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The best protection for your eyes

Laser surgery? High-tech glasses? Supplements? Here’s what’s worth doing—and not.

Publishd: November 2013

From eyeglasses and contacts to eye exams and laser vision surgery, adults in the U.S. spent more than $35 billion on vision care during a 12-month period ending in June 2013, according to the Vision Council, a trade group. But not all of what we buy for our eyes is necessarily worth the money or even a good idea. We reviewed the evidence and consulted experts for the latest on what helps, harms, or has no effect.

Laser surgery update

Laser vision correction involves using a laser to reshape the cornea (the circular portion on the front of the eye) and correct nearsightedness, farsightedness, or astigmatism. There are two main types: traditional Lasik, in which a surgeon cuts a flap on the surface of the cornea, then uses a laser to reshape the underlying cornea; and photorefractive keratectomy (PRK), in which a surgeon scrapes microthin layers of tissue off the cornea’s outermost layer instead of making a flap. Newer techniques have allowed for results that are as good as or better than those of the past. Indeed, nine of 10 patients who undergo Lasik achieve between 20/20 and 20/40 vision.

There’s a caveat, though: Laser surgery might not free you from glasses or contacts if you’re 40 or older. That’s because the procedure can’t correct or prevent presbyopia, the natural loss of focusing power for close-up objects that happens with age. So you could have Lasik or PRK only to find that you still need reading glasses. What’s more, laser surgery might actually hasten the development of presbyopia in some people who are nearsighted.

Possible side effects of laser correction include dry eyes, glare, and halos. How common are they? As we reported in 2009 when we surveyed almost 800 consumers who had vision-correction surgery, more than half­—53 percent—reported experiencing side effects soon after, and 22 percent were still dealing with them six months later. Still, 80 percent said they were highly satisfied with the outcome.

What to do

The people happiest with vision-correction surgery tend to be the ones with the strongest prescriptions, those who “really cannot function without their glasses,” said James Salz, M.D., an ophthalmic surgeon in Los Angeles. If you decide to have it, choose a board-certified ophthalmologist who does at least 250 procedures a year.

Lasik and PRK are about equally effective, so which to have depends mostly on the thickness of your cornea (it should be beyond a certain threshold to qualify for Lasik) and your tolerance for discomfort, since Lasik surgery may be less painful and can have a quicker recovery time. Expect to pay at least $1,500 per eye depending on the pro­cedure and the equipment.

Eyeglasses go digital

If you haven’t bought a new pair of glasses in a while, prepare to be overwhelmed by the number of lens materials and coatings available. What to get may depend on which type of lens you wear. If you have a simple single-vision prescription, you can generally get by with inexpensive plastic CR-39 lenses, which we found for as little as $10 a pair in a recent Consumer Reports investigation on shopping for eyewear. But they can look thick with stronger prescriptions (the Coke-bottle effect).

If you have a strong prescription, you may see more comfortably (and stylishly) with high-index lenses, which are made of thin, lightweight glass or plastic. They can cost a bit more than regular plastic lenses, though.

If you have progressive lenses—which provide a gradual change in power for different viewing distances and are an alternative to bifocals and trifocals—it may be worth springing for the pre­ci­sion diamond-cut high-definition (digital) lenses. A newer option, they are made using computerized surfacing equipment that results in superior visual performance. But they can cost at least 30 percent more, our investigation found.

What to do

If your eye doctor says that you need glasses only for reading, an inexpensive pair of drugstore specs are fine, says R. Linsy Farris, M.D., a professor of clinical ophthalmology at Columbia University in New York. For other eyeglass types, base your choice on cost, quality preferences, or both.

Food vs. supplements

There’s no definitive evidence that specific foods, such as green leafy vegetables, can directly improve or protect vision in people who aren’t malnourished, says Neil Bressler, M.D., a professor of ophthalmology at the Wilmer Eye Institute at the Johns Hopkins School of Medicine. But eating a healthful diet may help control weight gain. Being overweight increases the risk of developing type 2 diabetes. This can cause a complication called diabetic retinopathy, which damages the blood vessels in the retina at the back of the eye.

20-20-20 rule
When looking at a computer, look away every 20 minutes and focus on something 20 feet away for at least 20 seconds.

There are many dietary supplements marketed for eye health, often with ingredients including zinc and the antioxidant vitamins C and E. They might benefit some of the 1.8 million Americans age 40 and older who are affected by age-related macular degeneration (AMD). Dry AMD occurs when the cells in the macula—the part of the eye involved in sharp, central vision—break down slowly, gradually blurring vision. If it isn’t halted, dry AMD can lead to wet AMD, in which blood vessels grow under the retina and leak, causing rapid and severe vision loss.

Published research known as the Age-Related Eye Disease Study, or AREDS, found that a supplement containing high levels of vitamins C and E, beta carotene, and zinc decreased the five-year risk of progres­sion from in­ter­­me­di­ate to advanced AMD by 25 percent compared with a placebo. But the pills had no apparent effect on the risk of developing cataracts or the loss of visual acuity. In addition, high doses of certain antioxidant nutrients might be harmful to some. For example, taking beta carotene has been shown to increase the risk of lung cancer in smokers.

What to do

Eat a healthful diet and keep your weight in check. If you develop dry AMD, talk with your doctor about the benefits and risks associated with taking an antioxidant supplement like the one used in the AREDS research (Bausch & Lomb PreserVision Eye Vitamin and others). Otherwise, save your money.

Regular eye exams

Even if your eyes look and feel fine, a periodic exam by an optometrist or ophthalmologist is important. An exam can detect early signs of eye problems that often have no warning symptoms, including diseases related to diabetes, glaucoma, and macular degeneration, at a stage when they might be more treatable.

You should undergo an eye exam with dilation every two to four years from age 40 to 54, and every one to three years from age 55 to 64. People age 65 and older should go every year or two depending on their eye health and other factors. If you have diabetes or a family history of eye problems, you may need more frequent checkups.

What to do

Regular eye exams are a must, but it’s useful to know which tests are important and which are potentially a waste of money. For example, people without symptoms of significant eye disease generally don’t need visual-field testing unless there’s a specific medical reason, according to the American Acad­emy of Ophthalmol­ogy’s Choosing Wisely campaign, which aims to reduce waste and harm in medical care. You can learn about other eye-related procedures at ConsumerReports.org/choosingwisely.  

Dry eyes: Common, but treatable

Dry eye syndrome affects some 5 million people age 50 and older, according to the American Academy of Ophthalmology. The initial treatment should focus on identifying the cause of the dryness, says Anne Sumers, M.D., an ophthalmologist in Ridgewood, N.J., and a spokeswoman for the AAO.


Common culprits include contact lenses, dry air, medications including antihistamines and blood pressure drugs, and underlying medical conditions such as an overactive thyroid. Taking steps to address the cause, such as using a humidifier at home or talking with your doctor about changing your medication, may be sufficient to resolve the dryness. You can also use an over-the-counter preservative-free artificial tear product as needed, Sumers says.


If those steps don’t solve the problem, you might benefit from using the prescription eyedrop Restasis (cyclosporine ophthalmic emulsion). But the drops may take several weeks to work, Sumers says. If you’re prescribed Restasis, your eye doctor might also prescribe a topical steroid to use with it during the initial period.


Editor's Note: This article appeared in the December 2013 issue of Consumer Reports on Health.
   

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