Eye Health and Night Vision Problems - " Stephanie is a 35-year-old figure skating coach"

Case study ( 8486 views as of May 19, 2024 )

Stephanie is a 35-year-old figure skating coach who has recently noticed some difficulty driving at night when she returns from the rink after dark. She does wear eyeglasses and is up to date with her eye exams.

Stephanie visits her optometrist who performs some vision testing to assess Stephanie's symptoms. He notes that her glasses continue to provide 20/20 vision with only slight changes to her prescription. Further testing is done to see if there are any higher order aberrations (HOA's). HOA's are distortions in the eyes that can cause issues driving at night including glare and blurred vision. Significant HOA's are found in both eyes, and Stephanie is given a new distance vision prescription for eyeglasses to reduce the glare and bleeding of lights she is experiencing at night.

Stephanie would also benefit from being assessed for other eye conditions such as cataracts and macular degeneration, since this can cause HOA's and issues with night vision. Stephanie should speak with her family doctor to ensure any other health symptoms are considered, given the changes in her eye health. A registered dietitian could help Stephanie understand which foods would help her with the required vitamins and minerals to promote good eye health.

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Conversation based on: Eye Health and Night Vision Problems - " Stephanie is a 35-year-old figure skating coach"

Eye Health and Night Vision Problems - " Stephanie is a 35-year-old figure skating coach"

  • Macular degeneration is primarily considered a genetic disease, and this understanding has developed over the past decade or so. It is believed that much of the predisposition to macular degeneration is determined at birth, and there is limited control over it. However, there is evidence suggesting that certain behavioral factors, such as smoking and excessive exposure to sunlight or UV rays, may modify the genes associated with macular degeneration and increase the risk for specific gene-related problems. Therefore, it is important to be aware of these factors. If you have a strong family history of macular degeneration and are interested in knowing your genetic risk factors, testing can be done to provide that information. When you visit an ophthalmologist for an assessment of macular degeneration, your pupils will be dilated using drops. It is recommended to arrange for someone to drive you home afterward. It may also be helpful to bring sunglasses with you to shield your eyes from discomfort after the examination. During the assessment, you will sit at a microscope while the ophthalmologist carefully examines your eyes for any signs of macular degeneration, such as changes in the macula or hemorrhaging. Based on the findings, further tests may be conducted to confirm the diagnosis. The most common and traditional test is a fluorescein angiogram. This involves injecting a dye into your arm and taking photographs of your eye for several minutes to evaluate blood flow and examine the structures at the back of the eye in more detail. This test can be complemented by an optical coherence tomography (OCT), which uses laser technology to capture detailed images of the layers in the back of your eye. A more recent test called auto-fluorescence involves a bright blue flash of light. It assesses the health of the pigment layers beneath the retina and aids in diagnosing and monitoring the progression of dry macular degeneration. After the assessment and initial examination, your physician will have a good understanding of whether further testing is necessary. In most cases, the additional tests can be performed and interpreted on the same day, and treatment can often be initiated promptly. If you have more questions or concerns regarding the diagnosis or causes of macular degeneration, it is recommended to consult with your family physician. If they are unable to provide the answers you seek, they can refer you to a local ophthalmologist who can provide further information and address your specific concerns.
  • For diabetic retinopathy, laser treatment, which is the conventional treatment, is used for multiple reasons. There is laser that is done around the edges of the eye, and what you can expect is that you’ll put in a machine called a slit lamp—very much the same as the machine you have your eyes examined in. So something that’s familiar to most people if they’ve had an eye exam.
    • Have you previously had eye surgery, such as LASIK or PRK?
    • How important is reducing your dependency on eyeglasses or contacts after cataract surgery?
  • Diabetic retinopathy, which can cause permanent damage to the eyes, can be controlled by first of all controlling the sugars. The best way to control sugars, you need to do three things: not just simply take your medication, that’s one thing. You take the medications the doctor prescribes. Some people think that’s enough—if they take the medications they’re fine.
  • An eye disease in which increased pressure in the eyeball causes damage to the optic nerve and gradual loss of sight. People with diabetes are at higher risk of developing glaucoma.
    • Macular degeneration is primarily a genetic disease, and this understanding has emerged more prominently in the past decade or two. Many cases of macular degeneration are believed to have a genetic predisposition that is determined at birth, so there may be limited control over its development. However, certain behavioral factors like smoking and exposure to sunlight or UV rays may modify the genes associated with macular degeneration, potentially increasing the risk for specific types of gene problems. If you have a strong family history of macular degeneration and wish to know more about your genetic risk factors, there are tests available for assessing these factors. To assess macular degeneration, you will need to visit an ophthalmologist for an examination, which typically involves dilating your pupils with drops. It is advisable to have someone accompany you to drive you home afterward, and wearing sunglasses can help with comfort following the examination. During the examination, your ophthalmologist will carefully examine your eyes, looking for any changes, hemorrhaging, or other signs related to macular degeneration. Based on the findings, additional tests may be conducted to confirm the diagnosis. The most common and traditional test is a fluorescein angiogram, which involves injecting a dye into your arm and taking photographs of your eye to assess blood flow and examine the back of the eye in detail. This test may be supplemented by an optical coherence tomograph, which provides laser images of the layers in the back of the eye, offering additional information. Another test called auto-fluorescence uses a bright blue flash of light to evaluate the health of the pigment layers beneath the retina. This test aids in diagnosing the dry form of macular degeneration and monitoring its progression. After the assessment and initial examination, your physician will have a good sense of whether further testing is necessary. In many cases, the testing can be performed and interpreted on the same day, and treatment may also be initiated on the same day, depending on the logistics of the clinic. The diagnosis and treatment processes for macular degeneration can often be bundled together to provide timely and comprehensive care. If you have additional questions or concerns about macular degeneration, it is recommended to consult with your family physician. If they are unable to address all your inquiries, an ophthalmologist will be able to provide further information and guidance.
    • Are you bothered by glare or halos from lights while driving at night (for example, from oncoming headlights or streetlamps)?
  • Why is there so much talk about night vision problems and glare after surgery? This used to be more of a concern in the past. Current excimer laser treatments using wavefront-guided ablations have diminished the risks of glare, halos and reduced contrast sensitivity.
    • Do you have any other eye conditions besides cataracts (for example, glaucoma or macular degeneration)?
  • Is there an age where night vision problems occur and what are the signs to watch for ?
    • I don't know about anyone else but after 50 hit me hard at night driving.
  • What is the most common cause for eye issues ? Is there a way to avoid this by eating certain food or doing eye exercises ?
    • There may come a time when the treatments slow down, or you may not need treatment for months at a time.
    • I have never heard of the right foods but it would be interesting to ask a nutritionist. As for exercising my son does exercises for his eyes to help him focus on a target.
  • Vitamin A is the biggest nutrient to consider when it comes to eye health. Vision impairment, specifically night vision, is commonly the first sign of deficiency. As mentioned, it would be worth seeing a Registered Dietitian to ensure Vitamin A is not lacking in Stephanie's diet. If her diet includes red/orange/yellow vegetables and/or fortified milk or milk alternatives, deficiency is unlikely but a consultation would be worthwhile!
    • If you're getting intravitreal injections you don't need regular eye exams.
    • Its like the old wives tale about eating carrots. They are very high in vitamin A so do help your eyesight
  • Are higher order aberrations (HOA's) easily noticed by the patient experiencing them? I'm curious as to whether Stephanie noticed halos or anything in her field of vision, or if her symptoms were more vague (i.e. bleeding/glaring headlights at night) and the HOA's contributed to this?
    • I'm also curious as to whether the prescription she received for the HOA's was in addition to the slight change in her normal prescription ? Or if she now requires two pairs of glasses ?
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