Vision Check: A Q&A with Dr. Mital Patel, Optometrist for National Eye Exam Month

August is National Eye Exams Month. This week, I sat down with Dr. Mital Patel of Classic Vision Care to dive into the aging eye and the importance of eye exams for aging adults. Here's a recap:

Can you tell me the similarities/differences between optometrists and ophthalmologists? 

The difference between optometrists and ophthalmologists is pretty simple. Ophthalmologists do surgeries and optometrists do not. Optometrists diagnose and manage certain eye diseases until they need surgery. I went to four years of optometry school, and then did a one year residency in ocular disease. To become an ophthalmologist, you have to go to four years of medical school, and then do a residency in whatever specialty you’re interested in. 

So, both are eye doctors, and both can treat and manage many different eye diseases, but ophthalmologists are trained to do surgeries, whereas I/optometrists are not. If I am managing an eye disease and then you need surgery, I will refer you out to an ophthalmologist. I also specialize in contact lenses and getting you the right glasses prescription, dry eyes, things like that. I can also treat and manage certain levels of glaucoma, depending on the severity. If we do need any procedures or anything, we work very closely with other ophthalmologists. 

Do ophthalmologists also provide basic vision care outside of surgery? 

Most of them will not give you eyeglass prescriptions and glasses or contacts. They prefer being in the operating room doing surgeries. I’m sure you can find some that will give you a glasses prescription, but that’s not what they do all day every day, so it’s better that you see an optometrist for glasses and contacts.

What are some key myths and facts related to vision and aging?

Most people think vision loss comes with aging. In reality, we can do our best to keep your vision nice and sharp for as long as possible with comprehensive eye exams and diagnosing and treating early. For example, you might feel like your vision is getting dimmer and things just aren’t as sharp and clear as they used to be. You’re always turning the lights on higher. That could be the start of some cataracts developing, which is the lens that you’re born with. As we get older, it tends to get cloudier and things start to feel more dim and not as sharp and clear as they used to be. 

Cataract surgery is really easy nowadays - it’s about 5-10 minutes of surgery time, and you get to go home right afterwards! The ophthalmologist will take out the lens that you’re born with and put in an artificial lens that usually has your prescription built in. So if all things go well, you would be less dependent on glasses as well after cataract surgery. 

What are some of the most common eye exams you’d recommend for aging adults? What does each exam look for, and how frequently should they be completed?

The most common eye exam that everybody should be getting is a comprehensive eye exam at least once a year. Depending on your specific situation, they can be performed more frequently. In your comprehensive eye exam, we may find that you are struggling with dry eyes and we need to start you on some dry eye treatments. And then we may do some follow-ups in between maybe 6-8 weeks, and then a couple every few months.

If you’ve got diabetes or high blood pressure, depending on your A1c and the severity of your high blood pressure and diabetes, it can range from seeing you every 2 months to every 6 months. If you are a glaucoma suspect, which means your optic nerves look suspicious for glaucoma, which is an eye disease that we definitely check for at your comprehensive eye exams, those also may require some more follow-ups.

Everyone should start with a comprehensive, full eye exam at least once a year. 

Why is it so important for aging adults to get routine eye exams? Is there a preventive goal to it, or is it more early detection and intervention?   

Both. So preventatively, if you come into our office, we will actually spend some time talking about the things that you can do in your normal daily activities to help prevent some of the eye diseases like macular degeneration, which is a really common eye disease. A simple thing that you can do for that is wearing the right kind of sunglasses. So we’ll discuss what makes the right pair of sunglasses and why you should be wearing them, as well as what kind of foods you should be eating. A lot of people say, well, carrots are good for your eyes. Well, carrots are great for your eyes, but that’s not the only thing that’s good for your eyes. Sweet potatoes, dark leafy green vegetables, kale, spinach, collard greens, wild cod fish, omega-3s are really good for your maculas and eye health. So we would discuss those types of things with any eye health issues. 

For early detection and intervention, if there is something going on in the health of your eyes, you want to start managing it earlier so that you can stay on top of it before it starts to progress into something worse, causing vision loss. Because once you have vision loss, it’s almost too late, so we want to catch things early. 

What are the most common eye health diagnoses in older adults?

We talked quite a bit about cataracts and glaucoma already. Macular degeneration is another eye disease that can come with age. If you’re very nearsighted, you’re at a higher risk of macular degeneration. There are other risk factors as well, like if you have family members that have it. These are all questions that we would ask when you come in for your exam. We would take images of your maculas and a scan that lets us look at all the different layers. 

The macula is this tiny little spot in your retinas that is your focusing system. That’s what allows you to see centrally. So when you get macular degeneration, you will find deposits or bleeding spots, so you can’t see in the middle of your vision, just peripherally. It’s almost like if you walk around with two fingers right in front of each eye blocking the middle of your vision, but you can see around the fingers. 

There’s dry macular degeneration and wet macular degeneration. Wet means that there’s active bleeding in your macula, which would require an ophthalmologist. Usually, you may have to get injections in the eye to stop the bleeding and keep whatever vision you do have left intact. Sometimes, you can start noticing some of those changes really early on, so that way, we can catch it early and hopefully dry degeneration doesn’t turn into wet macular degeneration. That’s the bad one–you don’t want wet macular degeneration because it really takes a toll on your quality of life because of how it affects your central vision.

I’m aware that there are some health conditions that can lead to eventual vision loss. Can you highlight a couple?

Overall, all the issues are connected. If something is affecting your whole body, like diabetes and high blood pressure, it’s definitely going to affect your eyes as well. Anything from autoimmune diseases, thyroid issues, multiple sclerosis, any rheumatoid arthritis, any inflammatory conditions – all of those things can cause changes in the back of the eyes. That’s why getting your eyes checked is really important, just like going to the dentist. Sometimes things will pop up in the eyes that will indicate something going on systemically in the rest of your body. 

As an occupational therapist, I routinely screen my patients for visual functions. My goal is to assess for any impairments that may impact their functional abilities, and then either provide visual aids or modify tasks to support their function. Is this an area addressed by you/your colleagues as well?

Yes. So we can test for contrast. We check color vision and things like that too. Usually, if you’re color blind, you probably would have known by now before you’re aging, probably as a young adult. 

Our brain is really interesting. If you have one eye that’s weaker than the other, your stronger eye tends to become more dominant. So a lot of times, when you cover one eye and you compare, you’re like, “Wow! I really can’t see well out of one eye.” It’s because in your normal life, the dominant eye starts to take over and our brain can just adapt and figure out how to go about your normal functions. 

So yes, we look for all of that. We make sure the eyes are aligned and tracking properly. We check how they react to light, because that can indicate neurological issues. We check your side vision because glaucoma is a disease of the optic nerve that affects your side vision, and most of us don’t pay attention to our peripheral vision. We wouldn’t even know if something was missing out there. 

What is one takeaway you’d like the audience to consider as it relates to vision, aging, and eye exams? 

If you’re noticing any changes with your vision or the comfort of your eyes, make sure you tell someone. Go get your eyes checked, and tell them that your eyes are watery or bothersome, itchy, whatever it may be, or that things aren’t sharp and clear like they used to be. Just be vocal and make sure your doctor listens to you so you can figure out what’s going on. Don’t just say, “Oh, I’m just getting old,” because that’s not a good enough answer. 

===

At Caregiver Consulting & Healthy Solutions, we are dedicated to helping you navigate aging together.

===

#vision #aging #seniors #olderadults #eyeexams #nationaleyeexammonth