Eye health

"Eye does not see, heart does not hurt", says a well-known Italian proverb. Of course, the implicit promise of serenity is tempting but, to avoid misunderstandings, it is always better to highlight how important it is to take care of your eyes, without ever underestimating any disturbance, as we sometimes tend to do.

As proof of this, for several years the World Health Organization (WHO) and the International Agency for the Prevention of Blindness-IAPB (in Italy IAPB Italia Onlus), together withWorld Union of the Blind (in Italy UICIECHI) promote the World sight Day, which this year has taken place on October 11. The day focuses on the prevention of eye pathologies which may, if left untreated, damage a person’s vision: according to WHO FactSheet n. 213 in fact, around 180 million people in the world are visually impaired, and of these around 40-45 million are completely blind. The most striking figure is that 80% of cases of blindness that are considered preventable.

To understand how to adequately protect our eyes, the Journal of Italian Healthcare World has interviewed Dr. Sandra Flavia Fiorentini, ophthalmologist surgeon and specialist in laser and corneal eye refractive surgery in Dubai, starting from the basic definitions which can sometimes be confusing.

Dr. Flavia Fiorentini

Dr. Fiorentini, what are the differences among an ophthalmologist, an orthoptist, and an optician?

Theophtalmologist is a professional with a university degree in medicine who has subsequently specialized in ophthalmology and is certified for the diagnosis and treatment of all eye pathologies with drugs, surgery, laser, or simply with glasses or contact lenses. The orthoptist is a specialist in non-surgical treatment of the eye for issues such as strabismus (walleye), amblyopia (lazy eye), and eye movement disorders. Normally, in case of disorders of the eye muscles the patient goes first to the orthoptist to measure the entity of the eye deviation with the use of prisms and to try non-surgical treatments before moving on, if necessary, to surgery. Finally, theoptician is a technician who takes care of packaging, mounting, and verifying glasses, frames, or contact lenses, always under an ophthalmologist’s direction.

Based on your experience, which symptoms are most often underestimated or treated with over-the-counter medicines but which should really be brought immediately to the attention of the ophthalmologist?

Red eyes, certainly: they may be caused by different conditions, including some that may jeopardize eyesight, such as uveitis (inflammation of the ineer eye) or ocular herpes infection on the cornea, the surface of the eye. In such cases over-the-counter medicines may actually make the condition worse and may lead to permanent vision loss.

What are the conditions you diagnose most often, and in which age range?

It depends a lot on the area where patients are living in. In my case I certainly notice a high frequency of dry eye syndrome and blepharitis (inflammation of the eyelids). In general, refractive errors (myopia, astigmatism, hypermetropia, and presbyopia) are the most common all over the world. 

Especially , in early childhood and before the age of 8, squinting or eyes wide open are probable symptoms of one of the refractive errors listed earlier, with the exception of presbyopia. It is best not to ignore such behaviors and take the child to the ophthalmologist, because vision disorders left untreated may lead to permanent amblyopia (lazy eye).

In adolescents and in young people the risks are mostly correlated to domestic or work-related accidents, or to complications caused by the use of contact lenses. 

After the age of 40 , it is important to undergo regular visits to assess the risk of glaucoma, which is the main cause of irreversible blindness in the world. The most common type of glaucoma is the “silent” one, which does not present any symptoms until the condition has worsened to the point that it is too late to do anything. Around the age of 40 the eye often starts having trouble focusing on short distances because of the natural ageing process of the eye (presbyopia); this can be easily corrected with the use of reading glasses.

Beyound the age of 60, the major risk is cataracts, in other words the clouding of the crystalline lens of the eye, which causes blurred long distance vision, and which cannot be solved by the use of lenses but only by surgical removal. Individuals over the age of 60 should also regularly have their retinas checked for signs of macular degeneration, especially if there is a family history of this condition.

A risk condition for all, indipendent of age, is diabetes, which is becoming more common all over the world. Diabetic patients must undergo regular tests, on a yearly or monthly basis depending on the severity of their condition. 

In general, adults with no pre-existing conditions or illnesses or a specific family history should see an ophthalmologist every two years.

So, you don’t visit only adults?

Every ophthalmologist normally receives adequate training to be able to treat children as well; in our clinics we have instrumentation and equipment tailored to small children and to measure the visual acuity in pre-verbal children without the need to prepare them in advance to the visit. For newborns and very small children, or in case of more specialized treatments, including eye surgery, it is best to consult a pediatric ophthalmologist.

Let’s stay on the subject for a little longer: at what age should we take our children for a visit for the first time? Would you advise a checkup even if there are no obvious symptoms?

Generally the very first check happens in the maternity ward where the pediatrician, if adequately prepared, is perfectly capable of assessing the red reflection from the back of the eye without assistance from an ophthalmologist, who will be involved only if the initial screening raises the possibility of congenital issues. Later, in the absence of symptoms, I would advise routine checks at the age of one, three, and just before the start of school, to track the correct development of the eye and further rule out rare conditions. During school age, and in the absence of diagnosed conditions, it is sufficient to take the child to the ophthalmologist every two years.

Now let’s talk about a subject matter of our times, have you noticed any obvious effect on your patients from the frequent use of electronic devices? 

There is really no scientific proof concluding that the blue light emitted by the screens of electronic devices is harmful to the eye. On the other hand, it is true that at night blue light may interfere with the melatonin hormone because it tricks the brain into thinking that it is still daytime and may therefore exacerbate problems of insomnia. In addition, excessive use of these devices may lead to dry evaporative eye syndrome, because the reduction in the frequency of eyelid blinking caused by concentrating on what is happening on the video reduces lubrification of the eyes, especially when the users is scrolling the image or playing. Symptoms of dry eye include a burning sensation, red eyes, tiredness, itchiness, and sometimes even wavering vision. If left untreated it may reach varying degrees of severity and may negatively affect the quality of life. 

We thank Doctor Fiorentini for the time she has spared for us, and we add some practical suggestions she has for her patients: choose a healthy lifestyle and a diet rich in fruits and vegetables every day, perform physical activity, make sure that the sleeping rhythms are regular, and do not smoke; in addition: wear quality anti-UVA and -UVB sunglasses and adequate protection in case of activities at risk of damage or accident; consult an ophthalmologist for the proper choice of contact lenses; never use unprescribed over-the-counter medicines and, most importantly, in addition to regular checks which should be always be done in the course of one’s life, do not hesitate to visit a specialist in case of irritation or any other symptoms related to the eyes.

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