Coronavirus and Ocular manifestation

Coronavirus and Ocular manifestation

What is Coronavirus?

Structural protein

Function of Protein

Nucleocapsid Protien (N)

Bond to RNA genome to make up nucleocapsi

Spike Protein (S)

Critical for binding of host cell receptors to facilitate entry to host cell

Envelope Protein (E)

Interacts with M to form viral envelope

Membrane Protein (M)

Central organizer of CoV assembly & Determine shape of viral envelope

When a virus spread from animal to human its called Zoonotic virus. The official name of this virus is SARS-COV-2. “COVID-19 is the name of the disease it causes, which stands for “Coronavirus disease 2019.” Corona as in crown. The virus is named for its crown-like spikes. It spreads through droplets when we sneeze, cough or speak and can enter the human body directly through eyes, nose or mouth. This virus can also live on a lot of surfaces for hours, so people might pick it up on their hands and this way they can likely infect themselves if they touch their face. The average person who touches its face is approximately 20 times an hour.

Once this virus is inside the body, that spike acts as a key, locking onto the proteins found on the outside of many human cells. Once it has broken in the virus gives the cell instructions to produce more copies of itself. This way the virus starts invading more and more cells in the human body. This manifestation can lead to a fever, cough and fatigue. This further potentially leads to shortness of breath, sore throat, loss of appetite, diarrhoea, loss of sense of smell, lack of taste.

Current Stats of COVID-19 as of 30th August 2020

*Percent change in the number of newly confirmed cases/deaths in past seven days, compared to seven days prior.

Raising questions about Coronavirus and Eye related problems.

What is the incidence of conjunctivitis in patients with COVID-19?

Can the ocular surface serve as a reservoir of virus possibly transmissible to others?

Can the ocular surface serve as a portal of entry for COVID-19 virus through aerosolized droplets or hand-eye contact?

But the most important question is - Can COVID-19 transmits through eyes?

Some reports suggest that the virus can cause conjunctivitis. These reports have revealed that it can be transmitted by aerosol contact with the conjunctiva. Therefore, the suspected patient goes on the patients who are infected by a coronavirus and have travel history of domestic or international or who has visited ophthalmologist for conjunctivitis diagnosis and also have respiratory symptoms.

Conjunctivitis is an inflammation of the membrane covering the eyeball. It is often known as “pink eye.” Conjunctivitis often presents as an infected/red, “wet and weepy” eye.

Here are several studies and research that has shared their opinion about coronavirus and eye-related problems.

An eye expert at the University of Oxford, Prof Robert MacLaren, said after a recent study in Wuhan, China, where the coronavirus outbreak began, reported a range of eye problems, including swelling and sticky eye. Infected patients need to look for these symptoms too.

The New England Journal of Medicine has shared that they fond “conjunctival congestion”.

But the number of patients that are infected due with both viral conjunctivitis is known to have upper respiratory infections like cold, flu etc. and COVID-19 symptoms are very less. The approximate number found is 9 out of 1099 patients that are (0.8%).

A study in The Journal of Medical Virology found out of 30 patients hospitalized for COVID-19, only one patient diagnosed with conjunctivitis. From this information, it is very clear the occurrence of ocular manifestation to COVID-19 is very low.

Other finding included 38 patients with clinically confirmed COVID-19. Average age to these patients is around 65. Out of these, 28 patients i.e. 73.7% had positive findings for COVID-19 on RT-PCR from nasopharyngeal swabs.

How COVID-19 does enter the human body & infects eyes?

Along with Angiotensin-converting enzyme 2 (ACE2) and TMPRSS2 proteins are portals on the surface of the human cells. Coronaviruses may need heparan sulfate coreceptors, such as CD209 to enter the cells in the body. For example, on the cell surface to facilitate viral binding, especially for the highly pathogenic virus, such as SARS-CoV-2 may need help to enter the body. Check out the image shown above.

Such receptors have been detected on the eye. They are located, however, on corneal dendritic cells and conjunctival fibroblasts, which lie beneath the ocular surface and are not immediately accessible to the virus. There also are proteins in human tears, lactoferrin and 9-0-acetylated sialic acid, that can bind the virus, thereby potentially preventing its attachment to the ACE2 receptor.

Deceiving symptoms

After several observations, American Academy of Ophthalmology (AAO) passed the advice for eye care professionals to use face and eye shields while examining the patients with fever, breathlessness or any relevant or even irrelevant history of travel or even travelled to and from any hotspot that affected by the virus. There is a possibility, as conjunctivitis is the first sign to be spotted in the patient affected by COVID-19 including additional symptoms such as dry cough or anosmia.

The most important measures and outcomes to be undertaken considering ocular signs and symptoms as well as results of blood tests and RT-PCR for SARS-CoV-2. Patients who are infected and having ocular symptoms are more likely to have higher white blood cell and neutrophil counts and higher levels of procalcitonin, C-reactive protein, and lactate dehydrogenase than patients without ocular symptoms.

How to protect it?

Compared to other infections, eye issues in COVID-19 affected patients have found limited. This problem can be managed or treated with symptomatic care.

It has found at the early months when Covid had started spreading widely; it was suggested to front liners to conserve disposable medical supplies; especially by an ophthalmologist. The reason later found was only due to the shortage of medical supplies. As compared to 2003 SARS-CoV the spread of infection of SARS-COVID-19 is much higher. It has noted that health care providers are accounted for about 20% of all patients with infection.

It is, therefore, vital that proper protection of the front-line medical workers is absolutely set to be the priority.

In the absence of signiﬁcant eye pain, decreased vision, or light sensitivity, many patients can be managed remotely with a trial of frequent preservative-free artiﬁcial tears, cold compresses, and lubricating ophthalmic ointment. A short course of topical antibiotics can be added to prevent or treat bacterial superinfection based on the patient's symptoms and risk factors (e.g., contact lens wear) Speciﬁc criteria are presented below.

Although preliminary studies suggest that the risk of viral transmission through ocular secretions is low, large-scale research has not yet been done, and new data is emerging daily.

Healthcare providers are, therefore, still urged to wear proper protection of the eyes, nose, and mouth when examining patients. It has been suggested that ocular transmission of the COVID-19 virus may occur.

Eye care providers and technicians may be more susceptible to infection because of the lack of distance they need to maintain while examining the patient. Eye care providers must use slit lamp breath shields. They should guide patients to speak as little as possible when sitting at the slit lamp to reduce the risk of virus transmission. The medical workers should wear a surgical mask, a face shield, and gloves. Hands are washed before and after every encounter. If a patient is positive for any of the three criteria, the full PPE of gown, face shield, gloves, and the N95 mask should be worn.

It has been noted that droplets from sneezes can travel up to 6 m. Frontline doctors and workers can use slit-lamp shield made by passing two plastic sheets through a laminator without a paper in between and cutting openings for the eye-pieces.

As a shortage of surgical masks has become a reality, some institutions are storing used masks at the end of each day in a container with a view to re-sterilization if necessary. As many as a quarter of patients being injected under sedation may develop a severe involuntary sneeze. This is more common with eyelid injections than with retrobulbar injections. Ophthalmic surgeons should be acutely aware of this to take appropriate precautions during the administration of the local anaesthetic.

The slit-lamp shields are disinfected with 70% ethyl alcohol after each patient. 70% of ethyl alcohol has been shown to reduce coronavirus infectivity. Slitlamps, b-scan probes, and any other tools are similarly cleaned with 70% ethyl alcohol. Goldman tonometers are sterilized with a 10% diluted sodium hypochlorite solution, which inactivates coronaviruses. Other disinfection and sterilization practices should be employed for shared clinic equipment such as trial frames, pinhole occluders and contact lenses for laser procedures.

Does Ocular manifestation to COVID-19 possible?

The SARS-CoV-2 infection has evolved at a tremendous rate at global health emergency in the present era. There has been a very high risk of infection that has spread like wildfire across many countries boundaries. Not only patients but also many healthcare professionals had faced the same risk. An ophthalmologist treating a non-COVID-19 infectious patient is not at risk to attract the virus. Even though the number of patients found with COVID-19 and eye issues is very less, there are very rare chances that to ocular manifestation to COVID-19. Yet, ophthalmologists must work in tandem with infectious disease specialists for risk stratification and infection control measures as well as for the use of PPE. Till the time a cure is developed, artificial intelligence-based platforms, as well as teleophthalmology, should be encouraged.

There are several myths surrounded in terms of COVID-19. Check out the table below and clear your doubts.

Myths

Facts

Nucleocapsid Protien Any Ultraviolet can kill coronavirus disease 2019 (COVID-19).

No published data is available yet on ultraviolet light affects the COVID-19 virus, its effect on other SARC virus has been studied.

Any face covering will protect against the virus.

Scarves and bandanas made of a thin fabric or a single fabric layer will not be as effective in reducing virus transmission as those that have a filter or are folded 3 to 4 times to provide a better barrier.

Wearing gloves will provide protection from the virus

Gloves will be effective if the wearer discards them after touching something that can be contaminated. After use, the gloves must be removed properly by peeling them from so they are inside out, to prevent contacting the contaminated outer surface.

All hand sanitizer are the same, and the higher the alcohol content, the better the sanitizer will work against the virus.

The alcohol content of commercially available hand sanitizer has to be at least 60% for ethyl alcohol and 70% for isopropyl alcohol to work against the virus. Alcohol content over 80% evaporated too quickly and does not stay longer on the skin to kill the virus. Hand sanitizers need to specify the type of alcohol it contains. A hand sanitizer that simply shows alcohol contains does not guarantee that it will kill the virus.

Wearing shoe covers will provide protection from virus.

If it only affective if one knows how to put them on and off very cautiously to avoid contamination. Lack of training and knowledge may cause the wearer to inadvertently touch the contaminated area.

Keywords: Coronavirus and Eye, Coronavirus & Ocular manifestation, COVID-19, Ocular infection, Does Ocular manifestation to COVID-19 possible?

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Diet for Eye Health

Eating the right food in the right quantity is an essential part to have a healthy lifestyle. Diet also affects the long-term effects on ocular health. There are vitamins and minerals found in food helps in preventing two common causes of vision problems: cataracts which create cloudy areas in the lens of the eye and age-related macular degeneration (AMD), a condition that causes vision loss in the macula, the part of the eye that controls central vision. According to the World Health Organisation, 9 per cent of the overall population is 65 or older than that and this number is expected to increase to 17 per cent by 2050. As the name suggests, Age-related macular degeneration (AMD), the risk of this condition is higher in the old age group as compared to others.

It is necessary to consume the proper amount of nutrients in your daily diet. According to the National Cancer Institute and U.S. Department of Agriculture, it is necessary to have five servings of fruits and vegetables per day. This certain diet should include more than 100 mg of Vitamin C, 5mg to 6mg of carotenoids which should have sufficient elements of lutein and zeaxanthin. It is equally important to consume Vitamin E, so to get 8-14 mg of Vitamin E one should eat two servings of nuts and seeds. This is what expected to keep your eyes healthy for the long run. See the tables below for good food sources of these nutrients. Compared to given diet the average daily diet that we generally consume contains approximately 100 mg of vitamin C, 1 to 7 mg lutein and zeaxanthin, and 8 mg vitamin E which is certainly not potential enough for our eyes. In the studies mentioned here, the consumption levels associated with cataract benefits were considerably higher than the current average intake. Sometimes it is difficult to increase the level of these antioxidants and carotenoids in your diet, so at such times one can start taking multivitamin/mineral and eye health supplements containing these nutrients.

Here is proper recommended diet that one should follow:

There is certain food which helps in making your vision strong. Food which contains omega-3 fatty acids, lutein and zeaxanthin helps your eyes from attracting unwanted diseases.

Omega-3 Fatty acids

DHA substance in Omega-3 fatty acid is considered to be tout for many health benefits including health if eyes. DHA is also considered to be the most difficult substance to consume through a normal diet but if included in the regular diet it helps tremendously for vision protection. It occupies almost 30% of brain matter and prevents age-related vision loss. Omega-3 fatty acids are actually polyunsaturated fatty acids. It is also written as n-3 or w-3. These acids include alpha-linolenic acid, EPA, and DHA. Alpha-linolenic acid is a precursor of EPA and DHA.

Dr Bajart explains her research, “DHA is the primary structural fatty acid of the grey matter of the brain and the retina”. Therefore, it is conveniently proved that DHA supplements or a rich diet including DHA help in degeneration of the retina. Even though DHA will not reverse the retinal damage, it may certainly help to preserve vision, relive dry eyes and chronic inflammation of the eyelids.

DHA is majorly found in the food substances like salmon, cod, tuna and more. There are many cold-water fish which are rich in Omega-3 fatty acids such as salmon, tuna, sardines and mackerel. To get a good supply of omega-3s to have fish oil supplements or eat vegetarian supplements that are rich in black currant seed oil or flaxseed oil. Fish Oil, Flaxseed Oil and Black Currant Seed Oil contains omega-3 fatty acids and have many eye health benefits, including helping to prevent or control dry eye syndrome as well as reduce the risk of macular degeneration and cataracts. Pistachios, walnuts, almonds fancy are also highly rich in omega-3 fatty acids and vitamin E that will certainly boost your eye health.

The Faculty of Medical and Human Sciences at the University of Manchester showed that, "patients who achieved high red blood cell membrane EPA/DHA levels were significantly protected against AMD compared with those with permanently low EPA/DHA levels.” This helps or helps to reduce Macular degeneration which is commonly found in the old age people. Omega-3 fatty acids have also proved helpful for glaucoma patients.

How much one should consume Omega-3 fatty acids?
According to the researcher, the test has been conducted that measured the amount of EPA and DHA in the blood. So according to the study, one should have desirably 8% -12% of Omega-3 fatty acids in their body. Anything between 4%-8% is considered to be intermediate whereas <4% is totally undesirable and may cause serious issues in future with respect to vision.

Greens and coloured food

Green veggies and colourful fruits contain carotenoid lutein and zeaxanthin. Lutein and Zeaxanthin help reduce discomfort vision, risk of age-related macular degeneration (AMD) and many other eye-related problems. Carotenoid is only found in natural plants and helps to protect call damage. Lutein also is found stored in the macula of the human eye. It is an antioxidant found in carotenoid-rich foods. Lutein is found in the critical point of the retina that receives and absorbs light. Boost these healthy rainbows coloured lutein-rich food in your diet and help yourself and your family to reduce the risk of any eye-related problems.

Leafy greens like spinach, kale and collard greens, to name just a few, are packed full of lutein and zeaxanthin. It is one of the important plant pigments that can help stem the development of macular degeneration and cataracts. Broccoli, peas and avocados are also good sources of this powerful antioxidant duo. Also, colourful foods like oranges, grapefruits, lemons and berries are high in vitamin C, which may reduce the risk of cataracts and macular degeneration. To protect your eyes from night blindness and dry eyes and to promote eye health and function soundly one should increase the consumption of eggs. Eggs include Lutein and Vitamin A that will help your eyes stay healthy and disease-free for a long time. Similarly, one can snack on sunflower seeds too. These seeds are highly potential to provide your eyes Vitamin E and zinc.

Researchers from the National Eye Institute (NEI) suggested that including these foods in your diet will certainly prevent AMD risk. Another interesting benefit of eating lutein-rich food will decrease the risk of cataract formation in your eye. Not only these but these foods will help cancer prevention and improve heart health.

How much one should consume Greens and colourful food?
According to the Westmead Institute for Medical Researchers, beetroot has nearly 15 mg while spinach has about 20 mg and nitrate per 100 grams. The study has also proven the intake of these foods are more than 142 mg of dietary nitrate each day will not help resolve the eye-related problems. Hence, it is necessary one should know what and how much they are eating. Follow this particular table below for the right amount of food that you should consume in your diet.

Good food sources of Lutein and Zeaxanthin (mg/serving)

*depending on variety and preparation

Good food sources of Vitamin C (mg/serving)

Wink with Zinc

Zinc has proven to the trace element that helps cell metabolism. It helps in functioning ocular normally. Zinc is present in high amount in retina and choroid. If someone has zinc deficiency they might see the symptoms in vision especially at night. Zinc helps to create melanin which protects your eye through Vitamin A.

Food like lean beef in your diet can boost your eye health. To reduce the risk of advanced age-related macular degeneration, it is necessary to consume beef. Beef contains a good amount of zinc in it, which helps absorbing vitamins and lead to reduce the risk of AMD. Similarly, to protect your retina and to decrease the risk of macular degeneration and cataracts, try eating foods like kidney beans, black-eyed peas and lentils. These foods are good sources of bioflavonoids and zinc. Add swap refined carbohydrates for quinoa, brown rice, whole oats and whole-wheat slices of bread and pasta in your diet. It includes Vitamin E, Zinc and niacin. Other items like oysters, lobsters, pork, yoghurt, cashews, dry roasted, chickpeas also help improving zinc element to protect your eye.

However, a very high amount of zinc in your body does not actually even helps. It leads to other problems. So it is very important to consume zinc included food in the right amount.

How much one should consume zinc included food?
According to the researchers, the recommended amount of zinc needed in your daily diet is 8 milligrams per day for women; 11 milligrams per day for men. Pregnant women should get 11 milligrams a day.

Vitamin E

Vitamin E is another important supplement that is required to maintain eye health. The very reason to include it in this list is our body does not create Vitamin E. It helps in protecting cells in the eye from unstable molecules. Researchers suggested that mostly vitamin E is found in nuts, fortified cereals, and sweet potatoes, Almonds, broccoli, peanut butter, spinach, sunflower seeds, a wheat germ that can help protect the cell from damage.

Not only this, but Vitamin E also plays a significant role in improving the immune system of your body, it helps in repairing DNA and another metabolic process.

Food that makes the combination of Vitamin E and lutein and zeaxanthin helps to reduce the risk of cataract in the long run. Here is table which shows how much amount of Vitamin E certain food items have:

Key Takeaways

An abundance of evidence links that suggest eating more vegetables and fruits helps with better eye health as one age. Following the Dietary Guidelines as mentioned in the above article one should strictly abide with the quantity of supplement that they are taking for getting good results for the long run. For those already affected by AMD, health care providers may recommend supplementation.

Dietitian nutritionists should consider incorporating the topic of eye health into conversations with older patients and clients and should suggest them to consume ample amounts of vegetables and fruits.

Why it is so important to eat healthy for eye health?
Our body has cells that are constantly contained with the substance called free radicals. These free radicals have the power to damage almost anything and everything inside your eye like DNA, the inside of artery walls and even the proteins in the eye. Some of these free radical substance is developed in the body by taking the food and turning it into energy whereas others come from the air we breathe. It is not that we cannot do anything about these free radical that already exists in our body. Instead, we can help these free-radical fighters, named antioxidants, from the food we eat. This is the reason why we should eat the right vitamins, minerals, fatty acids etc.

Disclaimer for images: The images in the article are made by _________ and not sourced. We take full responsibility for the images.

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Reasons and tips to maintain your eyes healthy

Reasons and tips to maintain
your eyes healthy

Reasons and tips to maintain your eyes healthy

Keywords

Eye health, eye safety, Stop Smoking, nuclear cataract, glaucoma, diabetic retinopathy, eye care. How to protect your eyes, tips to maintain your eyes healthy, good eyesight naturally

Being one of the most sensitive organs of the human body, eyes need special care more than any other organ. Eyecare is an important health concern as the visual impairment can negatively affect independent living, quality of life, mental health and will also huge impact on accidental rates. To resolve these issues, it is important that the awareness and knowledge of eye health is a critical prerequisite for motivating behaviours and access to care.

People having any other health-related issues like diabetes or required some form of corrective vision must especially take extra care to prevent themselves from occurring any other severe eye conditions. Smoking, consumption of alcohol, proper diet impacts greatly for eye health. To understand what exactly the root cause of eye care professionals need to keep abeam information about the patient’s lifestyle and eye health so as to advice sound solutions. Take a look below to know all the reasons and tips on how to maintain your eyes and have good eye sight naturally.

Smoking

Many studies have indicated the role of smoking in the prevalence and commencement of Age-related Macular Degeneration. Smokers are easily prone to diseases like nuclear cataract, glaucoma, diabetic retinopathy and dry eye. People who prefer using contact lens have a tremendous risk of microbial keratitis if they are smoking. Current smokers are it men or women had higher odds of developing large drusen after 5 years than those who had never smoked or had quit.

Smoking is also associated with past cataract surgeries, i.e.

if the patient has had undergone through any cataract surgery and still smoking it is likely that he or she will sooner or later have affected vision. People who are depended on insulin for their diabetic conditions and if they continue to smoke it will eventually cause potential risk for vision loss.

Most of the time, people are easily associated with pipe smoking and cause nuclear cataract than getting associated with cigarette smoking. This type of behaviour is majorly observed between young generation. Hence, known effects on general health, sensible advice is not to smoke. People who are trying to “Stop Smoking” should join Stop Smoking Services or can also undergo nicotine replacement therapies.

Doctor should also ask the patient at their every follow-up visits to reduce and then quit smoking. They must also guide them through the process if required.

Diet

Keeping a healthy diet always helps to keep body fit. Eyes carry high activities, hence many studies and have reached to the fact that antioxidants like vitamins C and E and the carotenoids (plant pigments) B-carotene, lutein and zeaxanthin are especially helpful to prevent AMD (Age-related Macular Degeneration) and cataract.

Weekly if a person had two to three servings of oily fish, such as salmon, tuna, mackerel and herring, would achieve the recommended daily intake of omega 3, cutting the risk of both early and late-stage AMD.

Olive oil intake is also associated with a decreased prevalence of late AMD. One to two servings of nuts per week associated with reduced risk of an incident early AMD. Long-term use of multivitamins like B group and vitamin A supplements associated with reduced prevalence of nuclear or cortical cataract.

One can have a reduced prevalence of Nuclear Cataract by higher intakes of protein, vitamin A, niacin, thiamine, and riboflavin. Among specific foods high in carotenoids, broccoli and spinach help to diminish the risk of cataract.

Women were significantly less likely to have nuclear opacities than those in the lowest category. Tear dysfunction can be associated with the excesses of dietary fats, salt, cholesterol, alcohol, protein, and sucrose. If a patient has had a normal tear at its retina, he or she can have sufficient dietary protein, intake of vitamins A, B6 and C, potassium, and zinc will be helpful.

Sources of different nutrients in the diet

Nutrient

Dietary sources

Vitamin A

Cheese, eggs, oily fish (such as salmon, fresh tuna and mackerel), milk, margarine, yoghurt. Carrots, dark green leafy vegetables and orange-coloured fruits (eg mangoes and apricots) contain carotenoids, which are converted to vitamin A in the body

Vitamin C

Found in a wide variety of fruit and vegetables. Good sources include peppers, broccoli, Brussels sprouts, sweet potatoes, oranges and kiwi fruit

Zinc

Meat, shellfish, milk and dairy foods such as cheese, bread, and cereal products such as wheat germ

Vitamin E

Plant oils such as soya, corn and olive oil. Nuts and seeds, and wheat germ (found in cereals and cereal products)

Lutein, zeaxanthin

Spinach, kale, broccoli, red, orange and yellow peppers, mangoes, bilberries and corn

Omega-3 fats

Best sources are oily fish such as salmon, fresh tuna, trout and mackerel); vegetarian sources include vegetable oils, such as linseed, flaxseed, and rapeseed, and walnuts

Alcohol Consumption

Alcohol consumption was not a significant risk factor for AMD, glaucoma, diabetic retinopathy, retinal vein occlusion, pterygium, trachoma, optic nerve atrophy, dry eye, cortical cataract, subcapsular posterior cataract or nuclear cataract. In fact, the association between alcohol consumption and eye disease is comparatively weak than smoking.

Chronic alcoholism is associated with increased risk of cataract, keratitis, colour vision deficiencies and corneal arcus.

Heavy alcohol consumption (more than three standard drinks per day) or history of heavy drinking is associated with increased risk of early AMD, nuclear sclerotic, cortical, and posterior subcapsular opacities.

Recreational Drug use

Nowadays with growing abuse of drugs, there is a high risk that can cause ocular injuries and disease as some group of people used clinically and others with no legal or clinical use.

Grouping the drugs into five categories (opiates, marijuana, stimulants, depressants and hallucinogens), the researchers describe the pharmacologic, congenital, toxic, infectious, embolic, and psychological ocular manifestations of their abuse.

Recreational use of these drug(s) may result in Ocular sequelae which may affect visual acuity, the eye and adnexa, ocular posture and ocular motility.

Cannabinoids (cannabis, marijuana, hashish) have therapeutic potential for a range of conditions, including glaucoma, yet it doesn’t include for any recreation use.

There should be proper awareness that is required to spread among drug abuser. This way they will be aware of the consequences of illicit drug use which might lead to more pertinent questioning during history-taking.

Exercise

Intraocular pressure transiently reduced by dynamic exercise. For most patient’s exercise is beneficial to the eyes by reducing the risk of central retinal vein occlusion and neovascular AMD, and by improving control of systemic hypertension. Diabetes Ophthalmologists should advise regular exercise with appropriate eye protection for its patients.

For patients in good general health, and motivated, an aerobic exercise program might provide a small decrease in IOP.

A small study has investigated positive effects of walking, jogging, and running fast until exhaustion on IOP in normal and glaucomatous subjects. Hence, eye practitioners should encourage light exercise, such as walking for glaucoma patients.

Obesity

AMD, diabetic retinopathy, cataract and glaucoma and shows obesity is a significant risk factor for these diseases and hence to blindness.

Obesity is also significantly associated with cortical cataracts but not a nuclear cataract. Hence, it is strongly recommended for obese people to undergo a proper diet as well as practise regular exercise to stay healthy and avoid unnecessary guests in your eye.

Light Exposure

Many researchers have proved in their studies that there is significant evidence that clearly suggests a correlation between ultraviolet radiation (UVR) exposure and conjunctival pterygium, photo keratitis, climatic droplet keratopathy and cataracts.

Moderate cortical opacities were associated, at a borderline level of significance, with higher levels of sunlight exposure. There are also the possible risk factors for age-related nuclear and cortical cataracts in AREDS (Age-Related Eye Disease Study) participants aged 60-80 years.

Several researchers have recommendations to protect eyes against UV damage, UV rays. One should make use of a UV filter that stops most of the harmful rays of the sun entering the eyes. Most prescription glasses and some contact lenses now have a built-in UV filter. UV exposure found much higher where there are more reflective surfaces, for instance near water, so one should protect their eyes while at the beach, fishing, boating or on holiday. It happens to have intense the amount of reflected UV lights on or near snow, so it is always good to be prepared with required protection in these circumstances. Skiers and snowboarders should take particular care.

There are compelling reasons to counsel patients on the adverse effects of UVR and to offer them the various options available for UV protection. There is a British standard for sunglasses which should be looked for when buying them: BSEN 1836:1997. People who spend lot of their time under direct rays of sun or outdoors may need protection. Those living in countries with more sun may also need to take more care.

Eye Drops

Most of the time it has suggested that one should be compelled to use only prescribed medications. But at certain point, people acts irresponsibly and use non-prescribed medications. So whenever, you visit your ophthalmologist one must unequivocally inform about any prescribed or non-prescribed medication that are being used for any allergies that you may have. This is only way to stay clear from any wrong use of medications for your delicate eyes.

Use Quality Products while Eye Makeup

A bright yellow exclamatory warning sign is here for the ladies who prefer eye makeup. Inappropriate, fake, low-quality brands have flooded the market accompanied with its cheap rates and easy accessibilities. This may thrive harmful bacteria through products. Sharpening your eye pencil time to time is also as important as the quality to avoid getting hurt on your eye ball. Also, it is very important to note the expiry of eye make-up or any make-up products to avoid risk of infections.

Avoid Excessive Exposure to Computer Screens

Along with increased pay scales and responsibilities, exposure to computer screens and all other types of screens have also increased. If you are one of them who uses a computer or mobile phone for a long time, then there are chances that you may have a strain on your eyes. Less exposure to computer screen will help your eyes to stay healthy.

Family eye history

Some of the times eye diseases had clustered in the family. These unnecessary gifts have been passed on to future generation. Carrying any increased risk without having any whereabouts will certainly lead to age-related eye diseases. Hence, it is always important to know family history and take necessary precautions at the right time.

Give proper rest to your eyes

It is equally important same as your body and mind that your eyes required proper timely breaks while working continuously on computer screens. Taking breaks at right intervals, for example: after every 20 minutes of screen time, one should blink their eyes for 20 seconds. It is also healthy for eyes to use any type of screen from a distance of 20 feet.

Let your eyes breathe

Unlike lungs and heart, eyes are not depended on another organ of the body to get oxygen. Fresh and pure air is directly supplied to the cornea of the eyes. So it is utmost important that your eyes should receive fresh and pure air so that they can breathe.

Not every time-sharing is caring

Understand that sharing is not always caring, sometimes sharing may also lead to unwanted bacteria sharing or even diseases. Sharing your towel, washers are a strict no-no. If you have been sharing the same towel, then there is a high risk of getting infections likes contagious eye or conjunctivitis (or pinkeye). Hence, it is always better to use separate face towels and face washers to prevent eyes.

Sleep Well

Sleeping is an essential routine that should be maintained to get good results on your health. In case if a person is not sleeping a minimum 6 hours daily, then the lack of sleep will definitely build strain on eyes or even redness in eyes.

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Retinal Detachment: Causes, Symptoms, Diagnosis and Treatment

What is Retina?

Retina or the inner coat of the eye is the thin, delicate inner layer of the eyeball. The retina is continuously the hindered part of the body with the optic nerve. The retina lacks in thickness from behind and forward.

The optic part of the retina contains nervous tissues and is sensitive to light. The depressed area of the optic disc is called the physiological cup. It contains no rods or cones and is therefore insensitive to light. The rods and cones are light receptors of the eye. The rods contain a pigment called visual purple. Rods can respond to dim light (scotopic vision). Cones respond only to bright light (photopic vision) and are sensitive to colour.

What is Retinal Detachment?

The outer pigmented layer

The layer of rods and cones

External limiting membrane

Outer nuclear layer

Outer plexiform layer

Inner nuclear layer (bipolar cells)

Inner plexiform layer

Ganglion cell layer

Nerve fibre layer

The internal limiting membrane

So when the detachment of the retina takes place, the outer pigmented layer remains attached to the choroid, but all the remaining nine layers of the retina separate from the pigmented layers and are displaced inwards which ultimately affects the retina.

What are the symptoms of Retinal Detachment?

After the retina is detached from the back wall of the eye that is from sclera and dura mater and the eye no longer functions properly. It creates several problems for the visuals.Initial symptoms are very mere like flashing light (photopsias) and floaters (floating spots in the vision). These are also the symptoms of retinal tear or separation of the vitreous gel from the retina. So when someone is facing the symptom of flashing lights that means the vitreous gel is pulling on and covering the retina. This occurs due to the looseness of the vitreous gel it bumps on the retina. This usually occurs when the person is aged and egg-like gel becomes runny.

When the patients complain about flashing lights, they actually mean brief lighting streaks are seen in the outer layer of the eyes. These flashes may cause due to pressure or force on the retina. The floaters are usually described by the patients as strands, spots or little flies. Sometimes patients may also experience a shadow or curtain that prevent them from clear vision. When any of these symptoms are described by the patients there is mostly the chances that the central macular area of the retina detached from the outer pigmented layer.

What are the causes of Retinal Detachment?

There are several reasons which can cause a detached retina. But the three major reasons are:

Rhegmatogenous is a tear in the retina. A tear can be caused by the age when vitreous fluid starts getting thinner and free from its original place.

Vitreous body fluid is generally being thick more like jelly-white consistency and when it starts separating from retina causes a tear in the retina. The vitreous body fills the posterior segment of the eyeball.From the behind it is attached to the optic disc, and in front to the ora Serrata; in between it is free and lies in contact with the retina.

There is certainly a chance in the patient for a rhegmatogenous detached retina, especially if the patient has gone through cataract surgery, the age of the patient is more, if the case of myopia is too high, or has had a family history of a detached retina, or if the outer edges or the layers of the retina has thinned which is known as lattice degeneration.

When vitreous fluid overlaps on the retina and enters choroid and retina. This process of overlapping of fluid makes retina tent up away from the choroid. This is a very less common type of detached retinal which is known as tractional detachment. Usually, tractional detachment occurs when the patient has a diabetic eye disease. Diabetic eye disease is a disease in which vitreous body fluid draws on to abnormal blood vessels that are on the retina.

The third and rarest condition of retinal detachment occurs only due to dreadful circumstances. Such circumstances include any inflammatory situations near-eye which will lead fluid to leaks out of the blood vessel causing damaged and collecting underneath the retina. This process will certainly create a curtain which will prevent the patient from a clear vision. Such conditions are known uveitis and scleritis or tumours of the eyes or even autoimmune disease, and also congenital disease may occur in such situation like Coat’s disease.

Who is at Risk for Retinal Detachment?

Aforementioned are the causes, it is quite clear by now that which are those factors that may cause growth in the risk of developing the detached retina.

Family history. In case, any family member has had faced or had the history of retinal detachment then it is likely that someone in the family may catch the symptoms sooner or later.
Usually, the case of the detached retina is found in the middle or at an old age patient. But in very rare cases children may show these symptoms which is majorly the type of tractional detached retina known as retinopathy of prematurity. This condition is seen in premature infants who receive oxygen in the high-risk neonatal nursery.
Someone has the extreme nearsightedness (myopia) is likely to prone retinal detachment.If any patient has already undergone the retinal detachment surgery is also prone to the symptoms again in the future but not in every case.
If some patient has undergone through any complicated cataract-removal surgery should be aware of the possibility of a detached retina.
In case someone has been into any sort of trauma that is closer or directly related to the eye may cause damage to the blood vessel in the eye which will ultimately lead to the gathering of blood near retina which will eventually cause uveitis and scleritis or tumours of the eyes or even autoimmune disease, and also congenital disease.

Which are the possible ways to diagnose retinal detachment?

The diagnosis of retinal detachment is usually treated by Ophthalmologists. Ophthalmologist doctor is capable of treating any eye problems including vision. After 12 to 13 years to education and practise, some doctors are further trained to in specific medical or surgical eye care. These subspecialist doctors have to undergo through one or two years of the comprehensive studies training programme which is also known as Fellowship. After training, these subspecialist doctors are capable to treat diseases like Glaucoma, Retinal detachment, any other problems related to retina, Cornea, Pediatrics, Neurology, Ocular-Plastic Surgery and also vitreoretinal surgery.

Ophthalmologist’s doctors may use three different types of diagnosis ways for retinal detachment:

Through Instruments:

Doctors may use a special instrument which releases a bright light that will examine the back of your eye. It can also be done by using a special kind of lenses. These both ways can identify if your retina has any sort of tear or holes or detachment from the choroid.

Ultrasound image testing:

This method of diagnosis is done for the patients whose blood vessel are damaged and the bleeding had occurred. Bleeding in the eye makes it difficult for your doctor to see even through special lenses. However, ultrasound image testing helps the doctor to have a clear vision of your eye.

To diagnose retinal detachment, your doctor will perform a thorough eye exam. They’ll check:

For the clear vision of the eye
Any kind of pressure in the eye
The physical appearance of the eye
Ability to see colours

What are the possible ways to treat retinal detachment?

If you are diagnosed with any issue with your retina, maybe a hole or a tear or if your eye is bleeding, you are at high risk of developing retinal detachment. The reason why it is better in case if you are having any of the symptoms mentioned above.

There is two basic procedure of the retinal detachment:

Laser Photocoagulation:

Laser Photocoagulation treatment is mostly done when the retina is found with a tear on it. This procedure is relatively painless and largely practised. During the procedure, your doctor will first numb your eye with anaesthetic eye drops. After a few minutes, the bright light laser is focused through your eye which creates the scar or burns the area beside the retinal tear or any small detachment. The scar tissue will naturally help the tear or the detached retina to reattached that particular portion.

Cryotherapy:

Another way to treat a tear or a hole or retinal detachment is by Cryotherapy. Cryotherapy procedure is done by inserting a freezing probe in your eye. The probe is inserted next to affected tissue or nerve or the tear. The freezing probe inactivates the nerve. Every time the area is frozen by the probe; the scar tissue is formed. Then on the scar tissue helps the tear or the detached retina to fill attach is its natural way.

This procedure may take a little more time than laser photocoagulation as eye surgeon has to use the freezing probe several times to make the scar.

There are further three different procedures that are based on the location, size of the retinal detachment or if the patient has had any cataract surgery earlier.

Pneumatic Retinopexy:

For this procedure, your eye surgeon will first numb your eye. After doctor will inject intraocular gas bubble in a vitreous portion of your eye to help your retina move back into place up against the wall of your eye. Once your retina is back in place, your doctor will use a laser photocoagulation treatment or freezing probe (Cryotherapy treatment) to seal the holes.

Scleral buckling:

For severe detachments or delicate location of the detachment, the patient will need to have eye surgery in a hospital. Your doctor may recommend scleral buckling procedure to push retina at the back of your eye. This involves placing a small silicone band around the outside of your eye that is at sclera. To keep the band at its place, the eye surgeon will have to sew the silicon band. This buckle stays in your eye permanently. Scleral buckling may be done in combination with a vitrectomy. Cryopexy or retinopexy is performed during the scleral buckle procedure.

Vitrectomy:

Another option is vitrectomy, which is used for larger tears. This procedure involves anaesthesia and is often performed as an outpatient procedure, but may require an overnight stay in the hospital. Your doctor will use small tools to enter through the sclera of the eye and inserts an instrument that will remove vitreous, a gel-like fluid from your retina. Then the surgeon will place your retina back into its proper place by following laser photocoagulation or cryotherapy. To place retina at its original place, the doctor will again inject intraocular gas and replace the vitreous gel. This procedure will automatically push retina at its original place.

What to expect after retinal surgery?

The positioning of your head- Most of the time, your eye surgeon will ask you to keep your head at a certain position for a few days or weeks after the surgery. This way it will be safe that gas bubble or band will not leave its original place and it will help the retina to reattach.

Avoid flying in an aeroplane.

Avoid having nitrous oxide for anaesthesia or the intraocular gas may expand and may cause lasting damage to your eye.

Topical steroids or antibiotics are suggested by the doctor after the surgery so as to avoid any risk of bleeding or inflammation or any other complications after the surgery.

After the surgery, it may take several weeks or a month to have a complete and clear vision. However, it may happen with certain patients that they may have to undergo through cataract surgery after retinal detachment surgery as the retinal surgery may trigger changes in the lens of the eye. After the retinal surgery, the doctor may ask the patient to avoid heavy lifting or exercises, or bending down for first few weeks.

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Sleeping Habits and Health Effects

Modern-day humans are infamous for not getting proper sleep. Several popular theories abound as to why this is true, but in reality, the best answer is relatively straightforward: too many of us conveniently ignore proper sleeping habits.

According to various studies: Sleeping position may be correlated with the severity of your dry-eye symptoms.

What does the periodic table of elements and the song "Satisfaction" by The rolling stones have in common? Both are the products of dreams!

Before we explore more on this, let us understand what lack of sleep can do to affect our daily lives.

Lack of sleep affects all areas of health, from coordination to thought processes, so it's no surprise that it can affect your eyes, too.

Let's discuss some cosmetic issues first. Several experts confirm a direct correlation between lack of sleep and those dark circles or bags under your eyes.

That's because a lack of sleep tends to increase fluid and blood retention around our eyes.

You might not have noticed, but sleepy eyes are often dry eyes. For optimum function, our eyes need a continuous supply of tears, which will give you an idea of why blinking is so essential.

Insomnia prevents eyes from getting much needed fluid circulation. The natural eye fluid not only cleans but renews the eyes-staying awake for an odd number of hours works against eye health.

Eye spasms are another odd consequence of sleep deprivation.

The involuntary eye twitching can be distracting and uncomfortable, and this condition is also called myokymia.

Regular proper sleep rests the body and allows all its eye muscles in turn, so the twitching should only be a temporary issue.

Much higher on the trouble scale might be eye vessels popping that can quickly occur when a night's rest just doesn't come through.

Though they are generally not painful, the "bloodied eye" look is not one most will cherish.

According to neuroscientist Mathew Walker "Creative reawakening is just of the several boons provided by a full night's sleep."

There are rarer eye conditions that are easily linked to sleep loss: one of those is Anterior Ischemic Optic Neuropathy (AION).

Associated with people who have a history of sleep apnea, if ignored, this continuous inflammation of your eye vessels could lead to vision loss over time.

Those severe conditions are unlikely for the majority of deficient-sleep sufferers still, don't forget that consistently dry, puffy eyes after nights of turning and tossing can indicate you need to address the situation.

By now, it is quite clear to us that we humans are notoriously bad at getting adequate sleep.

Countless people would love to improve the quality of their sleep but then genuinely don't know how to do it. These people don't understand why their sleep quality is terrible. They have tried several things to fix it, but they are still unable to sustain and cultivate healthy sleep habits.

Then again, there are various over-the-counter and prescription medications that can be of great benefit for the sleep-deprived people.

But overusing these medicines can make you utterly dependent on them and result in a low quality of sleep that isn't as refreshing as natural sleep. Always talk to your family doctor about the warnings and benefits of any medication you take.

Most of us, eventually, do realize when we are sleep-deprived -- you can be fuzzy, cranky, and just "off." Making an honest effort to understand what's causing your sleep loss and trying to control the situation can result in a fresh perspective on a new day.

But exactly how? There are several approaches: drinking less caffeine, reduced noise, napping, getting more activity during the day, the right choice of sleeping temperature, and more.

Being aware that this problem actually exists, and taking the sleeping problem seriously is an excellent start.

Sleeping well is more than just knowing what to do. It's more important to know what not to do, as we'll soon find out here that most of us do share some rather atrocious sleeping habits and behaviours.

Before diving into the three regular sleeping habits that are ruining your slumber, it is critical to discuss the fundamentals of sleep science. If some of this information looks familiar to you, that's because it's everywhere.

We'll provide some vital insights into the latest research as well.

The vital functions of getting adequate rest

Cellular Repair
During sleep, large quantities of Human Growth Hormone is produced in our body. It is during our sleep most of the body systems recover, and cellular regeneration happens.

Immune Activity
Your immune system is at its peak during sleep. According to a study at the University of California, it is confirmed that even a modest loss of sleep can weaken the immune system's response to injuries and diseases.

Memory and Problem Solving Capability
Sleep plays a key role in the transformation of short-term memory to long-term memory.

Mental Health and Mood Swings
It is well known that insomnia is associated with depression. There is a clear reason why. Lack of sleep shuts down your prefrontal cortex. This can cause or worsen various numbers of psychological conditions, including depression, PTSD, and anxiety.

Inflammation
Lack of sleep also results in a higher cortisol level (a primary stress hormone) in our bloodstream.
This high level of cortisol creates low-grade inflammation throughout our body, and inflammations are associated with most modern degenerative diseases like inflammatory bowel disease, obesity, type 2 diabetes, heart disease, and cancer.

Weight Control Problem
Sleep deprivation has a significant role in making someone fat. Recent studies also reveal that just a single night of poor sleep causes dramatic food intake and appetite changes.
Lack of Sleep is also associated with severe medical conditions, including heart disease, high blood pressure, anxiety, diabetes, depression, (hypertension), obesity, and others.
According to a 2018 study by a prestigious group of researchers at the National Institutes of Health (NIH) confirmed that just a single night of poor sleep results in a beta-amyloid buildup in our brain. Beta-amyloid accumulation in the brain is considered to be one of the primary causes of Alzheimer's Disease.
Those sound pretty important, don't they?
"Sleep is like the Swiss army knife of health. When sleep is not adequate, there is disease and sickness. And when sleep is abundant, there is health and vitality."

Simple steps to get a perfect sleep

Avoid Sugar consumption Just Before you go to bed
Blood sugar crashing can stimulate cortisol production and stress response.
If you like having snacks after dinner sometimes, then pick some healthy protein or fats like a handful of cashews or other dry fruits, but avoid desserts, chocolates, or other sugar-loaded products before you go to your bed.

Sleep in a dark room
Darkroom means more profound sleep. Light exposure to the eyes and skin suppresses melatonin and increases cortisol production and.

Seven to Eight Hours of Sleep
It allows your body to have enough repair time.
Your sleep quality will also improve if you get in the regular habit of going to bed and getting up at the same time on a daily basis.
Not just during the week, but try to follow this on weekends as well. After just a couple of weeks, you will observe that you will fall asleep more quickly and stay asleep.

Avoid taking Alcohol Within 4 Hours of Bedtime
According to various studies, consuming more than two glasses of wine in the evening has been confirmed to interfere with our deep sleep cycles significantly.
You might "pass-out," but in reality, your sleep will be of poor quality.

Avoid Blue Light Before Bed
Display screens from smartphones, computers, laptops, and Television emits various lights across the spectrum. Blue light, in particular, is responsible for stimulating your body.
Dim the lights 1-2 hours before you go to bed.
You can also use 'Blue Light Filter App' like "Iris Tech" on your smartphone and computers to block these blue lights. You may consider changing the settings on your Television to get similar results.

Avoid Consuming Stimulants After 3:00 PM
Be it sugar, tobacco, or caffeine, all these stimulants excite your adrenal glands, and then it triggers the release of cortisol.
Caffeine has a half-life of about six hours, which means :
A cup of coffee at 3:00 PM; 300mg caffeine in your body system
By 9:00 PM;150mg caffeine in your body system
By 12:00 PM; 75mg caffeine in your body system
At midnight when you are in the middle of your repair cycle, you are still having 75 mg of caffeine in your bloodstream; this will elevate your cortisol and suppress melatonin (the repair hormone). This situation can be easily interpreted as "stress" to your brain, and as we know, your body always releases cortisol when it is under stress.

Foam Roller or Proper sleeping mattress
Invest in a good quality sleeping mattress, or you can buy these foam rollers in any fitness shop or sports store. These are very efficient at soothing your muscles, releasing the tension, and pushing the stagnant blood from your limbs back into circulation, which helps you to get a good quality sleep.

Final Thought
Forming new healthy habits and getting rid of old ones, takes commitment as well as time.
As you continue to destroy your bad sleeping habits and replace them with useful and healthier options, you will get used to the new changes eventually. Then, you will notice the handsome reward of a great night of rest every night.

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