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Eyes Have It: Tips on Good Eye Habits for Pathologists

Today, I made decisions that will drastically impact patients' medical treatment and lives. I determined diagnoses that required years of focused training and practice to learn. Every day as pathologists, we look through our microscopes and do these amazing things. It is easy to take for granted the most basic part of us without which we could not do any of this—our eyes. 

Like a surgeon's hands or a musician's ears, a pathologist's most valuable asset is our eyes. However, we rarely hear pathologists speak about protecting their eye health. We have of course heard a few pieces of advice that we all were familiar with growing up, like, "Don't sit too close to the television," "Don't squint," and of course, "Eat your carrots." Sometimes, these apparent truisms are not always accurate. For example,  during World War II, the British Royal Air Force said carrots were the reason for their pilots' successes during nighttime Blitzkrieg attacks? In reality, this was to hide the fact that on-board airborne interception radar had been invented. 

Can pathologists get more sound and scientific advice? To learn how an early career pathologist can maintain visual acuity and healthy eyes in a profession dependent upon them, I sought answers from a specialist. And that specialist is Dr. Whitney Lomazow, an ophthalmologist practicing in Seattle, Washington, who graciously answered my burning questions.

What are the most important steps someone can take to ensure the health and visual acuity of their eyes?

Dr. Lomazow

Just like everything else in medicine, there are no magic bullets for eye health. For all of my patients, I recommend a healthy diet with lots of green, leafy vegetables, regular moderate exercise, and no smoking. It's a good idea to wear sunglasses with 100% UVA and UVB protection even when it's cloudy, and for my patients with dry eyes, take a fish or flaxseed oil supplement. If you are a contact lens wearer, don't sleep, shower, or swim in them, and if you enjoy activities with potential for ocular injuries, please wear safety glasses/goggles. Know your family history regarding glaucoma, macular degeneration, and other hereditary diseases of the eye, and see an ophthalmologist if you believe you are at higher risk for these conditions. The most important thing is to see an ophthalmologist if you notice any changes in your vision or other concerns regarding your eyes.

Pathologists spend much of their day looking back and forth between a computer monitor and into a microscope. Is there a risk associated with the constant toggling and changing focus?

Dr. Lomazow

There are no studies showing that frequent shifts in focus lead to permanent eye damage, but it can certainly lead to things like eye strain and increased dryness. The American Academy of Ophthalmology recommends the 20/20/20 rule to decrease the risk of ocular discomfort: every 20 minutes, shift your focus to an object 20 feet away for at least 20 seconds. Eye strain usually presents as pressure sensation or headache behind or around the eyes and will resolve with cessation of focusing activity. 

Ocular dryness can present any number of ways, but some describe symptoms of "fluctuating" vision that improves with blinking, watering, pressure sensation, burning, or foreign body sensation with blinking. I recommend using an artificial tear, not a redness reliever, just before starting activities where eyes become dry. They can be used periodically throughout the activity if symptoms start, but If you need to use an artificial tear more than four times a day, I recommend preservative-free tears, which are sold in individual vials, rather than a large bottle. If your office seems excessively dry, you can consider using a small humidifier. If your eyes always seem to be dry, even with regular artificial tear use, I recommend an appointment with an ophthalmologist to discuss other treatments that may help to prevent the symptoms from starting. Contact lenses can exacerbate dryness, so I recommend at least one day per week for a contact lens "holiday" where patients wear their glasses.

Digital pathology, whereby slides are scanned and evaluated on a computer monitor, is increasingly being used in clinical practice and expected to rise over time. This will no doubt increase the time we spend staring at a monitor. What suggestions do you have for maintaining eye health?

Dr. Lomazow

Recently, many have started to discuss the role that computer use and specifically "blue light" has on the health of our eyes. There is no evidence that the light emitted by computer and phone screens will lead to vision loss. As discussed above, the 20/20/20 rule can help prevent symptoms of eye strain. The American Academy of Ophthalmology also recommends sitting approximately 25 inches, or an arm's length from the computer monitor, and positioning yourself so your gaze is slightly downward. If glare seems to be an issue for you, you can try a matte or polarized screen filter. Bright screens can increase eye strain, so increase the contrast on your monitor and, if possible, decrease the ambient room lighting (similar to a radiology reading room), so you can turn down the brightness of your monitor.

When looking through the microscope, pathologists often adjust the brightness depending on the tissue and staining being evaluated. Concerning eye safety, is the dimmest light possible best?

Dr. Lomazow

As stated previously, brighter light won't permanently harm your eyes but can increase your risk of uncomfortable eye strain. I recommend the dimmest light possible for you to safely make the correct diagnosis.

Are things like polarized sunglasses or special lenses worth the cost when outside?

 Dr. Lomazow

When it comes to ocular health, I recommend sunglasses with 100% UVA and UVB protection to be worn even when it is cloudy outside. Whether polarized, glare-reducing, blue-blocking, or other types of lenses are right for you is a matter of preference. Some people believe these lenses improve their vision and will happily spend more to buy them, while others haven't seen a significant distinction. Feel free to try different options and see what works for you.

Other than vision changes, what are some common signs and symptoms of developing eye disease?

 Dr. Lomazow

While blurry vision is the most common symptom that brings people to their ophthalmologists, they may experience other symptoms. The sudden onset of new floaters, especially when associated with arc-like flashes of light, or a curtain or shadow in your vision, can be associated with retinal issues and should prompt an urgent ophthalmology appointment. 

So-called metamorphopsia, or seeing straight lines as wavy, is also associated with retinal problems and should be evaluated promptly.  Sudden onset of binocular double vision, when each eye individually sees one image, but both eyes together see two, can be a sign of neurological issues. Sudden worsening of discomfort/pain in bright light, particularly when associated with new redness, can be a sign of ocular inflammation, infection, dryness, or ocular allergy. 

Of course, see your ophthalmologist if you have any concerning lesions on your eyelids or the eyes themselves. Importantly, there are many eye conditions which have no symptoms, or no symptoms until the late stages of the disease, so a routine, comprehensive exam by an ophthalmologist is recommended yearly or every two years.

For someone whose career depends on their eyesight, how safe is LASIK (Laser-Assisted In Situ Keratomileusis) eye surgery?

 Dr. Lomazow

This is a complicated question and one you should have with an experienced LASIK surgeon if you are seriously considering undergoing laser vision correction. For the correct patient, especially those with high myopia or hyperopia who cannot see the bedside clock without their glasses in the morning, LASIK can be a life-changing procedure that leads to years of clear vision. 

Of course, countless variables are considered when deciding whether or not someone is a right candidate for laser vision correction, both qualitative and quantitative, and LASIK on the incorrect patient can lead to very severe complications. While the vast majority of patients who elect to have laser vision correction are happy, no one wants to be a part of the very unhappy minority. Only an experienced LASIK surgeon can best decide who is a good candidate, so I recommend researching local providers thoroughly and scheduling an appointment if you believe LASIK may be a good option for you.

Special thanks to Dr. Lomazow for her detailed responses and sharing her expertise in keeping our eyes healthy. This gives me a list of simple actions I can take to help maintain my eye health. Now excuse me while I dim the lights in my office, check my computer monitor distance, and look away from the monitor for 20 seconds.

Adam L. Booth, MD, is chief resident in his third year of anatomic and clinical pathology residency at the University of Texas Medical Branch-Galveston (UTMB). Dr. Booth currently serves as Chair of the CAP Residents Forum Executive Committee and is a junior member of the CAP Digital Content Committee. His research and specialty interests include gastrointestinal and hepatobiliary pathology. You can follow @ALBoothMD on Twitter, Instagram, and Facebook.