May 15, 2014

Dr. Kirtly Parker Jones: How are women's eyes different from men's eyes? We know that women's eyes are much more beautiful, but there may be some other differences. And what do women need to know about their family's eyes? Today on The Scope, we're going to be talking to Dr. M. E. Hartnett from the Moran Eye Center. This is The Scope from the University of Utah, and this is about eyes.

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Dr. Kirtly Parker Jones: So with us today is Dr. M. E. Hartnett from the Moran Eye Center who is a specialist, an ophthalmologist, with a very particular interest in women's eyes. Welcome this morning.

Dr. M. E. Hartnett: Thank you very much. It's nice to be here.

Dr. Kirtly Parker Jones: I would say, having taken care of women all of my professional career, that I do pay attention to women's eyes. But, in fact, women's eyes may not be the same as men's eyes in terms of the diseases. Can you talk a little bit about men's eyes and women's eyes and the differences?

Dr. M.E. Hartnett: Sure. Women tend to have certain eye conditions more often more commonly than men do. Some of these examples include dry eye, that is much more common in women. And many of the age-related eye diseases that occur in both sexes, but this is thought to be partly because women live longer than men.

Dr. Kirtly Parker Jones: What about eyes and pregnancy? I've certainly had women say, "Oh, you know, my contacts just don't work since I got pregnant."

Dr. M. E. Hartnett: Right. Those are very important issues. So it's thought, especially in the third trimester, that there may be some swelling that occurs in some of the layers of the cornea and that this may change the visual acuity. It also may change the feel of the contact lenses. There can be dry eye more commonly in pregnancy as well. One of the things to remember is if a woman is pregnant, it's probably not a good time to get refractive surgery because it may change after pregnancy, the refraction.

Dr. Kirtly Parker Jones: Refractive surgery. Tell me what that is in English.

Dr. M. E. Hartnett: So that could be something like LASIK or PRK, photorefractive surgery or keratectomy.

Dr. Kirtly Parker Jones: Well, most women are pretty careful about not having . . .

Dr. M. E. Hartnett: Right.

Dr. Kirtly Parker Jones: . . . unnecessary surgical procedures when they're pregnant, but that's a good thing to know. How about at menopause? Clearly, that's where my patients complain of both dry eyes and dry mouth. But tell me about some things that might happen in menopause or aging and what you think might be related to hormones and what might be related to just getting older.

Dr. M. E. Hartnett: So certainly dry eye is a big concern for women, and there's recent research that suggests it has to do also with not having as much androgens, believe or not, and some of the lines of evidence are suggesting looking for treatments related to that. But besides dry eye, age-related macular degeneration is seen in women, and this may be because women live longer than men. And in some situations, cataract may be more commonly seen in women.
So glaucoma is also another condition. It's not so much more common in women, but it is an age-related condition. And one of the things that is helpful is to know your family history and whether or not anyone in your family has had glaucoma because it does increase the risk as does aging. And it's a silent cause of vision loss.

Dr. Kirtly Parker Jones: What can women do about dry eyes? Should they just get some drops or should they throw away the drops that they've had for two years or . . .

Dr. M. E. Hartnett: Yes.

Dr. Kirtly Parker Jones: . . . how long should you keep drops? What kind of drops? Are there prescriptions for dry eyes?

Dr. M. E. Hartnett: Yes. Okay. So all these things. There are artificial tear supplements. These are just natural tears that you can buy over the counter in the drugstore. But also bathing your eyes, using lid hygiene. You know, we bathe every day, but we don't often bathe our eyelids. And so warm compresses can help to promote the blood supply to the lids and the meibomian glands, which produce an oily substance that helps to reduce the evaporation of the tears.

Dr. Kirtly Parker Jones: What about soap? We're not supposed to put soap on our eyes, are we?

Dr. M. E. Hartnett: Well, no. No, that's true, but you can use baby shampoo, and there also are individual packets that you can use to clean your eyelashes of any debris and then be sure to rinse it free.

Dr. Kirtly Parker Jones: Yeah.

Dr. M. E. Hartnett: The other thing . . . sometimes if that's not enough, there are prescriptions that can be used for dry eye. And there also are punctal plugs that can keep the tears around longer, but that you would need to see an ophthalmologist for.

Dr. Kirtly Parker Jones: Well, are there any behaviors that make dry eyes worse?

Dr. M. E. Hartnett: Yes. Whenever anybody focuses on something to read for a long period of time or on a computer screen, there can be evaporation of the tear film, and that makes a dry eye worse. So I often recommend that people use a tear supplement right before planning on, you know, to be at a computer screen or working for a long period of time and then to supplement as needed. There's some evidence that alcohol in extensive amounts can also increase the symptoms of dry eye.

Dr. Kirtly Parker Jones: Well, what should women know about their family's eyes? We know women are really in charge of their family's health. So what kinds of things would happen in their kids or in their husband, or they're often caretakers for their parents or parents-in-law. So give me some things that women should know about their family's eye health.

Dr. M. E. Hartnett: Women are often the caregivers, as you say, and so if we can educate women about not only their own eye health but everyone's eye health, we can promote better prevention of eye diseases in some cases. So for children, let's start there, I think probably one of the most important things is to promote protective eyewear in sports or any type of activity where there can be knives like carving pumpkins, or fists or balls coming at the child. So protective eyewear in all sports is very important.

Dr. Kirtly Parker Jones: How early should kids start wearing sunglasses? Babies should wear sunglasses? Five-year-olds should wear sunglasses?

Dr. M. E. Hartnett: I usually think that when a child is old enough to walk around and be outside, that might be a reasonable time. When they're babies, many times they have their eyes closed or they have some kind of shield over their head, and a hat is a very good way to reduce the amount of light going to the eyes. But sunglasses are particularly important in conditions like if you're on a ski slope. Or if you're in a boat, the water, the reflected light can also be damaging to the eyes.
As I mentioned, conditions associated with aging, age-related macular degeneration, glaucoma, cataracts, it's good to get regular eye exams at least every two years. If you have diabetes, you should be examined once a year or more frequently depending on what your ophthalmologist recommends.
It's also very important, the symptoms of retinal tear and detachment. So the retina's the tissue that lines the back of the eye. You think of the eye as a globe. So the retina lines the inside of that. If you think of a dish almost. It lines the inside of the dish. And it is very important in processing light that is focused onto it into messages that are interpreted by the brain as vision.
Symptoms of a retinal tear are light flashes. These are usually described as bright lightning bolt flashes when someone moves from a light to a dark room, and floaters, things floating around in your vision that are not really there. They can be red or black or even not as dark colored. Certainly if you have a curtain coming up or down into your visual field, that's a concern, and you should be seen right away.
Retinal detachments tend to occur with trauma. It can be trauma at any time in a life. Like if a five-year-old gets hit in the eye, a retinal detachment might be more common later in life as an adult. They also occur more commonly in families. So it's important to not just say "Well, it's just a floater," but actually to have floaters looked at.

Dr. Kirtly Parker Jones: So how often should you get an eye checkup? When someone's healthy, let's just take women and mom, how often do you think they should get their eyes checked?

Dr. M. E. Hartnett: Certainly with any symptoms of distortion or changes in visual acuity, we generally recommend about every couple of years and to be checked also for glaucoma.

Dr. Kirtly Parker Jones: Okay, now let's get to what I really want to talk about, and that is eye makeup. So tell us a little bit about the dos and don'ts of eye makeup really in critical importance for your eye.

Dr. M. E. Hartnett: Okay, I'll do my best on this. So, you know, I think for eye makeup, it's the same kind of thing that I would say for eye drops. Don't touch. You know, be careful. Think of cleanliness when you use your eye makeup. Don't use eye makeup that's a year old. You know, after a period of time, get new makeup. Clean your eyelashes at the end of the day. You can use a warm wet washcloth and just kind of clean off any of the debris or the makeup. And then in the morning, that's also helpful as a prevention or as a way of treating the symptoms of dry eye as well.
As far as eyelash extenders, there are concerns that these may also cause blockage of the meibomian glands that produce the oily substance, and so they can lead to sties and . . .

Dr. Kirtly Parker Jones: So these are the artificial lashes or these are the drops that make your eyelashes grow longer?

Dr. M. E. Hartnett: So these are the artificial lashes. The drops that make the eyelash grow were developed based on a glaucoma medication. It may lower intraocular pressure. If you use it only on your eyelashes, one of the concerns is that it can also cause staining or discoloration of the lids and also of the conjunctiva as well, so . . .

Dr. Kirtly Parker Jones: The white part.

Dr. M. E. Hartnett: Yes.

Dr. Kirtly Parker Jones: So it might make the white part turn color?

Dr. M. E. Hartnett: Darker.

Dr. Kirtly Parker Jones: Do you know how often does it happen? One in ten or one in a hundred? Have you seen very many ladies who have their sclera, the white part, get colored?

Dr. M. E. Hartnett: No, I don't. But I also . . . you know, my practice is mainly in retina, so I probably don't see that many people who use Latisse, but those are the concerns.

Dr. Kirtly Parker Jones: They all came to me, and they looked fabulous. But we should make people aware that . . .

Dr. M. E. Hartnett: That it can happen . . .

Dr. Kirtly Parker Jones: First of all, it's prescription only.

Dr. M. E. Hartnett: Right. And I don't think it's common. It's more what we read . . .

Dr. Kirtly Parker Jones: It's expensive.

Dr. M. E. Hartnett: Is it?

Dr. Kirtly Parker Jones: Yeah.

Dr. M. E. Hartnett: So it's more what we read in the literature, but it is something that can happen, that you can get pigmentation.

Dr. Kirtly Parker Jones: And eyelash extenders can, when they stick the little extra eyelashes on for a party or for a wedding or something, but people do it all the time, it make actually . . .

Dr. M. E. Hartnett: Yeah, if it's kept on for a long time, it may be associated with that.

Dr. Kirtly Parker Jones: Okay. Well, anything else women should know either about their eyes or their family's eyes?

Dr. M. E. Hartnett: You know, a lot of the things that are healthy for your eyes are healthy for your heart. So things like having a diet rich in green and yellow and orange vegetables and maybe eating fish three times a week, those things can be healthy. Avoid smoking. Smoking is bad for your eyes. It increases the risk of cataract and of age-related macular degeneration. And then to protect your eyes from light, that may be useful, but also whenever you're involved in a sport or any activity where you could have a ball or something come to your eye.

Dr. Kirtly Parker Jones: Well, I actually saw on a handout from the Moran Eye Center that fish oil as supplements may actually help dry eyes. Is that true? Do you think there's much evidence of that?

Dr. M. E. Hartnett: I'm not aware of experimental evidence that has absolutely shown that or flax oil, and I've recently asked my [inaudible 00:11:49] colleagues about that. As far as a clinical trial that was done where they had placebos and it was randomized, I don't think there's been that kind of evidence. But there's been anecdotal evidence that it may be useful. And since there's not a lot of harm to it, it may be helpful.

Dr. Kirtly Parker Jones: So protect your eyes from trauma. Protect your eyes from too much bright light. A good diet for your heart is a good diet for your eyes. And don't use old makeup. Does that sum it up?

Dr. M. E. Hartnett: I think that sounds good.

Dr. Kirtly Parker Jones: From The Scope here at the University of Utah Health Care, thank you.

Dr. M. E. Hartnett: Thank you.

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