3 helps with this. Also, heat and air conditioning can cause dry eyes, especially if you sit near a vent or fan unit. Make sure that the vent in your car isn’t blowing toward your face.
   
   
7. Quit smoking. Need another reason to quit smoking? You got it: Smoking increases the risk and accelerates the development of cataracts, macular degeneration and optic nerve damage. “I’d be more afraid of losing your vision than lung cancer,” says Dr. Iwach.
   
   
8. Eye strain. Any focused work means you don’t blink as frequently. And all the computer work and internet surfing can take a toll. It’s always good to take a break from activities which involve prolonged staring. And artificial tears can help reduce eye irritation, lubricating the eyes to help you work longer.
   
   
9. Talk to your family. Eye problems are often hereditary. If you are diagnosed with glaucoma or another eye condition, share that information with your immediate and extended family. “It’s a way to give the gift of vision for the rest of their life,” notes Dr. Iwach. The sooner people are diagnosed, the more that can be done to treat and prevent further damage.
   
   
10. Stay healthy. We’ve already seen how eating right (veggies over processed foods) helps with eye health. Exercise increases circulation, which can lower pressure within the eyes, which helps with those who have glaucoma. Getting regular overall physicals may lead to early detection of diseases like diabetes or other systemic conditions that can lead to eye problems. And most important, if something bothers you or feels wrong, get it checked out. As Dr. Iwach puts it, “You get your oil checked regularly, so get your eyes checked regularly.”

My Appointment at SNEC

It was my second visit to SNEC, and this time I had waited relatively shorter to be seen by Dr. Lim Li.  I had waited only an hour plus. After my orb scan, a consultant had attended to me first.  She had assured me that for my case, it's relatively mild and should not be affecting me too much except for the poor vision.  After that, Dr. Lim Li came and said the same thing.  She told me that Keratoconus would usually stops developing when the patient becomes 40, and she wouldn't worry so much about me as I'm already 36.  Only 4 more years to go.  The orb scan scan shows that my corneal had become thinner by 5 nm.  It should be quite save for me not to take any actions at all.

Hmph.  That's quite different from Dr. Anna Tan, another Eye Specialist with NUH Eye Surgery Clinic.  She told me that I should be wearing the hard lenses to see if it could slow down the progression of the keratoconus, and I ought to be thinking if I wanted to do the Cross-linking procedures.

Anyway, since Dr. Lim Li was the expert in Keratoconus and Cross-linking, I decided to heed her advice.  Will be seeing her in 18 months, and in the meantime, I'd canceled my appointment with NUH Eye Surgery Center.

Wish me good luck!

Ps:  Anyone any idea if Keratoconus really stops progressing after 40 years of age?  Or any comments on SNEC, NUH Eye Surgery Center, Dr. Lim Li, and Dr. Anna Tan?  Do feel free to drop a comment below.  Thanks.

More Resources on Keratoconus and Treatment

OTHER PROCEDURES / CONDITIONS
		Your Guide to Keratoconus (178kb) Factsheet explaining the condition Keratoconus
		Your Guide to CXL (216kb) Collagen Cross Linking or C3R or 3CR - explained
		Your Guide to Intacs  (232kb) How Intacs Intracorneal rings help Keratoconus  If you have more resources to share, please post them in the comments below.  Thanks.

My Eye Specialist

Dr Lim Li Singapore National Eye Centre Cataract and Comprehensive Ophthalmology Service Senior Consultant MBBS, FRCS(Ed), MMed(Ophth), FAMS Dr Lim Li is a senior consultant ophthalmologist at the Singapore National Eye Centre with sub-specialist training in corneal and external eye disease.  She completed her medical  and general ophthalmic training in Singapore  and her corneal fellowship training both in Singapore and Australia. Her interests include cataract surgery, management of corneal and external  eye diseases, corneal transplantation surgeries, refractive surgeries including LASIK and medical contact lenses.  She has published several scientific papers in international peer-reviewed journals, written book chapters  and has participated as invited speaker at local and international meetings.  She is actively involved in undergraduate and postgraduate ophthalmology education and holds an appointment as a clinical senior lecturer at the Yong Loo Lin School of Medicine, National University of Singapore, Her current research interests include the surgical treatment options for keratoconus.  She is also the deputy director of the Singapore Eye Bank and Honorary Secretary of the College of Ophthalmologists, Academy of Medicine, Singapore.

Professional Appointments & Memberships

* Clinical Lecturer, National University of Singapore
* Deputy Director, Singapore Eye Bank
* Honorary Secretary, Chapter of Ophthalmologists, College of Surgeons, Academy of Medicine
* Secretary General, Asia-Pacific Contact Lens Association of Ophthalmologists
* Member, American Society of Cataract and Refractive Surgery
* Member, Singapore Society of Ophthalmology
* Member, Singapore Medical Association




Selected Publications, Research Interest & Trials

Publications:

1. Comparison of Argon Laser Iridotomy and Sequential Argon-YAG Laser Iridotomy in Dark Irides. L Lim, SKL Seah, ASM Lim. Ophthalmic Surgery and Lasers 1996; 27(4): 285-288.
2. Accurate Intraocular Pressure Measurements in Contact Lens Wearers. L Lim, TP Ng, DTH Tan. The CLAO Journal 1997; 23(2): 130-133.
3. The Surgical Management of an Advanced Pterygium Involving the Entire Cornea. CC Yip, L Lim, DTH Tan. Cornea 1997; 16(3): 365-368.
4. Changing Indications for Penetrating Keratoplasty: A Newly Developed Country’s Experience. TY Wong, C Chan, L Lim, TH Lim, DTH Tan. Australian and New Zealand Journal of Ophthalmology 1997; 25: 145-150.
5. Contact Lens Wear After Excimer Laser Photorefractive Keratectomy – Comparison Between Rigid Gas Permeable And Soft Contact Lenses. L Lim, KL Siow, JSC Chong, DTH Tan. CLAO Journal 1999; 25(4): 222-227.
6. Conjunctival Rotation Autograft for Pterygium, an Alternative to Conjunctival Autografting. A Jap, C Chan, Li Lim, DTH Tan. Ophthalmology 1999; 106: 67-71.
7. Randomised Clinical Trial of a New Dexamethasone Delivery System (Surodex) for Treatment of Post-Cataract Surgery Inflammation. DTH Tan, SP Chee, L Lim, ASM Lim. Ophthalmology 1999; 106: 223-231.
8. Antimicrobial Susceptibility of 19 Australian Corneal Isolates of Acanthamoeba. L Lim, DJ Coster, PR Badenoch. Clinical and Experimental Ophthalmology 2000; 28(2): 119-124.
9. Reverse geometry Contact Lens Wear After Photorefractive Keratectomy, Radial Keratotomy, or Penetrating Keratoplasty. L Lim, KL Siow, R Sakamoto, JSC Chong, DTH Tan. Cornea 2000; 19(3): 320-324.
10. Penetrating Keratoplasty for Keratoconus: Visual Outcome and Success. L Lim, K Pesudovs, DJ Coster. Ophthalmology 2000; 107: 1125-1131.
11. Therapeutic Use of Bausch & Lomb PureVision Contact Lenses. L Lim, DTH Tan, WK Chan. CLAO Journal 2001; 27(4): 179-185.
12. Late onset post-keratoplasty astigmatism in patients with keratoconus. Lim L, Pesudovs K, Goggin M, Coster DJ. Br J Ophthalmol 2004 Mar 88(3): 371-6.
13. Laser in situ keratomileusis treatment for myopia after acanthamoeba keratitis. Lim L, Wei RH. Eye Contact Lens 2004 April; 30(2): 103-4.
14. Laser in situ keratomileusis treatment for myopia in a patient with partial limbal stem cell deficiency. Eye Contact Lens 2005 Mar, 31(2): 67-9.
15. Juvenile xanthogranuloma of the corneo-scleral limbus. Lim-I-Linn Z/Li Lim. Cornea 2005 Aug 24(6): 745-7.
16. Evaluation of Keratoconus in Asians: Role of Orbscan II and Tomey TMS 2 Corneal Topography. Li Lim/RH Wei/WK Chan/ DTH Tan. AmJ Ophthalmol 2007; 143: 390-400.
17. Evaluation of orbscan II corneal topography in individuals with myopia. RH Wei/Li Lim/ WK Chan/ Donald TH Tan. Ophthalmology 2006; 113: 177-183.
18. Higher order ocular aberrations in eyes with myopia in a Chinese population. Wei RH, Lim L, Chan WK, Tan DT. J Refract Surg. 2006 Sep; 22(7): 695-702.
19. Evaluation of Higher order ocular Aberrations in patients with keratoconus. Li Lim/Wei RH/ Chan WK/ Donald Tan. In press.
20. An outbreak of fusarium keratitis associated with contact lens wear in Singapore. Khor WB/ Aung Tin/Saw SM/Wong TY/Tambyah PA/ Tan AL/Beuerman R/Lim L/Chan WK/Heng WJ/Lim J/Loh RS/Lee SB/ Tan DT. JAMA 2006 Jun 28; 295(24): 2867-73.


Contact Details
Tel: +65 62277255
Fax: +65 62277290
Email: NA
Department’s Website: http://www.snec.com.sg/clinical/corneal.asp and http://www.snec.com.sg/clinical/cataract.asp

Appointment with this Doctor
SNEC enquiries email: feedback@snec.com.sg

COLLAGEN CROSSLINKING (CXL) – to stop the progression of Keratoconus

The most promising technology for treating Keratoconus called collagen cross linking (CXL) with UVA is currently being introduced into the United States under experimental protocols in Clinical Trials. This treatment, which has been used in Europe for eight years, now is undergoing Phase 1 FDA clinical trials in the United States. It has been demonstrated to be safe and effective if performed, with the epithelium removed, and has the potential to stop the progression of Keratoconus. This treatment is recommended for individuals with progressive Keratoconus or Ectasia following LASIK to stabilize the cornea. It can be performed with our without INTACS. Even though enrollment for this procedure for the FDA trials is closed, our center is one of the only centers in the United States that has received and I.D.E. (Investigational Device Exemption) from the FDA to treat patients with this procedure and we are currently enrolling patients under an Investigational protocol.

This protocol allows us to enroll patients for the next 5 years and can be viewed on the government website – www.clinicaltrials.gov. Since this treatment is still regarded as experimental in the United States it should only be done with Institutional Review Board (IRB) approval, so that patients can adequately be protected.

The procedure, which is painless, is as follows. The top layer of the cornea is removed under local anesthesia. Vitamin drops are soaked into the cornea until they penetrate the entire corneal and evidence of penetration into the anterior chamber of the eye is demonstrated by slit-lamp evaluation. Once this is confirmed the patient’s eye is put under a specialized lamp, which emits UV light at a predetermined wavelength for approximately 30 minutes. During this process the cross links, which link the fibers of the cornea, are increased thereby stiffening the whole cornea. A bandage contact lens is then put on the eye and patients are given antibiotics and anti-inflammatory drops and follow up on a regular basis with their physicians for several months.  Many patients notice an improvement in their vision at 3 to 6 months and European studies suggest that only 5-8% of patients need to be retreated.

Click here for a review of the literature on this procedure read this recent article by Dr. Rabinowitz.

Click here to see another video on the procedure

More Resources on Keratoconus

Here are a list of Resources that I visit to learn more about Keratoconus, and how to manage it.

• The Keratoconus Center
• National Keratoconus Foundation
• Keratoconus - wikipedia
• All About Vision

If you have more resources to share, please post them in the comments below.  Thanks.

Keratoconus Treatment

My options for treatment were limited.  I can either choose to wear the Rigid Gas Permeable contact lens to correct my vision, or I can do the Corneal Cross-linking (A new treatment).  The rest of the treatment options can be found below.

In the mildest form of keratoconus, eyeglasses or soft contact lenses may help. But as the disease progresses and the cornea thins and becomes increasingly more irregular in shape, glasses and soft contacts no longer provide adequate vision correction.

Treatments for moderate and advanced keratoconus include:

Gas permeable contact lenses. If eyeglasses or soft contact lenses cannot control keratoconus, then rigid gas permeable (RGP or GP) contact lenses are usually the preferred treatment. Their rigid lens material enables GP lenses to vault over the cornea, replacing its irregular shape with a smooth, uniform refracting surface to improve vision.

Normal eye vs. eye with small amount of keratoconus. The keratoconic cornea bulges slightly, for a more cone-shaped surface. (Artist's re-creation of keratometry images.)

But RGP contact lenses can be less comfortable to wear than soft contacts.

Also, fitting contact lenses on a keratoconic cornea is challenging and time-consuming. You can expect frequent return visits to fine-tune the fit and the prescription, especially if the keratoconus continues to progress.

"Piggybacking" contact lenses. Because fitting a gas permeable contact lens over a cone-shaped cornea can sometimes be uncomfortable for a person with keratoconus, some eye care practitioners advocate "piggybacking" two different types of contact lenses on the same eye.

For keratoconus, this method involves placing a soft contact lens, such as one made of silicone hydrogel, over the eye and then fitting a GP lens over the soft lens. This approach increases wearer comfort because the soft lens acts like a cushioning pad under the rigid GP lens.

Your eye care practitioner will monitor closely the fitting of "piggyback" contact lenses to make sure enough oxygen reaches the surface of your eye, which can be a problem when two lenses are worn on the same eye. However, most modern contacts — both GP and soft — typically have adequate oxygen permeability for a safe "piggyback" fit.

ClearKone hybrid contact lenses. (SynergEyes Inc., Carlsbad, Calif.) These hybrid contact lenses combine a highly oxygen-permeable rigid center with a soft peripheral "skirt." The ClearKone version was designed specifically for keratoconus and vaults above the eye's cone shape for increased comfort.

The manufacturer says hybrid contacts provide the crisp optics of a GP lens and wearing comfort that rivals that of soft contact lenses.

ClearKone hybrid lenses are available in a wide variety of parameters to provide a fit that conforms well to the irregular shape of a keratoconic eye.

Scleral and semi-scleral lenses. Larger diameters found in these gas permeable (GP) lenses enable edges to rest on the eye's white sclera. Scleral lenses cover a larger portion of the sclera, whereas semi-scleral lenses cover a smaller area.

Because the center vaults over the irregularly shaped cornea, this lens doesn't apply pressure to the eye's cone-shaped surface and feels more comfortable. These types of lenses also are more stable than conventional contact lenses, which move with each blink because they cover the cornea only partially.

One example of a scleral lens is the Boston Scleral Lens Prosthetic Device (BSLPD). This cone-shaped device resembles a large contact lens and works partly by maintaining a "pool" of fluid on the eye's surface through which light rays pass and are bent to achieve proper focus.

The BSLPD also fills in a highly irregular eye surface with fluid to help achieve proper focus.
To qualify for the BSLPD, you must have a severe, unusual or otherwise untreatable condition.
In cases of financial need, the non-profit Boston Foundation for Sight providing the lens will help subsidize or pay outright the $7,600 needed for lenses and fittings for both eyes. The price of a lens and fitting for one eye is $5,000.

The BSLPD also has demonstrated effectiveness as a treatment for severe dry eye.

Intacs. (Addition Technology, Des Plaines, Ill.) Intacs, or corneal inserts, received FDA approval for treating keratoconus in August 2004. These tiny plastic inserts are placed just under the eye's surface in the periphery of the cornea and help re-shape the cornea for clearer vision.

Intacs may be needed when keratoconus patients no longer can obtain functional vision with contact lenses or eyeglasses.

Several studies show that Intacs can improve the best spectacle-corrected visual acuity (BSCVA) of a keratoconic eye by an average of two lines on a standard eye chart. The implants also have the advantage of being removable and exchangeable. The surgical procedure takes only about 10 minutes.
Intacs might delay but can't prevent a corneal transplant if keratoconus continues to progress.

Corneal cross-linking. This non-invasive procedure strengthens corneal tissue to halt bulging of the eye's surface in keratoconus. In the United States, FDA clinical trials for corneal collagen cross-linking (CXL) began in early 2008.

With CXL, the outer portion of the cornea (epithelium) is removed to allow application of riboflavin, a type of B vitamin, which then is activated with UV light. Another investigational method of strengthening the cornea, known as transepithelial corneal cross-linking, is performed with the corneal surface left intact.

Early results showing benefits of this method have been promising. In 2008, University of Siena researchers in Italy reported positive outcomes in all 44 eyes that were followed for three years after treatment with CXL.*

Other researchers have concluded that this simple treatment might reduce significantly the need for corneal transplants among keratoconus patients. Corneal cross-linking also is being investigated as a way to treat or prevent keratoconus-like complications following LASIK or other vision correction surgery.

Research involving a combination of corneal cross-linking with Intacs implants (see above) also has demonstrated early promising results for treating keratoconus.

Topography-guided conductive keratoplasty. While more study is needed, early results of a small study involving topography-guided conductive keratoplasty (CK) show this procedure might help smooth irregularities in the corneal surface.

This treatment uses energy from radio waves, applied through tiny probes, to reshape the eye's surface. A topographic "map" created through imaging of the eye's surface helps create individualized treatment plans.

In October 2010, the American Journal of Ophthalmology reported that 15 of 21 keratoconic eyes treated with topography-guided CK achieved more normal corneal symmetry.

Corneal transplant. Some people with keratoconus can't tolerate a rigid contact lens, or they reach the point where contact lenses or other therapies no longer provide acceptable vision.
The last remedy to be considered may be a cornea transplant, also called a penetrating keratoplasty (PK or PKP). Even after a transplant, you most likely will need glasses or contact lenses for clear vision

Read more: http://www.allaboutvision.com/conditions/keratoconus.htm#ixzz1EtE3I8bB

Keratoconus

I had been diagnosed with Keratoconus.  Talk about luck.  Keratoconus affects around one person in a thousand, and I'm the one person.  I have developed irregular astigmatism, and every visit to the eye doctor my eyeglasses prescription changes. *sigh*

Here's a description on Keratoconus.

Keratoconus is a progressive eye disease in which the normally round cornea thins and begins to bulge into a cone-like shape. This cone shape deflects light as it enters the eye on its way to the light-sensitive retina, causing distorted vision.  Keratoconus can occur in one or both eyes and often begins during a person's teens or early 20s.

Keratoconus Symptoms and Signs

Keratoconus can be difficult to detect, because it usually develops slowly. However, in some cases, keratoconus may proceed rapidly.

As the cornea becomes more irregular in shape, it causes progressive nearsightedness and irregular astigmatism to develop, creating additional problems with distorted and blurred vision. Glare and light sensitivity also may occur.

It's not unusual to have a delayed diagnosis of keratoconus, if the practitioner is unfamiliar with the early-stage symptoms of the disease.

What Causes Keratoconus?

New research suggests the weakening of the corneal tissue that leads to keratoconus may be due to an imbalance of enzymes within the cornea. This imbalance makes the cornea more susceptible to oxidative damage from compounds called free radicals, causing it to weaken and bulge forward.
Risk factors for oxidative damage and weakening of the cornea include a genetic predisposition, explaining why keratoconus often affects more than one member of the same family.
Keratoconus is also associated with overexposure to ultraviolet rays from the sun, excessive eye rubbing, a history of poorly fitted contact lenses and chronic eye irritation.

Read more: http://www.allaboutvision.com/conditions/keratoconus.htm#ixzz1EtCyGZ4I