Assoc. Prof. Saulius Galgauskas / Lrytas.lt archive
Our eyes are one of the most important and sensitive organs in our body. The accelerating pace of life, stress at work, the long hours of sitting in front of a computer screen and scrolling on a smartphone – these have become part of our daily routine and undoubtedly contribute to deteriorating vision. It is quite difficult to spot the first symptoms of eye diseases for yourself and ignoring them can lead to very serious health problems. On the occasion of White Cane Safety Day, we are talking to Assoc. Prof. Dr. Saulius Galgauskas, the Head of the Department for Optometry from the Institute of Health Sciences at the Faculty of Medicine, Vilnius University, about eye diseases, their diagnosis and treatment.
What signal does eye pain send to us? When should we see a doctor?
Dry, painful, watery eyes and reduced vision are just some of the symptoms of eye problems. The mildest vision impairments signalled by eye pain can be inflammation of the eye, a foreign body in the eye or ocular hypertension. However, if the eye pain persists for a few days, it is a good idea to see your GP or an ophthalmologist.
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Can you tell us more about the most common eye diseases and their symptoms? Which ones are the most dangerous?
The most common eye diseases among older people are cataracts, glaucoma and macular degeneration (Yellow Spot Disease).
Cataracts are a gradual deterioration in vision, where it becomes cloudy or blurry, despite there being no pain or redness in the eye. The only treatment for cataracts is surgery with an implantation of an artificial (intraocular) lens. The surgery is usually performed on an outpatient basis, takes about 15–20 minutes and local anaesthesia is sufficient. Different types of intraocular lenses are available: monofocal, multifocal, and lens that correct astigmatism. As each case is unique, the eye surgeon decides which type of lens to implant in consultation with the patient.
Glaucoma usually has no symptoms, which is why it is known as the silent thief of sight. The disease develops as a result of ocular hypertension. Gradually, the optic nerve is damaged, and vision is lost. The person usually does not feel increased eye pressure, which is why the disease can be overlooked. Everyone over the age of 40 should have their intraocular pressure measured at least once a year. This can be performed by your GP. Normal intraocular pressure is between 10 and 21 mmHg. Of course, the diagnosis of glaucoma cannot be made on the basis of high intraocular pressure alone, but it will provoke a number of additional eye tests: perimetry (measures the visual fields), pachymetry (measures corneal thickness), gonioscopy (examines the eye’s anterior chamber angle), and optical coherence tomography (an examination of the inner structure of the eye). Only after completing all the prescribed tests, can a diagnosis be formulated. Glaucoma is treated throughout a patient's life. Treatment starts with eye drops and laser treatments, and surgery is performed where necessary. The aim of the treatment is to reduce the intraocular pressure to preserve the existing vision and prevent the disease from progressing further.
Age-related macular degeneration (Yellow Spot Disease) is diagnosed in event of choroidal neovascularisation in the eye (the growth of new weak blood vessels beneath the macula), retinal haemorrhages, and macular oedema. The macula is an oval yellowish area on the retina of the eye, about 2 mm in diameter, that ensures sharp vision. Usually in macular degeneration, the patient’s central vision becomes impaired, they can see a spot in front of the eye, and normally straight lines become distorted. The diagnosis requires a retinal examination using optical coherence tomography. Injections into the vitreous with vascular endothelial growth factor inhibitors (VEGFs) are used to slow down this disease. Endothelium is responsible for the fluid/moisture balance in the corneal tissue.
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What are the most common eye diseases among young people and children?
For children, it is probably not eye diseases but refractive errors such as near-sightedness and far-sightedness that are most relevant. Then, for young people who work a lot at the computer, they can suffer from dry eye syndrome and inflammatory diseases of the conjunctiva (a thin, transparent membrane that extends from the eyelids to the limbus of the eye) – commonly called conjunctivitis (which can be viral, bacterial, chlamydial, allergic, or reactive).
Is it true that eye diseases are developing earlier? I.e. younger and younger people are diagnosed with eye conditions?
It's hard to say whether eye diseases are affecting more people at a younger age, but it is a fact that the number of near-sighted people is increasing. The two-year pandemic period, when people were working and studying from home and sitting in front of computers, contributed significantly to this.
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I’ve heard that near-sightedness is referred to as the eye pandemic... What is near-sightedness? What are the factors that predispose a person to having it?
Near-sightedness is a refractive error of the eye, where light rays that pass through the eyeball form an image in front of the retina, resulting in blurred distance vision and requiring corrective measures such as glasses or contact lenses. According to the WHO, there are currently around 4 billion near-signed people in the world. There is no scientific consensus on why near-sightedness occurs, but it has been shown that near-sightedness increases as the axial length of the eye increases. Therefore, for those children who are particularly prone to near-sightedness, modern spectacle lenses – defocus lenses – are used in an attempt to slow down the progression of near-sightedness as the child grows. There are also contact lenses that stop the progression of near-sightedness. Ensuring a child has outdoor activities for at least two hours every day has been shown to reduce the progression of near-sightedness by 2-3 times.
Probably the main cause of near-sightedness is intensive and prolonged work at a computer or a phone, tablet etc. In other words, intensive, close-up, screen exposure. Watching TV is a much lesser evil. The WHO recommends that children under three years of age should not be allowed to play with a phone or tablet at all, and that children aged 5-7 years should have a daily limit of two hours. They should spend as much time as possible outdoors, playing sports or games and being active. For schoolchildren, the 20/20/20 rule is recommended: taking 20-second breaks to look at objects 20 metres away every 20 minutes of screen time.
What about far-sightedness?
All children are born far-sighted (at about +3.0 dioptre). By the age of 7, the eyes become emmetropic, i.e. without dioptres. However, there are some cases of more severe far-sightedness in children. Correction of vision is then necessary, as strabismus and amblyopia (lazy eye – poor vision in one eye), can develop. By the age of three months, all babies may still have uncoordinated eye movements. However, if eye deviation or squinting is observed in older children, an eye doctor should be consulted.
What makes it possible to maintain good eyesight in general?
Good eyesight means correct work and rest balance, as well as precautionary eye and vision tests.