Aging And Dry-Eye Syndrome

By Dottie Evans

There are two hot topics sure to draw interested audiences at national medical conventions, according to a board certified doctor of optometry who practices in Newtown, Joseph Keith Young.

Not surprisingly, the new antibiotics are at the top of the list.

But who would have thought dry-eye syndrome (DES) would be second?

Dr Young has his office at Village Eye Care in the Newtown Shopping Village and he sees a full schedule of patients of all ages. He often lectures at area residential developments for senior citizens, and said during an interview held July 1 that when he asks audience members to raise their hands if they have ever experienced dry eyes, “most of the hands go up.”

This is to be expected, he said, because “tear flow normally decreases with age.”

“With DES, the eyes may feel irritated, scratchy, burning, and uncomfortable. It is the most common of all eye disorders, affecting approximately 20 percent of the population.”

Treatment might begin with the use of artificial tears of different viscosities. In the case of older or disabled patients, there may be additional issues involving multiple medications or manual dexterity.

“I sit down with them and find out what other medications they are taking, what the drug interactions might be. Their primary care physicians don’t always warn them about side effects.

“If eye drops are indicated, I ask whether they can physically manage to use the dropper, or does another person need to help administer the medication.”

Ironically, one symptom of dry eyes is excessive wetness or tearing. This is because reflex tears will flow due to irritation, yet they are not tears that have the proper lubricating composition for long-lasting eye comfort.

Females tend to have drier eyes, Dr Young said, which is due to hormonal changes that occur after menopause. Even HRT (hormone replacement therapy) can contribute to dry eyes.

Contact lens use can cause DES, as can the use of antidepressants, which effect eye health by causing a change in the intra-ocular pressure. The interaction of various medications, and, in particular, the long-term use of steroids such as prednisone may contribute to cataracts, he warned.

“Juggle the good with the bad” when taking medications, Dr Young advised.

Arthritis sufferers who might be using over-the-counter drugs such as Vioxx or Celebrex could experience dryness.

“Using glucosamine chondroitins might be a better choice,” he advised.

Finally, Dr Young warned about using “Get-The-Red-Out” products.

“They temporarily shut down the blood circulation to the eye surface, and this can be very damaging. There is also a possible rebound effect as often happens with antihistamines,” he said.

For older patients experiencing dry-eye syndrome, Dr Young prefers to use drops or gels, and to “start slowly and see if we can offer some relief.”

A New Remedy: Punctal Occlusion

Agnes Tokarski, 51, is a Newtown resident who works full-time and wears contact lenses.

 She gets up early in the morning, puts her lenses in about 5:30 am, and is on the road by 6. She does not take her lenses out until bedtime at 11:30 pm. Lately, she has been experiencing discomfort with the lenses, and complains that her eyes feel “dry and gritty” all the time.

After a consultation with Dr Young, Ms Tokarski decided to undergo a nonsurgical procedure called a punctual occlusion to alleviate her symptoms. It involves the insertion of a tiny plug to block (occlude) the drainage duct (punctum) at the corner of each eye, so the lubricating tears will not be lost or drained away too quickly.

Barely visible to the naked eye, the punctal occluders are made of a very soft and flexible silicone, similar to that used in contact lenses.

During an office visit July 1, Dr Young implanted the tiny gel caps in Ms Tokarski’s tear ducts. The caps would stay there indefinitely, or they could be removed at a later time if she decided they were uncomfortable.

“Usually the patient feels a little tug as the permanent plugs are put in. I tell them if there is any redness, to call the office. Remember, I can take them out at any time.”

During a return visit, Mrs Tokarski said she found the procedure very effective, commenting, “it was wonderful. I never felt a thing.”

Regular Check-Ups For Preventive Care

If Dr Young could change one thing about eye care, he would have patients schedule regular check-ups while their eyes are healthy. They should not wait for problems to arise.

“You can’t put back what is lost. A person can get by with a broken leg but, so far, eyes cannot be transplanted. They are an extension of the brain and we don’t want to lose vision.”

People should be aware that even the smallest fluctuations in vision –– such as blurred or double vision –– can be significant and should be looked into, he said.

Glaucoma, for instance, can be detected and treated in the early stages, and Dr Young is ready to refer patients to a complete range of eye specialists and physicians in the greater Danbury area for needed medical and surgical eye care.

“As you know, there have been tremendous strides in medical treatment. We can slow macular degeneration. We can remove cataracts during an hour’s procedure and the patient goes home the same day with only a small bandage,” Dr Young said.

This may be contrasted to past cataract treatment, which meant a week in the hospital, bandages over both eyes and sand bags around the head to keep the patient immobilized.

“We can regrow corneal tissue using stem cell transplants. But we can’t replace vision once it is lost,” he said, returning to his theme of regular checkups and early diagnosis.

“Take care of the eyes by not smoking, by avoiding ultraviolet radiation, by following good nutrition, and taking vitamins. We know that systemic diseases like high blood pressure and diabetes can affect the eyes and even cause blindness.

“People who have undergone laser vision surgery to correct near-sightedness may also suffer from DES,” he added.

“Preventive care is so important. If we catch problems early on, we can at least slow things down. The worst attitude we see is when a patient says, ‘I’ve got time,’ or ‘it’s not a problem.’”

Eye care begins early and should last a lifetime, Dr Young said.

Pediatricians are trained to pick up eye problems, but “the school eye exam is not comprehensive enough. A child may be getting headaches and his vision could be responsible. You need to check it out.”

 For young adults, Dr Young advised them to keep coming to the eye doctor even after their parents stopped bringing them. Middle-aged people and senior citizens need regular checkups, as well.

“Senior citizens are more than 200 times likely to have an automobile accident because of visual problems than for any other reason.”

“We don’t age, we rust,” he commented, adding that vitamins and antioxidants were also key to maintaining eye health.