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How Sleep Apnea Affects The Eyes

Did you know that some eye conditions are associated with sleep apnea? According to the National Sleep Foundation, more than 18 million Americans have sleep apnea, and Health Canada reports similar prevalence. It’s a sleep disorder where people stop breathing — often multiple times per night — while sleeping.

If you have sleep apnea: it tends to take longer for your tears to be replenished, you’re more likely to have ocular irritation, you have a higher chance of developing floppy eyelids, and you’re at increased risk for glaucoma.

What Is Obstructive Sleep Apnea?

There are different types of sleep apnea. The most common one is obstructive sleep apnea (OSA). During OSA, your airway becomes partially blocked due to relaxed muscles in your nose and throat. This causes apnea (the absence of breathing) or hypopnea (abnormally shallow, slow breathing). It’s twice as common in men, and is more likely to affect people with obesity, hypertension, diabetes or heart disease. 

What are the common symptoms of sleep apnea?

Sleep apnea occurs when the muscles in the back of your throat relax too much to allow normal breathing. These temporary breathing lapses cause lower-quality sleep and affect the body’s oxygen supply, which can lead to potentially serious health consequences. 

While snoring is a common symptom, not everyone who snores has sleep apnea. Interrupted sleep can cause excessive daytime sleepiness, fatigue, irritability or depression, headaches in the morning, difficulty concentrating and thinking, and a sore throat.

Which Eye Conditions Are Associated With Sleep Apnea?

Glaucoma

Glaucoma occurs when increased pressure within the eye damages the optic nerve, which connects the eye to the brain, leading to vision loss and sometimes blindness. In some cases, it might be due to a drop in blood oxygen levels, which happens when you stop breathing. However, CPAP machines, one of the most common treatments for sleep apnea, can also cause glaucoma. 

So, people with sleep apnea — even if it’s being treated — need to get their eyes checked on a regular basis for glaucoma.

Floppy Eyelid Syndrome 

Floppy Eyelid Syndrome (FES) is an eye condition where a person has an unusually large and floppy upper eyelid. It can cause eye redness, irritation, discharge, or blurry vision — and over 90% of people with FES also have sleep apnea.

Non-Arteritic Anterior Ischemic Optic Neuropathy

Non-arteritic anterior ischemic optic neuropathy (NAION) is an eye condition that occurs when there is a loss of blood flow to the optic nerve. Patients typically complain of significant vision loss in one eye without any major pain. Approximately 70-80% of patients with NAION have been found to have OSA.

Retinal Vein Occlusion

Also referred to as an ‘eye stroke,’ retinal vein occlusion (RVO) is a blockage of the small veins that carry blood away from the retina. A recent study of 114 RVO patients found that sleep apnea was suspected in 74% of the patients that had previously been diagnosed with RVO. 

Other Eye Health Issues Associated With Sleep Apnea

Some other ocular conditions that are more common in patients with sleep apnea include: papilledema, keratoconus, and central serous chorioretinopathy. Furthermore, in addition to glaucoma mentioned above, CPAP machines are associated with dry eye syndrome and bacterial conjunctivitis.

Talk To Your Doc

Get eye exams regularly to rule out eye disorders and prevent potential vision loss, especially if you have been diagnosed with sleep apnea. At Eye Associates of Richboro in Richboro we encourage you to share your medical history with us so we can better diagnose and treat any eye conditions or ocular diseases you may have, and help you keep your eyes nice and healthy.

The Best Foods for Your Eyes

We all know that eating nutrient-rich foods, drinking plenty of water, and exercising can boost our health. So it’s no surprise that these same activities also support eye health. Research has shown that regularly consuming certain vitamins and nutrients can actually prevent or delay sight-threatening eye conditions and diseases such as macular degeneration, cataracts, and glaucoma. 

Here’s a list of the best vitamins, minerals, and nutrients that can help keep your eyes healthy for a lifetime. 

We invite you to consult with our eye doctor, Dr. Richard M. Shetzline, to discuss which nutrients are most suited to your specific eye health and needs. 

Vitamins and Nutrients That Support Eye Health

*Always best to speak with your primary care doctor before taking any vitamins or supplements, and to ensure you consume the correct dosage for your body.

Vitamin A

Vitamin A deficiency can cause a host of eye health issues, including dry eyes and night blindness. In fact, vitamin A deficiency is a leading cause of blindness worldwide.

Vitamins A and A1, which are essential for supporting the eye’s photoreceptors (the light-sensing cells) in the retina, can be found in foods like carrots, leafy greens, egg yolks, liver, and fish. 

Omega-3 Fatty Acids

Eating Omega-3 rich foods like fatty fish can support eye health in a few ways. DHA and EPA, 2 different types of Omega-3 fatty acids, have been shown to improve retinal function and visual development.  

Omega-3 supplements can also ease dry eye symptoms. A randomized controlled study found that people who consumed Omega-3 supplements experienced improved tear quality, which resulted in reduced tear evaporation and increased eye comfort.  

Lutein and Zeaxanthin

Lutein and zeaxanthin are antioxidants that accumulate in the lens and retina and help filter out damaging UV rays and blue light. One study showed that individuals who had the highest levels of these nutrients in their diets had a 43% lower chance of developing macular degeneration than those who had consumed the least amount.  

Spinach, egg yolks, sweet corn, and red grapes are some of the foods that contain high levels of lutein and zeaxanthin. 

Vitamin C 

High amounts of vitamin C can be found in the aqueous humor of the eye, the liquid that fills the eye’s anterior chamber and supports corneal integrity. This has prompted scientists to consider this vitamin’s role in protecting eye health. 

Research suggests that regularly taking vitamin C (along with other essential vitamins and minerals) can lower the risk of developing cataracts, and slow the progression of age-related macular degeneration and visual acuity loss.

While vitamin C appears to support eye health in a variety of ways, it’s still unclear whether taking this supplement benefits those who aren’t deficient. Vitamin C can be found in various fruits and vegetables, like bell peppers, tomatoes, citrus fruits, broccoli, and kale. 

Vitamin E

Vitamin E is an antioxidant that helps protect fatty acids from becoming oxidized. Because the retina has a high concentration of fatty acids, sufficient vitamin E intake is crucial for optimal ocular health. 

Vitamin E can be found in almonds, flaxseed oil, and sunflower seeds. 

Zinc

Healthy eyes naturally contain high levels of zinc. A zinc deficiency can cause night blindness, and thus increasing zinc intake can improve night vision. Zinc also helps absorb Vitamin A, an essential antioxidant. 

Make sure to avoid taking high doses of zinc (beyond 100 mg daily) without first consulting your eye doctor. Higher doses of zinc have been associated with side effects such as reduced immune function. You can increase your zinc intake naturally by consuming more oysters, meat, and peanuts. 

Phytochemical Antioxidants

Phytochemical antioxidants are chemicals produced by plants that contain several health benefits. Some studies show that these plant-based chemicals may enhance vision and eye health as well as prevent age-related eye diseases and complications by alleviating ocular oxidative stress. Oxidative stress within the eyes contributes to several eye conditions, including  dry eye syndrome. Consuming more produce with these antioxidants can help balance the anti-oxidant and pro-oxidant system, resulting in healthier eyes. 

Personalized Eye Nutrition 

If you or someone you know is looking for ways to boost or maintain eye health, speak with an optometrist near you about what supplements and vitamins are best for you. For an eye doctor in Richboro, give us a call at 215-355-5818.

 

Your Eyes Are the Windows to Your Health

Your eyes aren’t just the windows to your soul — they can also reveal valuable information about your general health beyond whether you need glasses, including: diabetes, heart disease, and even cancer. It is not unusual for people to come in for an eye exam just to check their eyesight and then have certain health issues or predispositions picked up by the optometrist. 

Eye Exams and Your Health

Eye examinations can help doctors detect general health conditions early enough to intervene. Advanced screenings enable eye doctors to better predict cardiovascular incidents like stroke, and possibly detect signs of mental changes such as Alzheimer’s. Read below to learn how eye exams can unveil a whole lot more than just eye health.

Brain Cancer & Stroke

Because of the similarities between the blood vessels in the eye and brain, an eye doctor can occasionally detect an issue taking place in the brain by examining the blood vessels in the eyes. If swelling or shadows in the eye is observed, it may indicate a serious condition in the brain, like a tumor, or clots that might result in a stroke.

Diabetes

Diabetes can cause damage to the blood vessels in the retina at the back of the eye, resulting in Diabetic Retinopathy (DR) and Diabetic Macular Edema (DME). If an optometrist detects leaky blood vessels in the eye, the patient would be advised to see a doctor to help control their blood sugar. Changes are gradual, and they start before visual symptoms are noticed. The earlier diabetic eye disease is managed, the better the chances are of preserving eyesight. 

Hypertension

High blood pressure, characterized by having too much pressure in the blood vessels, can be detected during an eye exam, sometimes even before it’s diagnosed by your regular doctor. The damaged blood vessels lead to swelling, hemorrhages, and leaking — all of which can be observed in the eyes. According to the CDC, hypertension “the silent killer” affects nearly 1 in 3 adults, and up to a whopping 20% of those don’t even know they have it. So early detection at an eye doctor’s evaluation can be truly life-saving.

High Cholesterol 

Eye exams can also detect a buildup of cholesterol. High cholesterol is among the easiest conditions to spot during a complete eye exam, as the cholesterol deposits manifest on the front of the eye, appearing as a thin, gray rim around the cornea. It can also be detected in the retina by assessing artery and vein patterns.

These deposits may indicate the current or future development of Retinal Blood Vessel Occlusion, a condition where blockages restrict blood flow to the back of the eye, causing temporary or permanent vision loss. 

Heart Conditions

In some cases, heart conditions associated with a buildup of plaque in the carotid artery in the heart can also lead to deposits that clog the ocular arteries in the eye. If an optometrist detects such changes to the vascular structure at the back of the eye, he or she will typically recommend going to a specialist.

Multiple Sclerosis (MS)

Sudden vision loss may be attributed to Multiple Sclerosis (MS). While the optometrist can recognize signs indicating the presence of MS, such as the color and appearance of the optic nerve, such cases will be referred for further testing to confirm the diagnosis.

Thyroid

Thyroid disease can make itself apparent through the eyes in several ways. The thyroid gland controls the hormones that regulate tear production so some thyroid disorders can cause dry eye disease. Additionally, overactive thyroid (hyperthyroidism) can make the extraocular muscles enlarge and stiffen, causing bulging eyes — an indicator of Graves’ disease. 

Inflammation

Systemic conditions that are associated with inflammation in the body can have an inflammatory effect on the eyes. Uveitis, for example, causes eye inflammation, redness, and blurred vision, and tends to occur in people with lupus, rheumatoid arthritis, and other autoimmune diseases. 

Cancer

Breast cancer, leukemia, and other metastatic cancers are occasionally discovered during an eye evaluation. In addition to brain cancer mentioned above, melanoma and basal cell carcinoma (skin cancer) can be detected, and eye doctors can also diagnose lymphoma and other eye tumors. Eye exams save lives.

What the Future Holds 

Alzheimer’s 

Recent studies show that a non-invasive and precise imaging device called Octa (optical coherence tomography angiography) can signal the presence of eye changes associated with Alzheimer’s disease. Because the retina is in many ways an extension of the brain, the altered blood vessels at the back of the eye offer a glimpse into the changes taking place within the brain.

Parkinson’s Disease

Parkinson’s Disease can often be misdiagnosed as its early symptoms are characteristic of other conditions. Research has shown that subtle eye tremors, an early Parkinson’s marker, could be detectable using advanced eye exam technology. One day soon, practitioners may send patients to an eye doctor to test for this and other diseases.

Your Eye Doctor’s Appointment Could Change Your Life

So the next time you visit Dr. Richard M. Shetzline at Eye Associates of Richboro in Richboro, remember that a comprehensive eye exam can do more than determine your eyeglasses or contacts prescription. Dr. Richard M. Shetzline can evaluate your eyes for existing or potential health issues, and communicate them to your primary care physician for the best possible care. By knowing that you’re at risk for a certain disease, you can take precautions early on and manage the condition as needed. After all, an ounce of prevention is worth a pound of cure.

Dry Eye Syndrome and Treatment in Richboro, PA

Dry eye syndrome is very widespread. For some people, it’s a mild itchiness or irritation of the eyes. For others, Dry Eye Syndrome can be a chronic eye condition that is debilitating.

The symptoms of dry eye syndrome vary but usually include one or more of the following:

  • Dry, scratchy eyes
  • Excessive Tearing
  • Redness
  • Itchiness or irritation
  • Inflammation or burning
  • A feeling of grit, or like there is something in your eyes
  • Pasty, gunky, or crusty eyes
  • Blurriness

What Causes My Dry Eyes?

There are numerous causes and risk factors that contribute to the development of dry eye syndrome.

What Is Dry Eye Syndrome?

Dry eye syndrome is a chronic eye condition that is characterized by dry eyes and other symptoms including:

  • Dryness
  • Tearing
  • Redness
  • Itchy eyes
  • Burning
  • A gritty sensation
  • The sensation of a foreign body in the eye
  • Crusty eyelids
  • Blurred vision

Your tears comfort your eyes in many ways. Water moisturizes, an outer layer of oils lubricates and prevents evaporation, and proteins help protect against infection. Dry eye strikes when your eyes can’t produce enough tears for lubrication or the moisture in your tears evaporates too quickly.

What is Meibomian Gland Disorder?

In 80% of cases, Dry Eye Syndrome is caused by some problem with the meibomian glands, which produce the lipids (oils) essential for proper eye lubrication and for maintaining the appropriate breakup time (evaporation rate) of tears. The glands can get blocked or even atrophy by infection, environmental factors, and lifestyle.

Does Dry Eye Affect Many People?

Dry Eye is a very common condition which we treat in our practice. Some recent research by Harris Interactive indicates that about 70% of people with dry eye don’t ever see an eye care professional, despite the fact that nearly half of all Americans suffer from dry eye symptoms to some extent on a regular basis. This is unfortunate as most patients stand to benefit immensely from appropriate treatment for dry eyes. At our Richboro eye clinic, we develop a custom treatment plan for you, tailored to treat the specific causes of your dry eyes.

Why is Dry Eye so Prevalent Today?

Dry Eye Syndrome has probably always existed, especially in the presence of environmental factors such as dust, cold, dryness, and, pollution. However, it seems to been getting more common and more severe, particularly over the last decade. 

One likely reason is the explosion in the use of digital devices. More and more, we spend many hours of the day continually looking at computers, smartphones, and digital televisions. This makes us stare for long periods of time while blinking much less than normal. Infrequent blinking, in turn, causes our meibomian glands to be blocked and even atrophy, resulting in serious and chronic dry eye syndrome.

The widespread use of contact lenses is likely also a contributing factor. Long days of use, combined with improper care and cleaning irritates the eyes and contributes to dryness and discomfort.

Various medications, becoming more widespread, also have side effects including dry eyes. Lastly, age is the most common contributor to developing dry eyes. As we live longer and longer, the rates of dry eyes are bound to increase.

Does Staring at a Screen Cause Dry Eye?

Continuous staring at a fixed object, such as a phone or computer screen, usually results in a decreased blink rate. The lack of blinking actually causes the eyes not to replenish the tears often enough. The meibomian glands, therefore, can become blocked or even atrophy and die.

Does Drinking More Water Help with Dry Eye?

The main component of tears is water. Most of us don’t drink enough water. If you are dehydrated or not drinking enough, then you may not produce enough tears to keep your eyes moist. Snapple, Coke and other caffeinated drinks like coffee and tea may feel like they quench your thirst, but they actually dehydrate the body. Your body needs water to prevent dry eyes symptoms.

Antihistamines and Dry Eyes

Certain medications are known to contribute to dry eyes. In particular, anti-histamines (allergy) medication. Prolonged use of antihistamines will often lead to dry eye symptoms developing.

Beta-Blockers and Dry Eyes

Typically prescribed for controlling blood pressure, beta-blockers are proven to cause or exacerbate existing dry eye symptoms. If you are taking beta-blockers and experiencing symptoms, let us know! Your Richboro dry eye doctors can help.

A recent study about the correlation between migraines and dry eyes has interesting results. Comparing migraine sufferers to people without headaches. The results showed a much greater prevalence of dry eye in the migraine group than in those without headaches. So, researchers are speculating that some migraines may worsen when dry eye symptoms are present. It has been recently hypothesized that when people report on headaches these could actually be caused by dry eyes, amongst other factors.  However, it is unclear whether one causes the other, or whether computer use is a contributing cause of both headaches and dry eyes.

As we age, we experience hormonal changes. These changes are known to cause or contribute to dry eyes. While this is true of both men and women, it seems that women over 50 are particularly more prone to developing dry eye symptoms.

The following environmental factors are known to play a huge role in causing or contributing to dry eyes:

  • Smoke
  • Pollution
  • Cold-climate and central heating
  • Dry climate
  • Sandy or dusty conditions

Various diseases contribute to dry eyes. Autoimmune diseases are a known factor. Rheumatoid arthritis, and Sjogren’s syndrome – a common symptom that rheumatologists treat can also contribute to dry eyes. Diabetics or those with Glaucoma that requires medication are more likely to have dry eye syndrome.

One of the main reasons people discontinue contact lens usage is due to dry eyes. The good news is there have been major improvements across all the brands with special contacts that are aimed at preventing dry eye symptoms.

What Treatments for Dry Eye Are Recommended?

Lifestyle Changes & Common Treatments for Dry Eye

Lifestyle Changes to Manage Dry Eye

There are many ways to treat dry eye. The first recommendation is to prevent dry eye symptoms. Blink a lot and drink a lot. Avoid eye irritants, use lubricating eye drops if you are taking medication that puts you at risk for dry eye. Over the counter eye drops for dry eye are widely available. Maintain a healthy lifestyle with a focus on vitamins like Omega 3.

  • One of the most common treatments we recommend is simple. Just BLINK! Blink regularly. Good, hard, fully closed blinks help restore the tear film.
  • The 20-20-20 Rule! During prolonged computer or digital device use take 20 seconds, every 20 minutes, to look at an object at a distance of at least 20 feet away. This gives your eyes a needed rest.
  • Drink adequately. Women need at least 91 oz. of water a day. Men need even more.
  • Omega 3 fatty acids have been shown to decrease dry eyes symptoms. Fish and flax are good natural sources of Omega 3 fatty acids, also available in tablet form.
  • If using a medicine that is known to contribute to dry eyes, like antihistamines or beta blockers, it’s important to combat dry eye with over the counter teardrops.
Omega 3 & Dry Eye

Omega 3 vitamins are very well-known to be good for general health, and heart health, but they are also helpful in treating dry eyes. There are even formulations specific for dry eyes. These usually consist of Omega 3 with DHA from flaxseed oil and includes vitamin C, vitamin E, Vitamin B6, magnesium, and a variety of other vitamins specifically geared toward patients with dry eyes.

Restasis and Xiidra: Prescription Eye Drops for Dry Eyes

In cases of chronic dry often, we often see patients who have a decreased ability to produce tears. This occurs because of the constant inflammation they experience. Unlike simulated tears, Restasis and Xiidra are prescription eyedrops which are both proven to increase the eye’s ability to make its own tears. Instead of having to constantly replenish your eyes’ moisture, with Restasis or Xiidra you are actually stimulating your eyes to make more tears over time.

When do I need prescription eye drops and when is a dietary supplement enough?

Typically, Restasis or Xiidra is used for chronic cases, while a recommended omega-3 supplement usually can and should be used in most cases even as a preventative measure and to maintain optimal eye health.

Our eye doctors are experts in treating dry eye syndrome and will diagnose and guide you through the right treatment plan for you. You don’t have to continue to suffer. Book an appointment with our Burlington dry eye specialist today.

Restasis vs. Xiidra for Dry Eyes

Restasis has been in use for a number of years. It is an eye drop that is used twice a day. It’s the teardrop form of cyclosporine, an autoimmune suppressant which is prescribed for many chronic conditions, and it has been found to alleviate the symptoms of dry eyes by reducing the inflammation and increasing tear production. However, Restasis doesn’t necessarily help to improve the outflow of the oil that needs to be produced on top of the tears so that the tears don’t evaporate. Right now some of the studies are suggesting that over 50% of people with dry eyes actually have meibomian gland dysfunction. So, if the first lines of treatment are failing to manage dry eye symptoms, consider more rigorous treatments for dry eyes and blepharitis. Restasis also has side effects, with some patients experiencing burning and discomfort.

Xiidra is a newer drug that has recently received FDA approval for the treatment of Dry Eyes. Clinical studies have shown it to be significantly effective in alleviating symptoms, and it works far faster than Restasis, providing significant relief within as little as 2 weeks without the side effects of Restasis. However, the long-term benefits for dry eyes have yet to be conclusively proven. Nonetheless, it is considered a very safe drug.

Punctal Plugs for Dry Eyes Treatment

At our Burlington eye clinic, our optometrists occcasionaly use punctal plugs to treat dry eyes. For those suffering from dry eyes caused by a lack of tears (as opposed to meibomian gland disorder) can often benefit from punctal plugs. These are small devices that are inserted into the tear ducts to slow or even block the drainage of tears. This increases the tear-film and moisture present in the eyes.

In most cases, the procedure is quick, painless, and uneventful. Find out if punctal plugs are right for you.

Scleral Lenses for Dry Eye
Scleral lenses for treating dry eye in Burlington, NJ

A scleral lens sitting on the eye

Scleral lenses are a special contact lens that is large. It sits on the sclera, rather than the cornea, leaving a pocket of space over the cornea. In our Richboro eye clinic, our optometrists use scleral lenses to treat a variety of eye conditions, including keratoconus and for people with sensitivity to regular contacts.

Scleral lenses are highly useful in treating Dry Eyes. Studies have shown that the use of scleral lenses is effective in treating moderate to severe dry eyes. In more than 50% of cases, patients fitted with scleral lenses report reduced discomfort and dry eye symptoms, decreased use of artificial tears and improved visual acuity.

Alipour F, Kheirkhah A, Behrouz M. Use of mini-scleral contact lenses in moderate to severe dry eye. Cont Lens Anterior Eye. 2012 Dec;35(6):272-6. 

Amniotic Membrane Treatment

This is a revolutionary treatment that has been developed in the past few years for treating severe and chronic cases of dry eye. Amniotic membranes are collected during elective cesarean births from the placenta. Amniotic membranes protect and nurture the baby in the womb. When placed over the eye, this membrane dramatically heals the eye surface which has been damaged by prolonged dry eyes. Absolutely no sale of body parts is involved, and absolutely NO harm comes to the infant or the mother in extraction.

The results of using an amniotic membrane to treat dry eye are dramatic. At our dry eye clinic, we make use of both wet and dry membranes, which differ slightly in use. Both types offer significant, dramatic, and real healing and relief for inflamed and scarred eyes due to dry eyes. The use of amniotic membranes is a gamechanger in the treatment of dry eyes.

Wet Amniotic Membrane

The "Wet" amniotic membrane is a thin membrane held together by a small plastic ring. Applied directly to the eye, the ring holds it in place right where the eyelid meets the sclera (the white part) of the eye. The healing from this method is very fast. Usually, the membrane needs to be worn for no more than a week before dramatic improvement occurs. 

Dry Amniotic Membrane

Looking more like a thin dry bit of tiny corrugated cardboard, the dry membrane is placed right on the cornea and held in place with something called a "bandage contact lens" on top.

Do You Live in Richboro, Newtown, Southampton, or Ivyland or surrounding areas and suffer From Dry Eyes?

Doctor Richard Shetzline is a founding partner of Eye Associates of Richboro, New Jersey.

DR RICHARD M SHETZLINE Dry Eye doctor in Richboro, PADr. Richard Shetzline is an associate of Eye Associates of Richboro specializing in Dry Eyes, Geriatrics, and Low Vision Rehabilitation. Dr. Shetzline completed his undergraduate study in Biology at Messiah College prior to receiving his Optometry degree from the Pennsylvania College of Optometry in 1998 and is licensed in both Pennsylvania and New Jersey. Dr. Shetzline also completed an externship with the He Philadelphia Veterans’ Medical Center during his studies at the Pennsylvania College of Optometry. In addition to his membership to the American Optometric Association, Dr. Shetzline has also been appointed as staff to various organizations including, the Burlington Woods Convalescent Center, the Granville Assisted Living Center, the Brendenwood Retirement Village, the Alterra Sterling House Assisted Living, the Alterra Clare Bridge Assisted Living, and Sunrise At Floral Vale Assisted Living.

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