Pathak, MD, FACP, DipABLM: Welcome to the WebMD health discovered podcast. I'm Dr Pathak, WebMD's chief physician editor for health and lifestyle medicine. Today, we're exploring a topic that affects nearly everyone as they age: eye health with increasing screen time, longer hours on digital devices, and the natural aging process.

It's more important than ever to understand how we can protect and preserve our vision from recognizing early signs of conditions like cataracts and glaucoma to understanding how lifestyle changes can impact our eye health, this episode will provide invaluable insights into what it means to keep our eyes healthy at every stage of life. We'll unpack the essentials of maintaining eye health as we age, including common symptoms from eye strain, presbyopia, and dry eyes, and why annual exams are critical for everyone.

We'll discuss age related eye concerns like cataracts, glaucoma, macular degeneration, exploring preventive steps and treatment options that can make a difference. Whether you're a digital device user, or someone in their forties or fifties starting to notice visual changes, this conversation offers a wealth of practical advice to help you take proactive steps in preserving your site.

But first let me introduce my guest, Dr Jennifer Chinn. Dr Chinn is a network doctor with VSP vision and a second-generation optometrist at Dr Chinn's Vision Care in sunny San Diego, California. Dr Chinn specializes in glaucoma, retinal disease, and low vision treating patients of all ages at her family practice.

She's also passionate about giving back volunteering on mission trips across the world with the volunteer optometric services of humanity to provide eye care services to underserved populations, welcome to the WebMD Health Discovered podcast, Dr Chinn. 

Chinn, OD: Thank you. I'm so honored to be here.

Pathak: I am really excited to jump into our conversation. I'd love to just talk about your own personal health discovery, your aha moment around eye health and the work that you do.

Chinn: Yes, absolutely. So as mentioned previously, I am a second-generation optometrist, so I grew up around all things eyes and I kind of knew that I always wanted to go into eye care, but I didn't really have my aha moment until I met a friend of mine in college who actually is diagnosed with a genetic eye condition called retinitis pigmentosa and getting to know him and hearing some of the stories that he had about how he discovered how he had the condition really hit home for me and was really impactful.

So, as a young child, he was one of eight brothers. And being boys they would be rambunctious and kind of play around with each other a lot. And at home, he would trip on things, run into walls. And maybe if he was looking for a toy, he wouldn't be able to find it as easily. And so, his brothers and family just thought, oh, maybe he was just, you know, a little clumsy or something like that.

And it wasn't until he got a little bit older that him and his brother started playing sports. Football, basketball, and baseball, that he wasn't able to keep up with his brothers. And that's when his family really started to realize, hm, something may be a little bit different. So, they decided to bring him into an eye doctor and that's when he was diagnosed with retinitis pigmentosa.

And so that story really impacted me because it made me realize there's such a need for education out there on the importance of getting an eye exam, no matter whether your family has vision correction or not. And being able to utilize my place as a clinician as well as my social media platform to be that advocate and educator for people to start taking care of their eye health and their vision.

Pathak: What we're noticing a lot in my primary care world and amongst my own friends of a certain age, as we come into our forties and fifties, there are certain expectations that our vision is going to diminish over time.

I would love to just first start with that. So, what is part of natural eye aging? What kinds of symptoms should we expect as we get a little older?

Chinn: These days we are all using our eyes a lot more than we used to with being on computers a lot, scrolling social media, reading, helping us track targets and playing sports outside. So we use our eyes a lot. And that's why vision is one of the first senses that we notice starts to decline as we age.

So, some of the symptoms we might experience are headaches, eye strain from sustained periods of time of doing up close work, or blurry vision up close, and also noticing that your eyes are more sensitive to your lighting environment. So, if it's darker it's harder for you to pick up on details. So definitely in dimmer restaurants or nighttime driving, those tend to be some of the symptoms that a lot of patients will experience.

Pathak: So that's really helpful in terms of the types of symptoms you might have started noticing. I've also noticed with a lot of my friends and myself that if I was once comfortably able to wear contacts, I just feel like it completely dries out my eyes a lot of us are shifting to just wearing our eyeglasses more. Is dryness of the eye also something you see more as you age?

Chinn: Absolutely. As our eyes are changing, as we have more wear and tear and using our eyes, we definitely experience more dryness. And there's a number of factors that contribute to why we experienced dryness when we age. Some of that can be hormonal. Some of that can be normal wear and tear. Some of that can be maybe we have some systemic conditions that we're taking medications for that contribute to it.

And then also we have to think about how our body changes as well. So when we blink, that's actually how we create tears. So as we age, our muscles may not be as flexible, as strong as they used to. Our blink patterns may change as we age as well. So we may not be able to blink and produce the same quantity of tears as we used to when we were younger. 

Pathak: In terms of what that means for getting ourselves evaluated or coming to see an eye care professional, are there certain symptoms that we should just say to ourselves, okay, this shift means I need to get my eyes checked. I know a lot of people do a lot of self-care, try to do a lot of things on their own before they go to see an eye doctor because they just say, okay, well, this is just part of getting older. So, what are your thoughts? What are your recommendations on how do you counsel someone when they first start noticing some of these changes?

Chinn: One of the key things to keep in mind that you could be doing for your own self care is actually to schedule an annual eye exam with your eye doctor. So, even though there can be things that you can do on your own at home to maintain or help to preserve changes.

It's definitely important to go in so that they can help provide you better solutions and actually diagnose you with things if you have them. So they may be able to find signs of vision changes, provide solution for potentially reading glasses or contact lenses. Or if you are experiencing issues with dryness, they'll be able to diagnose.

The specific type of dryness that you have and potential solutions that may be able to help with that. So, symptoms of course, any vision changes, light sensitivity, headaches, eye fatigue, sometimes even more serious, concerns you may have like dark spots in your vision, eye floaters, any discomfort that you experience with your eyes, definitely schedule an eye exam with your eye doctor.

Pathak: Can you talk a little bit about what is something to you that would be like a red flag symptom that would suggest that you should get an eye appointment sooner rather than later?

Chinn: Yes, that is an absolutely great question. So pain of any sort. If you see any serious signs of flashes of light or floaters would definitely be very serious to go in also difficulty with some peripheral vision loss, or maybe central vision loss. Anything that doesn't really go away quickly, you definitely want to go in.

So, those could be signs of things like glaucoma, macular degeneration, or the development of cataracts as well. Those are all some more serious eye diseases or eye conditions. So we're going to be looking at the different ways that definitely need to be diagnosed, treated and manage, and it's especially better if we can diagnose them earlier so that we can treat it earlier.

And then we can also prevent potential irreversible changes to your eye health and your vision.

Pathak: So let's go step by step from the preventative visit to when there's something actually going on. So when would you suggest that someone starts with the annual eye exam if they don't have something like diabetes where you know that your primary care doctors probably told you that you need to go for an annual eye checkup?

Chinn: Actually, we recommend that everybody go in to get an annual eye exam, even as early as six months old, and then after that would be three years. And then every year after that, especially for children before starting the school year, so everyone should be getting annual eye exams because many people do not notice any symptoms of change to their vision, especially younger people.

But even my children. But I also have patients that are 40 years old that come in that have never had an eye exam before and they come in I find that they have a pretty significant prescription but they just don't realize that they are not seeing the world the way they should be because they have nothing to compare it to. So definitely annual eye exams should be part of your normal routine every year. Just like getting an annual physical getting your teeth cleaned because it's something that can help prevent vision loss prevent any eye conditions down the line and you can get great solutions from your eye doctor on how to do those things.

Pathak: Annual eye exam. So that's step one. Step two, when they come to you, we're here for our annual eye exam, what are some of the things that you're screening for or checking for beyond vision loss?

Chinn: Absolutely. So besides visual acuity or vision loss, which is inability to read the letters on the screen, we're also checking for things like color vision, contrast, perception, peripheral vision loss, your eye health as well. So, if you didn't know, when you come in for an annual comprehensive eye exam, optometrists and eye doctors can actually diagnose up to 270 different eye related conditions or health conditions.

Just by looking at the health on the inside of your eyes. So those are all different things like diabetes, high blood pressure, even thyroid issues, inflammatory conditions that you might have. So those are all things that we can actually diagnose by just doing a routine comprehensive eye exam.

Pathak: So, let's dig into the visual acuity piece, because I think that's what a lot of people just expect. Okay. At some point, I'm going to just need to go and pick up some readers and that's it’s just going to happen. So talk to us a little bit about when those changes start happening. How do you make that diagnosis? And can we do anything to prevent it or slow it down?

Chinn: As we age is natural for our eyes to grow and change and adapt to the environments that we're putting them through, especially nowadays for most of us using digital devices a lot. So, when you come in for an annual exam, we will check your acuity, which is showing you some letters on a screen that you'll read.

And they're in this chart form that decrease in size. So we're measuring how well you can see at a certain distance. And when you go in, your doctor is going to provide you a solution to improving your vision. So what you can do. Besides going in for your annual eye exam is of course to maintain a healthy lifestyle.

So eating healthy exercise, wearing sunglasses or sun protection when you're outdoors are all ways to maintain your eye health and vision as much as possible. But the visual acuity part, it's definitely good to go in for the annual eye exam so that we can check, we can monitor, we can prescribe you the prescription or correction that you may need, if there is a need for it.

Pathak: So talk to us a little bit about presbyopia. What is it? When do we need to start thinking about it? And what are some of the solutions that you talk to your patients about? Okay.

Chinn: So presbyopia is a process that everybody goes through and is an aging process. Definitely kind of a wear and tear process that we go through where we begin to have difficulty seeing up close. So a lot of people start to notice they can't see their phones as well. So they try to kind of move it away from their face or closer to the face to try to get it in more focus.

And it's basically an inability. to what we call accommodate or focus at near. So what happens is there's actually a lens on the inside of the eye that kind of works like a quote unquote muscle. So when we're young and we bring something up close to read like a book or an iPad or something like that, that lens quote unquote flexes for us.

And that's how we're able to focus up close. As we age, just like the rest of the muscles in our body, this is the analogy I use for my patients as well, is our muscles are not as flexible. They become a little bit more stiff when we get older. So that is a similar process that our lens on the inside of the eye goes through, is it starts to harden and stiffen as we get a little bit older. So it's less flexible, less able to change focus and shape for us to see up close. And that's why that process of presbyopia or difficulty seeing up close doesn't happen overnight. It's not like you wake up one day and then all of a sudden you can't see everything up close. It's a gradual process that people start to realize, my computer is a little bit harder, like my phone is definitely harder.

But then gradually at some point, then it gets to a point where they're noticing. Yes, I definitely need reading glasses, but this process usually begins around your forties to fifties, but I've seen it in some patients even as early as the late thirties these days because of the amount of up close work that we do.

So the more focusing we're doing, the harder the eyes are working, the harder this lens is working for us, especially for sustained periods of time. So those symptoms. Up close being a little bit blurry and definitely needing better lighting as well as some eye fatigue and headaches are some of the things that you can start to notice as symptoms of presbyopia and then some of the solutions that your eye doctor might offer you are of course reading glasses depending on your prescription they may offer something like occupational glasses or multifocal lenses to give you multiple ranges of focus that you can see at so not only the computer but your cell phone up close, and then also some contact lenses may also be a great solution that you can use to improve the vision up close when you're going through this process of presbyopia.

Pathak: And does that at some point sort of even out, or does that just continue to worsen over time as you age?

Chinn: Fantastic question. So even though it starts around the 40s and 50s usually it'll stabilize around the mid to late 60s is most of the time we notice patients will kind of stabilize and they will just have a consistent reading prescription or up close near prescription that can help them see up close.

Pathak: You mentioned that some of the things we’re doing ourselves, a lot of us we're at our desk, we're at our computer, we're digitally sort of connected at all times of the day and hours of the night. So as a primary care doc, I think a lot about, okay, so sedentary lifestyles, get up and walk, you know, every hour, et cetera, to just sort of get some activity in what do you advise people if they are on a screen throughout their day? Do you have advice for people for ways to break it up? 

Chinn: Absolutely. That's a fantastic question. So we are all the same. Glued to our digital devices these days. There is something in our industry called the 2020 rule, which is every 20 minutes, take a break for 20 seconds and look 20 feet away. So that can relax your eye muscles from over focusing up close again.

That sustained period of doing one thing for too long is what. Causes a lot of that fatigue and I strain and those changes with your vision. So if you can look 20 ft away for about 20 seconds, and I always tell my patients during that time to try to actively blink the eyes because we tend to stare a lot when we're on digital devices that can help with the tear production and that dryness that you might experience.

So taking breaks is definitely super important as well as drinking enough water and making sure that you have the adequate prescription for yourself. So your eye doctor will be able to determine that for you. But sometimes some people feel like when they're on digital devices because it's closer to them, they don't have to work as hard.

But because of the fact that they're doing one thing for a sustained period of time, and especially if they're patients, like maybe you're an accountant or a lawyer and you're reading small details and small, fine print for long periods of time. That's what's going to hurt your eyes the most in the sense that they have to work so hard for you.

So definitely, those are some of the things that we kind of talk about on a consistent daily basis with my patients.

Pathak: Can you talk a little bit more about what specifically you counsel your patients on when it comes to lifestyle for their eye health.

Chinn: Yes, so spending time outside is super important because, again, that relaxes is the eyes from doing the sustained up close near work. So especially for children these days, getting them outside to play, go to the park, playing sports is really helpful. It's also helpful for their development because having things like color perception and depth and all the different things that you see in a visual environment outside helps their eyes to develop even sharper and clearer vision and react to different types of environments as well.

So of course, when you're outdoors, even if it's not sunny outside all throughout the year, you should always have sun protection of some sort to protect your eyes from harmful UV. So lots of exposure to UV over many, many years can cause things like cataracts to develop over time. And then of course, having a healthy lifestyle.

So exercise is always super important. Keep that body moving, keep the blood flowing. As well as having a nutritious diet. So eating things like green leafy vegetables, fruits, high in antioxidants, any nutrients that have high amounts of omega threes or beta carotene are always helpful for your eyes, especially, but also for your overall health.

So those are some of the things that we talk about as well as getting that annual exam, just so that we can check to maintain and see where your vision is at and see where your eye health is at. 

Pathak: I'd like to kind of funnel down now to certain things that might impact smaller populations, but just learn more about that glaucoma. Cataracts, age related macular degeneration. So can we start with cataracts? Is that something that is going to affect all of us? Is there a genetic link? Are there things we can do to prevent cataracts?

Chinn: So cataracts is something that almost everybody is going to develop. There's several different types of cataracts that you can develop and the type that you develop will determine whether you need surgery, whether you need correction or not. And the reason why cataracts develop the most common reason is cumulative amount of sun exposure.

So the ways that you can prevent them, of course, especially from when you're young, too much older is of course, wearing sun protection. So sunglasses or light reactive lenses, also making sure that you wear hats. Especially if you're outdoors for a longer period of time. If you do develop cataracts, again, it's not something that develops over nighttime.

It's a very slowly progressing development of the cataract, which is basically a fogginess of the lens. So things start to get harder and harder to see. It's almost like you're looking through a fog or like frostbite. Sometimes some people say nighttime driving gets a little bit more difficult. Some other symptoms are light sensitivity, and some, dulling down of colors.

So a lot of patients come in saying like, oh, the grass is not as vibrantly green as I remember it being. So coming in for the annual eye exam, that is the greatest way for your optometrist or eye doctor to diagnose you with cataracts, but also see the progression and see how far along that process of the cataract development you are and provide you some great solutions to how you can prevent them from getting worse.

But the main thing I always tell my patients is always to make sure to wear sun protection when you're outdoors.

Pathak: Glaucoma. Can you talk a little bit about symptoms to what you're looking for in the office and possibilities for treatment?

Chinn: Absolutely. Glaucoma is a condition that damages the optic nerve due to high eye pressure, and the symptoms typically are that peripheral vision starts to decline. So, like, nighttime becomes a little bit more challenging for people, but for a lot of patients with the important thing to keep in mind is.

With a condition like glaucoma, most patients don't actually have any visual symptoms, which can be scary. We kind of call it the silent condition because a lot of people don't realize, especially when they're peripheral vision, that it starts to change because it's much harder to notice that peripheral vision changes, rather than if you have central vision changes.

So, glaucoma is something that can be genetic. There can be a lot of other factors like race and lifestyle that also contribute to it, but definitely some of the things that we check for during an annual eye exam are your eye pressure. We check how your optic nerve looks and how healthy it looks as well as your peripheral vision awareness or peripheral vision tests.

And that allows us to screen you to see if you're at risk of developing or you have any signs of change that could indicate that you might have the condition glaucoma.

Pathak: And different from cataracts, not everyone is going to, over time, develop glaucoma.

Chinn: That is true. Not everyone will develop glaucoma, but there are some populations that might be more prone to developing them again. We mentioned race. And sometimes, age as well as one of the biggest factors and then sometimes hereditary.

Pathak: And then one more condition while we have you, age related macular degeneration. What are some of the symptoms? It's in the name, age related, but does that mean that everyone is potentially at risk? Are there people more at risk than others, and is there anything we can do to prevent or slow it down?

Chinn: So age related macular degeneration, just like you mentioned is more common as we age. There are certain populations that are definitely more risk than others. So people that definitely have lighter eyes and lighter skin tones, it does have some hereditary component as well. So again, race plays a role into that and then age as well. And some of the signs that people might notice is that their vision in the central area. So anything that they're looking at in high detail, so maybe reading a book or recognizing somebody's face is not as sharp as they remember it being. So details start to get a little bit more fuzzy or blurry around the edges and definitely in the central vision.

But again, just like glaucoma, this condition is very slowly progressive, and lots of patients will not notice any symptoms because it doesn't happen overnight. You don't wake up one day and everything goes blurry in the middle. It's a very slowly progressive condition, so again, coming in for the annual eye exam is a great way for us to catch the early signs of it, but those are some of the symptoms that some of our patients might experience with our age-related macular degeneration patients.

Of course, sun protection is super important because anybody that has lighter eyes is more prone to light damage, which means they're more sensitive. They don't have enough light pigment to block the light away. So always using sunglasses when they're outdoors and a hat for sustained periods outside.

And then, of course, eating a healthy diet is always going to help to maintain healthy tissue on the inside of the eye. So eating green leafy vegetables, fruits, tiny antioxidants are very helpful. And then if you are diagnosed with the condition. Your eye doctor will give you other solutions to help to maintain and prevent further vision loss or eye health changes with this condition.

Pathak: My goodness, this has been an amazing whirlwind tour of the eyes and eye health. Anything that you wish I had asked you that I didn't, myths, misconceptions that you're hoping to dispel in our time together? 

Chinn: Absolutely. I think a very common misconception is that you don't need an eye exam unless you have vision correction or vision problems like we mentioned previously There are many eye diseases and conditions that don't have any symptoms so people can come in here We can test their visual acuity. They can read the lines of letters like the 20/20 letters and see just fine, but they could also have glaucoma, or they could also have macular degeneration.

They could also have dry eye disease or cataract development. So seeing 20/20 is only a very small portion of what your vision actually is. Your vision is color, depth perception, contrast perception, peripheral vision. So definitely everybody should be coming in every year for an eye exam because it's not only checking your vision it's also checking your eye health as well.

Pathak: And you've given us so much advice about what we can do to maintain healthy eyes as we age from lifestyle to sun protection. Any other final thoughts? 

Chinn: The biggest piece of advice that I have that I've been hitting hard this whole time is just scheduling that annual eye exam so scheduling the eye exam is going to be a great way to monitor your eye health changes and vision changes and then besides that the sun protection eating healthy Exercising as well and then last thing would be of course not to smoke any cigarettes. Which most people don't do these days, but those are kind of the key things that I always tell my patients.

Pathak: Thank you so, so much for being with us today.

Chinn: Thank you so much for having me. It was such a pleasure.

Pathak: As we wrap up this episode, let's reflect on some of the valuable insights shared by Dr Jennifer Chinn on aging and eye health. We learned that eye care is about much more than just vision correction. It's about preserving our overall eye health. Dr Chinn emphasized the importance of annual eye exams for everyone, regardless of age, whether or not you wear corrective lenses.

These checkups are crucial for catching silent but potentially serious conditions like glaucoma and age-related macular degeneration, which often don't show early symptoms. Dr Chinn also shared practical lifestyle tips that can help us protect our vision as we get older. Simple steps like the 20/20/20 rule, eating a balanced diet, rich in antioxidants, and wearing sunglasses with UV protection all year round can make a meaningful difference. 

The takeaway is clear with a combination of regular eye exams, preventive habits, and healthy lifestyle choices, we can all take proactive steps to maintain clear vision and eye health throughout our lives. Thank you so much for joining us on this journey to discover the best ways to age with healthy eyes.

To find out more information about Dr Chinn, visit Dr Chinn's Vision Care dot com or find her on Instagram @DrChinnChinn. We'll have more information about how to connect with her in our show notes. Thank you so much for listening. Please take a moment to follow rate and review this podcast on your favorite listening platform.

If you'd like to send me an email about topics you're interested in or questions for future guests, please send me a note at [email protected]. This is Dr Neha Pathak for the WebMD health discovered podcast.