Loss of Corneal Sensitivity

The next time you get a piece of dust in your eye don’t complain about the pain and buckets of tears. Be thankful that your system is working as it should. The pain, of course, is a warning that something is damaging the cornea; the profuse tearing is an attempt to wash the offending object away.

In some rare instances, the cornea may lose its sensitivity. If you can’t feel foreign matter rubbing the cornea, serious eye damage can result. It’s quite easy to test for sensitivity with an instrument or a thin wisp of cotton. Total lack of sensitivity indicates a serious neurological problem. This should not be confused with the gradual diminishing sensitivity of aging.

Bulging or Protruding Eyes

We are not referring to people with naturally large eyes such as very nearsighted individuals, but when one or both eyes give the appearance of becoming larger. It doesn’t really mean that the eyes are getting bigger, but rather that they have started to protrude. If both eyes become more prominent,”frog-eyed” look—chances are an overactive thyroid is responsible. When only one eye protrudes, the chief causes are hemorrhages, inflammation, or tumors which must be quickly dealt with. Often the protrusions are tenuous, and instruments must be used to carefully compare the two eyes.

Double Vision

If you have ever experienced double vision when you are tired, after taking medication, or after drinking too much alcohol, you know how very disturbing it can be. Sudden double vision without any apparent cause is very frightening. No matter what the reason, it attests that the two eyes are not pointing at the same spot.

In the case of fatigue or drugs (including alcohol), there is a temporary interruption with the brain’s ability to control and coordinate the eye muscles. Getting sufficient rest or eliminating the offending chemical is usually all that’s needed.

A more serious matter is double vision which occurs abruptly and is present all the time. The typical culprit is a small stroke or hemorrhage; less likely is a brain tumor. In most instances, proper treatment of the underlying cause may slowly restore single vision. As a temporary measure, special prism glasses can keep the double vision under control.

When one eye is treated at a time, you can resume normal activities within a few days, because you can see well out of the untreated eye while the treated eye is healing.

Ethan had his eyes treated on different days. After the first PRK procedure, his vision was so blurry that he could barely see out of the treated eye. While it was healing, he wore a contact lens in the untreated eye. He could drive, read, and go to work. “I would just concentrate on seeing out of the one eye,” he said. “It’s difficult, but you can do it.”

Nicole, a thirty-seven-year-old actress, also had PRK performed on her eyes on separate occasions. After her first surgery, her eye was tearing and scratchy. “It felt like someone had kicked a whole pile of sand into my eyeball,” she said. She relied on painkillers to dull the discomfort and slept a lot during the next two days.

For the first month or two after the operation, Nicole wore a contact lens in the untreated eye. Her naturally dry eyes, however, caused the eye with the contact lens to become red and gritty. After a few weeks, Nicole decided to leave the lens out. “I just relied on my one good eye until the second eye was treated,” she said. “That was fine.”

Nicole’s second surgery was easy in comparison to the first. She experienced less pain afterward and felt like “more of an old pro,” she explained. “I covered the newly treated eye and read with my one good eye.”

Treating one eye at a time is less convenient for many people, but it is definitely safer. The results from the first eye can be assessed and, if needed, alterations can then be made in the technique planned for the second eye. For example, if an overcorrection occurred in the first eye, less laser energy might be used for the second eye. It takes several months to know with certainty the final outcome from the first procedure. It is very common to have the second eye treated sooner than this, but patients need to know that their first eye is still undergoing some change for several months.

If both eyes are treated on the same day, then the healing for both eyes will occur at the same time. You will not have to go through two separate healing periods or a period of misbalance between the first and second eye treatments. However, your vision will be limited in both eyes at the same time as they simultaneously heal.

After having a long conversation with his doctor, David decided to have PRK on both eyes on the same day. He knew he might feel more pain after the surgery and that it might take longer for him to be able to see clearly, but he couldn’t tolerate contact lenses and didn’t want to have to wear a thick lens on one eye and nothing on the other while recovering from the surgery. “The perceived benefit to me seemed so much greater than the risk,” he said. For two days after his surgery, David had difficulty seeing, but by the third day, he was in good shape. In his mind, the temporary inconvenience was worth the price.

But even though I enjoy computers, I still seem to notice some niggling little resistance to increasing the time I have to spend on them. Although it makes a lot of sense to convert more and more printed material into computer files, I would hate to give up reading a printed copy of the morning newspaper. I also would have a hard time giving up the pleasurable experience of snuggling up on the sofa with a good book or magazine. Sometimes I wonder if this is just my own knee-jerk reaction to moving into the high-tech age, but I think that the truth is that it is just not as relaxing working on the computer as it is reading a printed page. This is especially apparent when I am ready to do a final read-through on the computer — I give up and print out a copy which I can read in a more comfortable and leisurely setting.

Generally speaking, optometrists have reported that workers who use video display units (VDUs) have more visual focusing complaints than those viewing printed material, and the complaints increase as the workers spend more hours at the computer. What are the most common problems that people complain about?

• blurred vision
• colour perception changes
• discomfort with prescription glasses
• double vision
• eye focusing problems
• eyestrain
• headaches
• irritated eyes
• short-sightedness.

The indirect symptoms include:

• back, neck, shoulder or arm pain
• irritability
• increased nervousness
• lowered visual efficiency.

Do any of these problems reflect your own experiences? I’ve definitely noticed some of these symptoms in myself.

Computer use is very demanding on our visual abilities.The eye could not focus on the video terminal with the same accuracy as the printed page. Over a period of hours the computer user’s focus point relaxed and extended beyond the screen, causing the screen to appear less clear and harder to read. Optometrists have found that a few computer users overfocus, which means they are focusing at a point in front of the screen so the image they see is not clear. Other computer users experience a breakdown of eye coordination skills which causes them to see double images after working on the computer for long periods of time. If an individual lacks the visual skill to see the image easily on a computer screen, he may begin to tense his body and move his head in an attempt to focus better. This may lead to posture- related pains in the neck, shoulders or back. Because workers are not aware of ways to reduce computer-induced visual stress, they may make begin to experience job burnout, high absenteeism or visual problems such as short-sightedness or eyestrain.

The modern, effective treatment of cataract is to remove it from the lens capsule, or, if necessary, remove the whole lens itself. From about the age of fifty onwards the ligaments which hold the crystal lens in place become weaker. The lens can therefore be quite easily removed from the eye by rupturing the ligaments, especially if they have been ‘prepared’ by appropriate weakener-enzymes. Special forceps or a ‘freezing probe’ then lift the lens out of the eye. Usually the surgeon will supply counter-pressure to facilitate this operation. Another technique makes an opening in the eye and tears out the lens capsule. The hard nucleus of the lens may be ‘broken up’ whilst it is still in the eye, and the debris then washed out.

Once the nucleus has been removed the cortex, which is softer, naturally disintegrates so that it too may be washed out.

Once the inner lens has been removed the surgeon will decide whether to replace it with an artificial lens, or not to replace it at all.

Suppose, for example, that both parents had a recessive trait `A’. If they had nine children the chances are that only three of them would be marked by ‘A’. But if they had only two children, the chances of either of their offspring showing trait ‘A’ are small indeed, whether the trait is for weak legs or musical genius. But if both parents had dominants of a certain trait, this would almost certainly come out in the offspring. And this, as farmers have known at a practical level for centuries, is the essence of breeding. But whereas farmers have an unwritten licence to `improve their stock’ by processes of trial and error that involve disposing of runt animals, humans in their own breeding do not. When an unknown Swiss woman wrote to George Bernard Shaw suggesting they should have a child together because he had the greatest brain in the world and she ‘the most beautiful body‘, Shaw declined with admirable prudence: ‘What if the child inherits my body and your brains?’ Nonetheless, all societies indulge in some selective breeding. Incest is a near universal taboo, although different communities have different standards of what is the impermissible degree of incest. Great attention is paid in the scriptures as to who may marry whom, how the identity of race may be preserved, but also how new blood may be introduced through the maternal line. Only amongst the ancient Egyptians was incest actively encouraged, and then only as an exception to a general moral law. Certain individuals (pharaohs) were deified, and then it was hoped to produce a new line of gods by careful close breeding. The theory was perfectly correct: hereditary defects were given a new lease of life. The same happened in Europe, among the royal families, but for somewhat different reasons. Hence the famous Habsburg Jaw.

To return to the retina. Most nervous tissue that is highly specialized and not reproduceable (remove any part of the retina and it does not grow again) begins to lose its sensitivity after the age of thirty, or thereabouts. Naturally it can continue to function well, but not at the same level of perfection. By the age of seventy most retinae will have begun to atrophy to the point where the individual cannot help but be aware of diminished vision. Where there are hereditary defects, the decline in sensitivity can set in much earlier.

The retina and choroid should be completely formed at birth. If they are not, good vision may never be possible. Again the iris and pupil may similarly be incomplete at birth, a condition known as coloboma. Sometimes these conditions appear to be inherited, sometimes not. Very premature birth may in itself be sufficient explanation as to why the infant’s eyes are not perfectly formed, but there again prematurity may itself be an inherited tendency in the mother.

On the other hand, certain infectious syndromes are clearly not inherited. The body’s method of confining an infection to a particular area is to wall it off with inflammation cells, and then fibrous tissue cells. But in some instances this defence mechanism fails. Either the infection, or its toxic by-products, or even the very active inflammation cells and their products, end up in the small blood vessels of the retina and choroid and create areas of tissue reaction. Even when such an area is very small some loss of vision can result. Whilst such a reaction is very rare, it is relatively less rare among hard drug users who introduce infections into their blood stream when injecting themselves with heroin or other potent substances. Without knowing it they sometimes inject altogether harmful ‘filler’ substances, such as talcum powder, into their veins, and these can cause very acute retinal problems. This is as much a social as a medical problem. Teachers and parents have come to assume that rigid behavioural codes as to right and wrong are either unnecessary or may even warp the individual child, and so a necessary respect by the individual for his or her body has to be learned the hard way.

Blood vessels, however, are not the only route by which infections can reach the retina. They can come from the front of the eye, especially when the cornea has been infected. A severe corneal infection can spread backwards through the eye and eventually destroy the irreplaceable retinal cells. This is only likely to happen when the cornea has in some way been injured, and an infection allowed to enter the wound. In most cases the patient is likely to seek medical advice before his retina is affected.

Occlusion of the Arterioles

Blockage, as opposed to hardening and shrinking, of the blood vessels in the retina or the optic nerve causes much more abrupt signs of vision-loss. Depending upon which part of the system is affected, loss may be partial or it may be total. Recovery takes place over a period of months, and is likely only to be partial. If an artery is blocked, recovery is unlikely unless the blood can find an alternative route. (Arteries convey blood from the heart to the body, veins convey blood from the body back to the heart.) Such a condition is miserable to observe because even with early treatment a successful outcome is rare. Patients become easily despondent and sometimes seek fringe treatments which, while temporarily boosting morale, produce no long-term improvement. The blockage of a vessel in the eye is also generally a symptom or signal of a much deeper degeneracy in the blood circulation system, and a general physical check-up must always follow an eye diagnosis. Many otherwise seemingly healthy adults in their fifties suddenly suffer this form of loss of sight, and within a matter of days their mental attitude towards life is changed and they realize that their physical zenith is well and truly passed.

Blockage of the arterioles is perhaps the most common retinal problem among the normal- or average-sighted. Its incidence is low enough. However, there are other even rarer conditions, such as periphlebitis and blood dyscrasia. For the purposes of this account they can be passed over, but something should be said about sickle cell anaemia. This is an inherited abnormality of the haemoglobin molecule concerned with sulphur linkages. An estimated ten per cent of black people in the United States, and an estimated eight per cent of black people in Britain, are born with a sickle cell anaemia trait. That is to say, they are carriers of the disease. Between 20 and 25 per cent of these have the disease itself, which also affects a small minority of Mediterranean people. The haemoglobin makes the red blood cell an abnormal (sickle) shape and unable to function as an efficient carrier of oxygen. Those afflicted are likely to develop acute and even chronic retinal abnormalities for which, sadly, there is at the present time no cure. Money for medical research is administered very largely by white people in white foundations, and this provides one unpleasantly cogent explanation as to why so little has been done, until relatively recently, to overcome an ‘outsider’ disease.

Retinal Degeneration

Retinal failure is not invariably explicable in terms of blood deficiencies or defects. There are many other conditions, some of cause unknown. For want of a better name they are called degenerations. The suffix `-pathy’ is sometimes added, giving retinopathy. (Similarly some diseases of the cornea are called keratopathy.) Retinopathic conditions are generally progressive, developing over very long periods of time. Retinitis pigmentosa is one such condition, resulting in loss of visual field and eventual blindness. Night blindness may be the first symptom, although the practitioner, looking at the retina through an ophthalmoscope, easily recognizes the signs long before the patient realizes there is anything seriously wrong with his or her eyes. The doctor sees areas of pigment surrounding narrowing blood vessels. Retinitis pigmentosa can be either hereditary or acquired, and it is sometimes associated with other systematic abnormalities. Much is unknown about this disease, which can have tragic consequences even among the young, and so not surprisingly many different treatments are offered. In this and some other progressive diseases there are usually periods of apparent improvement, of temporary remission, generally governed by the patient’s mood. The promise of treatment and the build-up of expectations, especially if the treatment is to be undertaken abroad, lifts the patient’s spirits, and this alone is sometimes enough to affect the progress of the condition beneficially, regardless of any efficacy that the proposed treatment may have. The same kind of expectant aura, with the same kind of short-term relief, is also sometimes derived from acupuncture, hypnosis and other fringe medicines.

As far as retinitis pigmentosa is concerned, however, almost every known approach to aetiology and treatment has been attempted and eventually proved of no great value. Perhaps tomorrow there will be better news. Meanwhile the disease does exemplify another aspect of the medical world. The patients who have this condition, and more especially the parents of child sufferers, have combined to form a strong society with sufficient funds to establish research programmes and collect data from the society’s members. Patients and their relatives as a group are in effect saying to doctors: ‘We have the financial and social means, you produce the result.’

Imagination is closely allied to memory, for we can imagine only as well as we remember, and in the treatment of imperfect sight the two can scarcely be separated. Vision is largely a matter of imagination and memory. And since both imagination and memory are impossible without perfect relaxation, the cultivation of these faculties not only improves the interpretation of the pictures on the retina but improves the pictures themselves. When you imagine that you see a letter on the test card you actually do see it, because it is impossible to relax and imagine the letter perfectly and at the same time strain and see it imperfectly.

The following method of using the imagination has produced quick results in many cases. Look at the largest letter on the test card at the near-point, and you will usually be able to observe that a small area, about an inch square, appears blacker than the rest, and that when the part of the letter seen worst is covered, part of the exposed area seems blacker than the remainder. When the part seen worst is again covered, the area of maximum blackness is still further reduced. When the part seen best has been reduced to about the size of a letter on the bottom line, imagine that such a letter occupies this area and is blacker than the rest of the letter. Then look at a letter on the bottom line and imagine that it is blacker than the largest letter. If you can do this, you will at once become able to see the letters on the bottom line.

Eye Flashing or Blinking

Since it is effort that spoils the sight, many persons with imperfect sight are able, after a period of rest, to look at an object for a fraction of a second. If the eyes are closed before the habit of strain reasserts itself, permanent relaxation is sometimes very quickly obtained. This practice I have called “flashing” or “blinking,” and many persons are helped by it who are unable to improve their sight by other means. Rest the eyes for a few minutes by closing them or palming, and then regard for a fraction of a second a letter on the test card, or a letter of fine print if the trouble is with near vision. Close the eyes immediately and repeat the process.

Eye Central Fixation

When the vision is normal the eye sees one part of everything it looks at best and every other part worse in proportion as it is removed from the point of maximum vision. When the vision is imperfect it is invariably found that the eye is trying to see a considerable part of its field of vision equally well at one time. This is a great strain upon the eye and mind, as anyone whose sight is approximately normal can demonstrate by trying to see an appreciable area all alike at one time. At the near-point the attempt to see an area even a quarter of an inch in diameter in this way will produce discomfort and pain. Anything which rests the eye tends to restore the normal power of central fixation. It can also be regained by conscious practice, and this is sometimes the quickest and easiest way to improve the sight.

When you become conscious of seeing one part of your field of vision better than the rest, it usually becomes possible to reduce the area seen best. If you look from the bottom to the top of the big C on a test card and see the part not directly regarded worse than the part fixed, you may become able to do the same with the next line of letters, and thus you may become able to go down the card until you can look from the top to the bottom of the letters on the bottom line and see the part not directly regarded worse. In that case you will be able to read the letters.

Since small objects cannot be seen without central fixation, the reading of fine print, when it can be done, is one of the best of visual exercises, and the dimmer the light in which it can be read, and the closer to the eye it can be held, the better it is for you.

Eyecare and Sun Treatment

Sunlight is as necessary to normal eyes as is rest and relaxation. If it is possible, start the day by exposing the closed eyes to the sun. Just a few minutes at a time will help. Get accustomed to the strong light of the sun by letting it shine on your closed eyelids. It is good to move the head slightly from side to side while doing this, in order to prevent straining. When you have become used to the strong light, raise the upper lid of one eye and look downward as the sun shines on the sclera. Blink when the desire to comes, or when you lose the power of relaxation. One cannot get too much sun treatment.

How to Practice Eye Vision with the Test Card

Place the card permanently on the wall in a good light.

Place yourself from ten to twenty feet from the card and read as far as you can without effort or strain. Over each line of letters are small figures indicating distance. Over the big C at the top is the figure zoo. The big C, therefore, should be read at a distance of two hundred feet if the vision is normal.

Now let us say you can only read as far as the fifth line at the distance indicated. Notice that the last letter on that line is an R. Now palm your eyes and remember the R. If you will remember that the left side is straight, the right side partly curved, and the bottom open, you will get a good mental picture of the R with your eyes closed. This mental picture will help you to see the letter directly underneath the R, which is a T. Use the same method at whichever line the vision seems to fail: notice the last letter of the last line you can read, palm, get a good mental picture of the last letter seen, and you will find it easier to see the one directly beneath it.

Now if you stare at the final letter, you will notice that all the letters on that line begin to blur. It is beneficial to close your eyes quickly after you see the final letter, open them, and shift to the first figure on that line. Then close your eyes and remember the first figure. You will become able to read all the letters on that line by closing your eyes for each letter.

It takes only a minute to test the sight with the card. If you spend five minutes in the morning practicing with the card, it will be a great help during the day. Also keep a record of each test in order to note your progress from day to day. Record the vision in the form of a fraction, with the distance at which the letter is read as the numerator and the distance at which it ought to be read as the denominator. For example, 20/ 20 is normal, 10/20 less than normal, and 25/2o be^tter than normal.

Without Force or Pressure

The first lesson starts with relaxation exercises for the eyes (tapping massage) and relaxation exercises for the whole body (stretching and yawning exercises). Eyes that become increasingly moist, perhaps they even shed a few tears, are a wonderful sign that your eyes are relaxed!

Do all the exercises gently and smoothly. Never do them in a jerky or mechanical way. If one exercise is painful or difficult, do not continue it. Stop immediate ly if you feel any pain or nausea and go to the next exercise.

Eye Exercise 1: A Tapping Massage

You can easily do this relaxation exercise in any position at any time, walking, sitting, or lying down. Recommended time: one to five minutes.

Rub the palms of your hands together. Shake them and rub them as if you were washing them. Then, move one hand over the other, as if you were taking off a pair of gloves.

Imagine that the stress of seeing and of being tired and exhausted surrounds your eyeballs like a crust of clay. Imagine the thickness, color, and density of the clay.

Now, gently tap your fingertips along the edges of the eye sockets, between the eyes (where glasses would rest) and on your temples.

Relax your jaws by exhaling the tension released by the tapping massage. Open your mouth and exhale with a gentle sigh. Then, yawn a few times.

Imagine that the tension, the crust of clay packed around and behind your eyes, is slowly cracking and crumbling.

Continue tapping your forehead, your jaw muscles, and, finally, the back of your head to awaken your visual center.

Continue tapping, moving to the base of the skull, the area between neck and head, and along both sides of the spine. Notice how the tension is slowly melting away.

At the conclusion, gently stroke the areas that you massaged, stroking away from the center of the body.

Eye Exercise 2: Stretching

Do these total-body relaxation exercises while sitting. Recommended time: one to five minutes.

Yawn and stretch your legs, lifting them slightly off floor.

Spread your fingers and move your left arm as if trying to touch the ceiling with the tips of your fingers. Notice how the left side of your rib cage spreads out a fan.

Now, reach up as if picking apples. Alternate bet` looking at the tip of your nose and at your hand, which is reaching towards the ceiling.

Squeeze your eyes shut and playfully wrinkle your mouth. Don’t worry, no one is watching! Feel how the muscles around your eyes and neck begin to stretch. Make a clown face or do yoga exercises.

Repeat this whole exercise with your right arm.

Relax.

Eye Exercise 3: Shielding

This is a very simple and effective relaxation exercise for the eyes. Sometimes, people refer to it as optical fasting or palming. Dr. William Bates, the ophthalmologist, suggested this exercise.

The purpose of the exercise is to shield the eyes from all light and to bathe them in darkness. Only eyes that are totally relaxed, closed, and covered with your hands will see a deep blackness.