Another Reason to Get My Eyes Checked

2021: at the Costco optometrist

It's been four years since my last eye exam. Although the contact lenses and glasses still perform adequately, the eyeglass metal frames are bent, and it's probably time to make an appointment.

Here's an additional incentive: [bold added]

For years, doctors have known that high blood pressure, diabetes, smoking and excessive alcohol increase your risk of dementia.

More recently, a growing body of evidence also suggests a link to vision problems, leading to the influential Lancet Commission in 2024 to add untreated vision loss to the list of 14 modifiable risk factors for dementia. The commission, which issues periodic recommendations on public health matters, found that about 45% of dementia cases in the world are potentially preventable by addressing 14 modifiable risk factors — which also include high cholesterol, social isolation and hearing loss — and that 2% of cases can be prevented or delayed by addressing treatable vision loss.

That includes conditions like cataracts, glaucoma, age-related macular degeneration, nearsightedness, farsightedness and diabetic retinopathy (when blood vessels in the retina get damaged, often from poorly controlled diabetes).

A recent study published in JAMA also found that among roughly 2,800 older U.S. adults with dementia, an estimated 5% to 19% of dementia cases were attributable to vision impairment.

I get regular audio exams and updated my hearing aids last year. I should do the same with vision, not only because of the importance of sight but to keep senility at bay.

“When you’re depriving your brain of key sensory inputs like vision or hearing, those parts of the brain aren’t going to function as well,” [UCSF neurologist Dr. David] Soleimani-Mangooni said. “With decreased function, you can start to lose synapses or connections between cells of the brain. That can be a risk, potentially, for further cognitive changes.”

“The eyes are truly the window to our souls”

Maybe her eyes can tell us what she's thinking

The nature of consciousness has long been a fundamental question of human existence, and it's no surprise that scientists are employing scientific methods to improve our understanding of the subject.

For example, human beings are not "conscious" when they are asleep, so one criterion of consciousness is that a person must be aware of objects in the person's surroundings: [bold added]

[Researchers] used a combination of artificial intelligence, mathematics, and a close examination of the eye movements of individuals as they were shown images of people’s faces.

As it turns out, they found that important clues are revealed in the eyes. When people were shown clear images, their eye movements showed a distinct pattern that indicates they were aware of their surroundings. However, as the subjects were presented with progressively dimmer images of faces, the pattern of eye movement changed. Tracking these changes, [Yale Prof. Hal] Blumenfeld said, allowed researchers to discern whether the subjects actually perceived the face or not without asking them.

“The eyes are truly the window to our souls,” he said. “We can tell if people are aware of something by simply looking at their eyes.”

The eye-tracking tool allowed researchers to explore the amorphous dividing line between consciousness and unconsciousness, a state most obvious as we awake from sleep. People become progressively more aware of their surroundings as slumber recedes, a process that is controlled in a region of the brain known as the thalamus.

Ultrasound waves directed at the
thalamus can "jump start" coma
patients (Medindia)

The Yale researchers found that when people awake the thalamus discharges a brief pulse which jumpstarts the transition to consciousness. However, this activity is only a first step in a series of actions throughout the brain that leads to full awareness, they found. For instance, that initial pulse from the thalamus may fail to activate other neural networks, keeping the individual unconscious of most surrounding stimuli. However, the pulse can also activate neurons involved in processing visual cues in the frontal cortex, which in turn amplifies circuits involved in arousal and attention. At the same time, signals irrelevant to the event are turned off.

To those of us who have friends or relatives who regularly experience visual and/or auditory hallucinations, the research into consciousness and awareness can't proceed fast enough.

But for those like your humble blogger, whose brain is healthily grounded in reality (!) and is concerned about scientists being able to read thoughts through eye movements, wearing sunglasses is strongly recommended.

Cleanup in Aisle 70

Castro Valley Trader Joe's after the crash (Chron)

My late father gave up driving at the age of 90. His reflexes and eyesight, especially his night vision, had deteriorated to the point where he knew that there was too much of a risk to himself and others if he continued to drive.

Unlike Dad, some older drivers don't have the self awareness to quit:

The man who rammed his car through the front window of a Castro Valley Trader Joe’s on Thursday, injuring eight people and spilling debris across the floor, was a 90-year-old Hayward resident apparently trying to park.

The accident left a bizarre scene, a 2005 gray Toyota Avalon sitting among red shopping carts and racks of colorfully packaged organic cereal. The eight people injured included a 5-year-old child and a Trader Joe’s employee. Four were taken to hospitals by ambulance, while the other four were treated at the store.

Though the man is not facing criminal charges, the incident represents a growing concern on Bay Area roads, which the California Highway Patrol has begun to tentatively address: the ballooning population of older drivers...

A spokesperson for the California Department of Motor Vehicles did not immediately respond to questions about requirements for older motorists; state law mandates drivers who are 70 and older to renew their license every five years, and take a vision and written test, but not a behind-the-wheel test.

Your humble blogger hasn't reached the point where he (thinks he) is even close to being unable to drive, and unless forced not to do so, I'll keep my license as long as I can. The plan is eventually to use the car only in case of emergency and switch to public transportation or taxis for normal transportation needs.

Maybe in ten years owning and/or subscribing to a driverless car will become reality, and that will be another option.

In any event Trader Joe's will have nothing to fear from me.

Gene, Looking Keen

Gene has been a member of our congregation for over 20 years. His guide dogs are a fixture in the pews, lying still and quietly throughout the entire service and setting a good example for the children (and many of us adults).

Gene reads the lessons once a month and doesn't skip a beat using the electronic refreshable braille display.

He has a favorite thing he likes to do. On Palm Sunday he announces to everyone that they should bring bells to ring on Easter Sunday, especially when "Hallelujah" is spoken or sung. On Easter Sunday his bell rings the loudest.

St. Paul long suffered from an affliction ("thorn in the flesh"), yet nevertheless insisted on giving praise and thanks to God. "Hallelujah," proclaims Gene, and we can say no less.

The Meanness of an Urban Setting

The office is a mile from downtown San Jose.

My opthalmologist whom I liked very much, retired a few years ago, and the doctor who took over his practice seems to be competent.

However, lacking the personal connection with the new fellow, I find it hard to justify driving 30 miles to San Jose when there are other skilled opthalmologists nearby.

Our visit yesterday tipped the balance. We asked to use the restroom, and the receptionist told us to go to the Starbucks a mile away. At Starbucks the baristas said that the restrooms were not for customers (we offered to purchase something) but for employees only. They directed us to a Chipotle across the street, where we bought a burrito and used the facilities

A half an hour later we were back for the eye exam, which went as expected.

We don't blame the opthalmologist or Starbucks for the unhappy experience. The responsibility rests with COVID-19, public health regulations, and most significantly the homeless population that makes it difficult to find a restroom in an urban setting.

The businesses in the suburbs are far more relaxed about these things, which is why we will be changing doctors.

A Happy Result

After my opthalmologist retired from practice, I had not had an eye exam for four years, until yesterday.

The Redwood City Costco's optometrist-in-residence runs an efficient operation in a compact space. The various machines are placed on one table, and the patient moves down the line for the various tests plus photographs of the retina.

When the doctor went over the findings, they were better than expected. The cataracts had grown, but the corrected vision will still be good enough to pass the DMV test. There's no urgency in having cataract surgery.

In addition to eyeglasses she will prescribe hard contact lenses, which cost $80 apiece and were much cheaper than the $600 per year for soft lenses.

I expressed surprise about the contact-lens recommendation: Costco sells three different kinds of soft-lens solutions and none for hard lenses, which I assumed were passé for medical reasons.

She said that few people select the latter because of the time it takes to adapt to the irritation, and Costco only sells items that move. However, since I was acclimated 40 years ago there's no reason to go soft. Besides, soft lenses are bad for the environment.

From the start of the exam to the ordering of the glasses and lenses only an hour had elapsed. There's no surgery required now--as well as no glaucoma or macular degeneration--and I'll soon see better.

Once in a while a medical visit yields a happy result.

Dispelling the Fog

(WSJ graphic - click to enlarge)

At the beginning of the coronavirus panic we were given a few rules:
1) stay indoors as much as possible;
2) wash hands frequently;
3) practice social distancing;
4) wear a mask;
5) stop touching our face.

Recently we haven't heard much about touching our face---btw, what's up with that?---but that dictum made me switch from contacts to glasses two months ago. (We wouldn't want to stick washed and sanitized fingers in our eyes because rules.)

But wearing spectacles led to another problem: they fog up when wearing a mask, especially when exercising.

The WSJ describes a simple trick: place a folded tissue inside the mask at the top. It's the most useful advice I've read in the paper all week.

Surprising Development

Costco Optical will never run out of pliers.

At Costco Optical one can order prescription eyeglasses for $130--more if you want fancy frames, lenses that darken in the sunlight (polychromic), or multi-focals.

I chose the cheapest option--why invest in expensive glasses when cataract surgery is a likely possibility?

I' m exclusively an eyeglass- and hard-lens-wearer. Hard contact lenses last at least three years, and I can't, er, see disposing of soft contact lenses every day. Soft lenses encourage behavior that is bad for the environment: Flushing Your Contacts Does Terrible Things to Our Land and Oceans

For a lot of people, contact lenses are a daily necessity. Market research shows 45 million Americans, about one in eight, wear contacts, meaning the United States alone consumes somewhere between five and 14 billion lenses annually. And now, new research shows all those contact lenses may end up as micro-plastic pollution in our soil, rivers, and oceans.

An estimated 20 percent of contact-lens wearers, studied as part of a 400-person online survey, flush their lenses down the sink or toilet, as opposed to placing them in the trash as industry experts recommend. That amounts to 20 metric tons of plastic, or 20,000 kilograms (about 44,000 pounds), flushed per year—about the weight of a small airplane. The biggest culprit? Daily-use lenses, which occupy about 40 percent of the market.

As I slouch into my dotage, one surprising development has been that many of my penurious ways (transportation, cooking, consuming) have turned out to be friendly to the environment.

Things Will Get Brighter

High-res picture of my lens and retina.

"But doc, you said it would be ten years before I had to do something about it."

In 2015 he had spotted a cataract growing in my left eye.

Today he told me that the lens had clouded to the point where I could justify having the surgery now. He pulled out one of the favorite doctorly strategems ("if it were my eyes...")

[Sigh] at least the timing was propitious. It's open enrollment for another couple of weeks, so I'll check out the providers who cover cataract surgery in 2018.

I'm aware of one bad experience, but the dozen or so other acquaintances who have gone through it had excellent results.

It Goes Quickly

(Image from Annamated Adventures)

The science of aging confirms what we all know: deterioration is inescapable.

Every function of the human body declines 5% every 10 years,” says Michael Roizen, chairman of the Wellness Institute at the Cleveland Clinic. “That’s brain function, heart function, liver function."

The mind: "Speed of processing and working memory peak in the 20s and gradually start declining...Learning new information after 40 can be harder."

The eyes' afflictions: presbyopia, cataracts, glaucoma, and macular degeneration.

Hearing loss: "There’s no way to restore such hearing loss, since it’s caused by both genetics and environmental factors, such as exposure to loud noises and chemicals, as well as your diet and medications."

Muscle and bone loss: “When you lose core strength, you start having more and more trouble with balance...The combination of muscle and bone loss becomes a real problem when people reach their 60s and 70s."

We are fortunate to have more than a few friends and relatives who are in their 80's and 90's, but every one is a shadow of their mid-70's selves. It goes quickly, doesn't it?

Old age is like everything else. To make a success of it, you've got to start young - Theodore Roosevelt

We've been making regular visits to a relative at Brookdale in San Jose.
Very nice, but even the cheapest level of service is $5,000 per month.

Cheap by Waterfront Standards

Infrared image of a subject sitting on a bench.

While yesterday's visit to Super Bowl City didn't live up to expectations, I was glad that we went. The content was mediocre, but San Francisco impressed with its organization, security, and minimal (tolerable?) disruption to city life. Super Bowl 50 demonstrates to the Olympic Committee that the SF Bay Area could be a viable host.

The day wasn't lost; we spent a couple of interesting hours at the Exploratorium science museum. Though we're members, we've delved deeply into only 20% of the exhibits.

The Exploratorium is normally very crowded on weekends. This Wednesday afternoon it was empty. The $29 adult admission may seem high, but it's cheap by San Francisco waterfront standards.

The Original

The mind's eye switches between the columns and the shadowy figures.

Contained within the vision and hearing section of the Exploratorium is the original "angel column" optical illusion.

In 1989 David Barker designed, lathed and painted the columns, an achievement perhaps unappreciated in an age of high-speed computers, rendering software, and 3D printing technology.

Keeping an Eye on It

The ophthalmologist compared the scans with those taken two years ago. The faint shadow had grown.

"You don't need to do anything about it now, but you will need cataract surgery in 10, 15, or 20 years."

The doc wasn't very encouraging about whether I could do anything to prevent the condition from worsening. Some evidence exists that diet and wearing sunglasses outdoors could arrest the development of cataracts, but currently there's little consensus. In the meantime there's no downside to trying those measures.

On the whole the news was good: eye pressure was normal, and the nearsightedness hadn't worsened. I typed in a reminder on the iPhone to come back next year. In the 21st century eyesight is the sense that one can least afford to lose.