September 21, 2010 - 9:00 pm
There are certain health conditions that women are more predisposed to than men, among those diseases are breast cancer, cervical cancer, diabetes, osteoporosis and a wide array of health conditions — but what a lot of women don’t know is that biologically, their vision health is also more at risk than a man’s.
According to Women’sEyeHealth.org, two-thirds of visually impaired or blind people in the United States are women.
It’s no surprise to optometrist Alissa Nagel, from Vision Source, who knows how much hormones play a role in eye health.
"Women will typically suffer from conditions like dry eye more than men, and that comes from hormonal changes, but there are also cancers and certain medical conditions that make a woman more sensitive to vision problems," she said.
One of the most notable vision problems that affect women in larger numbers is dry eyes, or keratoconjuctivitis sicca. More than 60 percent of women suffer from dry eyes at a ratio of nine to one over men, according to WebMD. Usually it’s a result of a fluctuation in hormones — such as when women go through menopause, pregnancy or are on the birth control pill.
"The solution sometimes lies with the gynecologist and not the optometrist," said Dr. Laura Maloney, an optometrist with Vision Source.
Because it happens frequently during menopause, there is very little an optometrist can do to control the hormones that cause the dry eyes symptoms.
"We personally won’t just put women on estrogen medication to clear it up, because there can be some negative consequences. That is a decision and something they have to discuss with their gynecologist," she said.
The exact relationship between hormone changes and dry eye isn’t completely understood, but it is believed that the linkS between androgen (testosterone) and estrogen receptors on the cornea of the eye and on the meibomian gland are involved in the cause. Dry eyes can result from an estrogen deficiency, testosterone and progesterone deficiency or from an imbalance of any of those three hormones.
Dr. Victoria Mar sees many female patients who are unaware of the link between their hormones and dry eyes.
"A lot of women come in with complaints of tearing and burning but it’s rare that they link it to hormone changes. Many of them think it’s the fact that we live in the desert, which is another cause of dry eye," Mar said.
If estrogen or hormone supplements are not an option Dr. Mar said she recommends many over the counter and natural supplements that help with lubrication such as Omega-3’s, nutritional supplements specifically for the eyes and in some cases prescribed products such as Restasis.
Another problem that begins to happen around that same time in life is age-related macular degeneration (AMD), which is a condition that causes vision to deteriorate over time. According to the Centers for Disease Control there are an estimated 1.6 million Americans who suffer from AMD. Most of them are women because they live longer than men.
Macular degeneration can leave someone with only peripheral vision, making it difficult to recognize faces.
This condition is sometimes confused with presbyopia, or blurred near vision, when people over 40 need glasses to read or do detailed work. According to the National Institute of Health, presbyopia is more prevalent and more severe among women than men; however, both men and women typically end up needing vision assistance as they age.
Eye health problems are not just tied to older age in women — they also tend to occur during hormonal fluctuations that come with pregnancy.
Like women going through menopause, pregnant women also suffer from dry eye, most likely because of the high level of estrogen and they may also experience a change in vision or prescription.
"This typically occurs during the last trimester. That is when they see a lot of dryness and because of chemistry and slight changes in astigmatism, their vision can change slightly, but that tends to go back to the way it was before and it is usually not so severe," Dr. Mar said.
If it gets too bothersome, Dr. Mar recommends that a woman who is pregnant should plan a visit to the optometrist. The change is so slight and occurs toward the end of the pregnancy, so it is not likely a presciption change for glasses or contacts will be necessary.
"It is so slight and gradual that it wouldn’t be necessary to do anything like that," Dr. Mar said.
As if having diseases that are more specific to women are not enough, some of those health problems such as breast and lung cancer can also lead to health problems, according to Dr. Nagel.
"They say one and three women will get cancer and the cancers that are prominent in women (breast and lung cancer) are the ones that can go to the eye and spread," Dr. Nagel said.
For this reason Dr. Nagel said she usually recommends that women who have had a history of breast and lung cancer or have these cancers run in their family should get their eyes dilated during an eye exam.
"This is why we ask all those questions in the questionnaire, we need to know what is going on in your body. It’s an interesting fact that not many women are aware of," she said.
Other medical conditions such as rheumatoid arthritis, thyroid problems and diabetes can also lead to vision problems and are also very common in women.
Diabetic retinopathy is the leading cause of blindness in American adults, and according to the National Women’s Health Report, nearly half of all people with diabetes will develop some degree of diabetic retinopathy during their lifetime. People with diabetes are also twice as likely to get cataract or develop glaucoma.
"It’s that link that the whole body is really connected," said Dr. Nagel.
Much like diabetes, rheumatoid arthritis although primarily tied to bone and joint disease can also affect the vision and cause inflammation of the eye, glaucoma and cataracts as well as dry eyes.
Women are worriers and the stress caused by worrying can also have a direct affect to eye health such as eye twitching, also called blepharospams which is more common in middle-aged and elderly women than in men, according to the National Institute of Neurological Disorders.
"Stress manifests itself in a number of odd ways from sleepless nights and if the eyes are open longer they are drier and can get inflamed, this then causes fluctuation in vision. Problems focusing and headaches, those are some of those things we wouldn’t discount in regards to eye health," Dr. Mar said.
Women, like men also tend to stress out more about the health of the family over their own health, Dr. Mar recommends scheduling dual visits with the optometrist when they take their own children for their eye exams.
"As optometrists in primary care we see people of all ages so doing all the exams at once would be a good place to start. I always tell women ‘Remember yourself,’" Mar said.
In addition to genetic predispositions women have to vision problems, the use of eye makeup only increases vision risks.
Eye liner, mascara, eyelash extension, eye shadow — all these accessories can create problems for eye health if not used properly, according to Dr. Nagel.
"I think with makeup people, keep it longer than they should. We recommend that women replace it every six months, and if you suffer an eye infection you should discard all eye makeup," she said.
Applying eyeliner at the rim of the eye is also a big problem that can have big consequences.
It is not recommended that eye liner be applied along the rims near the tear ducts and oil glands area, because it can block the tear ducts and and cause dry eye and infection that leads to sties.
Sties can also be caused by leaving eye make up on overnight and using expired cosmetics.
"If women also wear contacts, I always tell them to put the contact in first, before they apply the makeup and before removal to avoid getting make up residue inside the eye," Dr. Nagel said.
Eyelash extensions, although not harmful to the eyes can have consequential effects, according to Dr. Mar.
"First of all it is unbelievable to me that women will actually put adhesives on this very thin sensitive part of the skin," she said, "but if done properly it works out great and doesn’t typically cause harm." The biggest problem with eyelash extensions is the cleaning of eye make up.
"I notice that when women have these extensions they don’t wash that part of the eyes thoroughly because they want it to last and I’ve seen a buildup in the extensions of makeup and debris and that can lead to eye infections," she said.