LYON, France — A 72-year-old woman with dry age-related macular degeneration (AMD) was the first patient to receive an artificial retina implant as part of the multicenter PRIMAvera clinical trial, which is looking at the safety and efficacy of the PRIMA system.
“Her vision was severely impaired by this condition. We used the ETDRS chart to assess her visual acuity, as this is the current method in ophthalmology. She was able to read only nine letters,” said Laurent Kodjikian, MD, PhD, from Hôpital de la Croix-Rousse in Lyon, who is a former president of the French Society of Ophthalmology. To put that in perspective, a person with normal vision can make out 85 letters, he explained.
“The goal is to get her reading another ten letters,” he told Medscape Medical News.
The hospital where Kodjikian works is one of six centers in France selected to take part in the ongoing AMD clinical trial; other study sites are in Germany, Italy, the Netherlands, and Spain. The 38 study participants will be followed for 12 months after implantation to assess visual acuity and adverse events, and outcomes will be monitored for 3 years. Investigators hope that the findings will lead to the device receiving authorization to enter the market.
The PRIMA artificial retina system has three elements: a tiny wireless retinal implant; a pair of glasses with a camera and digital projector; and a portable processor connected to the projector. The camera captures visual scenes from the surrounding environment. The processor uses algorithms to process and simplify the images, which are then sent back to the glasses. The digital projector uses pulses of infrared light to project the processed images onto the retinal implant’s photovoltaic receptors. These receptors then convert the optical information into electrical stimulation, which excites the nerve cells of the inner retina, allowing them take in the information and transmit it, via the optic nerve, to the brain. This then induces visual perception.
A Delicate Operation
To implant the chip, Kodjikian made a rather large incision — 3.5 mm — and then peeled off the retina, all while looking through a surgical microscope.
“It’s easy to peel off the retina in a healthy eye. However, the procedure becomes more difficult in an eye affected by dry AMD, where the retina tissue is not only very thin and firmly attached to the back wall of the eye, but is also very fragile. A lot can go wrong during this step, so we have to really take our time,” he said. “You can’t go too deep, and if you go too close to the surface, you risk perforating the retina. Like walking on a very thin tightrope, there’s danger all around, and very little room for error.”
After the chip was inserted under the retina, Kodjikian put the retina tissue back into place. “This was the first time I’d ever done this kind of procedure, and it was quite a challenge,” he told Medscape.
The operation took 2.5 hours, which is much less time than the 4 to 5 hours estimated by the manufacturer.
The patient will undergo rehabilitation for 12 months to help her adapt to the system. “Our hope is that this patient will be able to see better with the implant. She probably won’t get to the point of being able to drive a car. And while reading novels in small print may not be possible, it’s quite likely that she’ll be able to read large-print editions,” Kodjikian explained.
Upon activation of the retinal prosthetic, the patient experienced visual impressions that she couldn’t see before the surgery. And 1 month after the procedure, things seem to be on track, according to a press release. “The postoperative result is excellent. There are no complications, the chip is perfectly in place and the vision has not been degraded by the operation. She should now start to improve thanks to rehabilitation,” said Kodjikian.
“Of the various artificial retina systems out there, this one is the most sophisticated because it has the most pixels. The technology will certainly continue to advance. But for the time being, the clinical study should allow us to show that it does work,” he concluded.
In December 2021, he implanted an artificial retina in a second patient, and it took him 50 minutes less than the first one.
This articleoriginally appeared in the French edition of Medscape.
The authors have disclosed no relevant financial relationships.
You are greatly remembered at this special season. May your life be continually filled by the love and joy of christmas. And may God continue to keep and bless you abundantly
Toxoplasmosis is an infection caused by a parasite known as Toxoplasma gondii (T. gondii). This single-celled organism is commonly found throughout the world and tends to infect birds and mammals. The parasite forms egg-like structures called oocysts. These must be ingested by mouth, which means the infection cannot be transferred from person to person.
Humans become infected with the toxoplasmosis parasite through contact with infected animal faeces (poo). Cats are the main hosts. They acquire T. gondii from eating infected rodents or birds and then may pass the infection to their human handlers.
Another way of catching this infection is touching or eating raw or undercooked lamb, pork or kangaroo meat. The parasites can be stored in small pockets (cysts) in the muscle tissue of these meats. Drinking contaminated unpasteurised milk can also cause infection with toxoplasmosis parasites.
Symptoms of toxoplasmosis
In most cases of animal and human infection, toxoplasmosis does not cause any symptoms. The only evidence of infection is detection of antibodies in the blood against the toxoplasmosis parasite.
Symptoms, if they do occur, include:
Swollen lymph glands, especially around the neck
Muscle aches and pains
Headache
Fever
Generally feeling unwell
Inflammation of the lungs
Inflammation of the heart muscle
Inflammation of the eye, for example, the retina (at the back of the eye).
Duration of infection with T. gondii
The toxoplasmosis parasite can cause a long-term infection. Following infection, a small number of parasites can remain locked inside cysts within certain parts of the body, such as the brain, lungs and muscle tissue.
Under normal circumstances, the immune system will easily destroy any parasites that escape these cysts, but a person with lowered immunity may not be able to fend off an attack. The parasites can greatly increase in number and cause a variety of serious illnesses, including infection of the brain.
Effects of toxoplasmosis on unborn babies
If newborn babies are infected, at worst, they will only suffer from mild illness. However, toxoplasmosis in pregnancy can expose babies in the womb to the parasite and this is potentially more serious. If a woman contracts toxoplasmosis for the first time while pregnant, the parasites may affect the baby through the placenta.
Most unborn babies aren’t affected at all, but a minority may be harmed by infection. Effects of toxoplasmosis on unborn babies can include:
Skin rashes
Nervous system damage
Mental retardation
Cerebral calcification (hardening of brain tissue)
Liver damage
Eye problems
Fetal death (in rare cases).
Precautions against toxoplasmosis
Pregnant women and people who have compromised immune systems should take precautions against toxoplasmosis. If a woman is infected before she becomes pregnant, then her immune system will attack the parasite and make it harmless. Problems only occur if a woman becomes infected for the first time while pregnant.
A pregnant woman and people with compromised immune systems can take simple precautions to reduce the risk of infection with the parasite. These include:
Wash hands after handling raw meat.
Cook meat (including kangaroo meat) thoroughly until the juices run clear.
Do not eat rare or medium-rare meat dishes.
Wash vegetables to remove any traces of soil.
Wash hands thoroughly before eating.
Immediately wash cutting boards, knives and any other implements that have come into contact with raw meat.
Wear gloves while gardening.
Avoid contact with cats.
Get someone else to handle litter trays.
Make sure litter trays are cleaned daily.
Toxoplasmosis in cats and sandpits
The infectious oocysts are robust and hardy. They can survive in water, soil or sand for around 12 months. Young children who play in sandpits and gardens may be at risk if they come into contact with infected cat faeces. Precautions include:
Make sure your child’s sandpit can be covered when not in use.
Discourage stray cats from your property.
Ask your child to always wash their hands thoroughly before eating.
Precautions against toxoplasmosis for your household cat
Cats are only infectious for a few weeks after ingesting the parasites and kittens are more likely to pass on the infection than older cats. Suggestions on reducing the risk of infection in your cat include:
Keep your cat indoors whenever possible.
Don’t allow the cat to hunt and eat birds or other wildlife.
Feed your cat canned or dry foods, instead of raw meat (including kangaroo meat).
Treatment for toxoplasmosis
Treatment of toxoplasmosis is often unnecessary. The infection is diagnosed with a simple blood test that checks for the presence of specific antibodies. A healthy person who is not pregnant and becomes infected does not require treatment. Symptoms, if any, are usually mild and disappear after a few weeks.
For pregnant women and those with compromised immune systems, such as those in the later stages of human immunodeficiency virus infection/acquired immunodeficiency syndrome(HIV/AIDS), medications including antibiotics may be prescribed.
Where to get help
Your doctor
Things to remember
People become infected with Toxoplasma gondii parasites through contact with infected animal faeces (usually cat faeces).
A healthy person does not require treatment for toxoplasmosis, as symptoms are mild and usually disappear within a few weeks.
Pregnant women and people who have compromised immune systems should take precautions against toxoplasmosis.
A pregnant woman is advised to avoid contact with cats, as her unborn child is at increased risk of birth defects if parasites cross the placenta.
Recurrence is your worst enemy. Here, a surgeon discusses ways to avoid it and what to do if the pterygium comes back.
It’s best to approach pterygium surgery with the goal of reducing the chances of recurrence at all costs. While most pterygia are asymptomatic and regarded as garden variety lesions, they become serious problems if they recur after removal. These cases most certainly warrant a subspecialist evaluation. In this article, I’ll discuss some surgical approaches to pterygium, with particular emphasis on recurrent pterygium.
At the Outset
When a patient presents with a pterygium, the first thing to decide is whether it’s necessary to do anything at all. Many patients have only mild complaints related to dryness or irritation, and are often best observed or managed medically. Lubrication or topical NSAIDs may help relieve ocular inflammation and reduce the pterygium’s appearance. Protecting the face and eyes from excessive UV exposure may also help, as pterygium is more prevalent in regions that receive strong ultraviolet radiation.
Only a small percentage of pterygium cases warrants surgical excision. Indications for surgery include obstruction of the visual axis, pterygium-induced irregular astigmatism, chronic eye irritation and cosmetic dissatisfaction.
If you do decide to surgically remove the pterygium, your next decision will be to determine how extensive a procedure is required. One day postoperatively, no matter which method you used to remove the pterygium, it’s going to be gone. The question is: Is it going to come back? You want to do everything you can to make sure the answer is “no.”
Surgical Strategy
There are many different ways to do a basic pterygium removal, and potentially hundreds of modifications of the surgical technique. The most common method of simple excision takes about five minutes but is associated with a much higher relative risk of the pterygium recurring. For this technique, you simply pry the scar tissue off the cornea and snip it off. It’s effective for about 90 percent of cases, but that means you can expect approximately 10 percent of cases to recur (often with a vengeance).
As a medical adjuvant to the simple snip excision, one might also consider the adjunctive use of antimetabolites such as mitomycin-C on the surgical site. This isn’t something that I usually do however, because mitomycin carries the risk of scleral melting. If you’re concerned enough to pour chemotherapy on the surface of the eye to prevent the pterygium from coming back, then, rather than using the mitomycin technique, the optimal thing to do would be to try the PERFECT technique (explained in detail below).
Pterygium Excision
We often use a nerve blocker for pterygium excision. Retrobulbar anesthesia is typically most comfortable for the patient because it provides good levels of pain control during the procedure. Take care not to damage the underlying corneal tissue or remove stroma when prying the pterygium off the surface of the eye.
First, make an incision at the limbus where the pterygium begins to encroach over the cornea. Cut it free and peel it from the corneal surface using blunt dissection. Once the pterygium’s been removed, we often polish the cornea with a diamond burr. When the cornea has been repaired, we turn our attention to the sclera and conjunctiva.
Dissect the conjunctiva free from Tenon’s capsule. Remove all of Tenon’s capsule where the pterygium was.
Once you remove the scar tissue from the nasal aspect of the cornea and globe, you must then decide what to put in the gap where the scar tissue used to be. You have a few options:
Option 1: Do nothing. You can just leave it bare and it’ll re-epithelialize on its own. This has the highest risk of recurrence and induces the most patient discomfort, but it can be done.
Option 2:Cover the area with a biological material. Amniotic membrane, which can be placed and glued or sutured over the area of the defect, is a very effective method. We prefer to use glue, since it’s fast and simple. Amniotic membrane makes patients more comfortable and contributes to the healing of the tissue. However, it’s not quite as effective in discouraging recurrence as the third option.
Option 3:Rotational conjunctival autograft. This method might not be necessary in every case, but it’s the least likely to lead to recurrence. It’s also the technique I perform most often.
To perform a rotational conjunctival autograft, first measure the conjunctival epithelial defect and how much bare sclera you need to cover. Then, harvest the conjunctiva approximately 90 degrees or 3 to 4 clock hours away from the resected site, usually in the superior globe, with Wescott scissors. Dissect the conjunctiva free from the underlying Tenon’s capsule to an extent that matches the surface area of the pterygium. Create a pedicle flap and rotate it down to cover the area. Glue or suture the flap to the bed with 8-0 vicryl. If using glue, aim for as little glue as possible. Postoperatively, prescribe topical antibiotic drops such as fluoroquinolone q.i.d. for a week, and a steroid drop such as prednisolone acetate q.i.d., tapered over one to three months.
In terms of graft stability, gluing and suturing will give you the most peace of mind. A third technique, autologous in situ blood coagulum, will also work if you don’t have access to glue and you do have an extra 10 minutes to hold pressure on the site. The patient’s natural bleeding in the area will coagulate and anchor the amniotic membrane; however, you can’t be as sure as with glue or suture that the tissue will still be adherent after a day or a week. Besides, glue and suture are expensive, but the most expensive thing of all is time in the operating room—holding tissue down with your fingers for 10 minutes is quite expensive.
Recurrence (discussed below) is the most serious postop complication of pterygium excision. Additionally, you have to be concerned about scarring. When you’re cutting on the eye you’re generating scar tissue, so you need to be careful that you don’t end up with a tangled, fibrous mess. This is entirely possible, especially with multiple surgeries.
Other complications you may encounter include scleral melt due to the use of mitomycin-C; fibrosis, especially around the extraocular muscle in that location; infection, which is rare; and ocular surface discomfort, which can last for weeks or even months. Typically, the steroids help ease discomfort, but we also encourage the use of lubricant drops. Keep these complications in mind when forming your surgical strategy.
Recurrence
Young people are generally at increased risk for recurrence, as are African Americans and Hispanics of all ages, who tend to have more inflammatory phenotypes. Additionally, patients with double pterygia (on both the nasal and temporal aspects of the cornea) and bilateral double pterygia are at extremely high risk for recurrence. In these patients, you need to take every possible precaution and be very careful if you do any surgery on them.
It’s critical that these patients be watched carefully for recurrence. If you notice the area you’ve resected is starting to grow back, usually at a millimeter-by-millimeter pace, begin aggressive topical steroids immediately, since you want to do everything in your power to avoid a second surgery. If the eye is red and inflamed, that’s the time for drops, not surgery.
However, if you lose the battle—whether you’re inattentive, or the patient comes back years later, or was referred elsewhere and upon their return to you, the pterygium is growing over the visual axis—then it’s time to consider reoperating.
In the event that the pterygium recurs, I recommend trying the PERFECT technique. This technique, which stands for Pterygium Extended Removal Followed by Extended Conjunctival Transplant, was pioneered by Australian ophthalmologist Lawrence Hirst, MBBS, MD, MPH, who runs The Australian Pterygium Centre. It has by far the lowest risk of recurrence, at just 0.1 percent (Figure 1). This method involves extensive removal of Tenon’s capsule from the area of the pterygium and surrounding areas and is meant to be used on patients who have recurrent pterygium after previous surgical removal. This procedure has very good cosmetic outcomes, with most patients reporting being unable to tell which eye had surgery.
The PERFECT technique for pterygium consists of three components that each take about 15 to 20 minutes to perform. Following are the steps of the technique as described by Prof. Hirst in a video of the procedure.
First, mark and transect the pterygium. Strip it from the corneal surface. Try to avoid having any residual pterygium tissue. Next, separate Tenon’s layer from the overlying conjunctiva and sclera, almost to the superior and inferior rectus muscles, and over the medial rectus muscle back to the caruncle (Figure 2). Adequate removal will result in visible bare sclera above and below the medial rectus muscle.
For the extended conjunctival transplant, mark the donor graft starting at the superior bulbar conjunctiva (Figure 3). The mark should extend almost to the superior fornix, and about 1 to 2 mm short of the limbus, and nasally, almost to the pterygium excision site. Leave a 5- to 7-mm bridge of conjunctiva and Tenon’s layer. At the donor site, the conjunctiva to be grafted should be separated from Tenon’s. A successful autograft should be virtually transparent, without any Tenon’s layer carried over with the graft. This helps to ensure that the donor site will heal with minimal-to-no scarring. The conjunctival graft is then transferred to the site of the former pterygium and sutured into place (Figure 4). To view a video of this technique, visit youtu.be/ODpQ_RbgHn4.
While it has the best success rate for preventing recurrence, by a wide margin, PERFECT is a long procedure—taking an hour to two hours of operating time, depending on your experience and skill level. However, I believe that anyone who’s had a pterygium recurrence needs to undergo this technique, as opposed to the standard “rip and clip.”
Ultimately, a pterygium isn’t something you want to keep hacking off over and over again. If it recurs early on, and you don’t feel comfortable doing the very refined PERFECT surgery yourself, it’s a good idea to refer the patient to a specialist. REVIEW
A chalazion is a small, slow-growing lump or cyst that develops within the eyelid. They are not usually painful and rarely last longer than a few weeks.
A chalazion can develop when a meibomian gland at the edge of an eyelid becomes blocked or inflamed. These glands produce oil that lubricates the surface of the eye.
In this article, we look at the symptoms of a chalazion and the differences between a chalazion and a stye. We also describe causes, home treatment, when to see a doctor, surgery, and prevention.
In the early stages, a chalazion appears as a small, red or otherwise inflamed area of the eyelid.
Within a few days, this inflammation can develop into a painless and slow-growing lump.
A chalazion can appear on the upper or lower eyelid, but they are more common on the upper lid.
Although chalazia are generally painless, they can cause the eye to become watery and mildly irritated. A particularly large chalazion may press on the eyeball, which can lead to blurry vision.
People sometimes confuse a chalazion with a stye due to the similarities in appearance. A stye is also a small lump that can develop in the eye area.
Although people often use the two terms interchangeably, they refer to different types of lesion.
A chalazion results from a blocked oil gland, whereas a stye indicates an infected oil gland or hair follicle. However, a chalazion can sometimes develop into a stye.
There are two types of stye:
External hordeolum: These occur at the base of the eyelash and usually result from an infection in the hair follicle.
Internal hordeolum: These develop inside the eyelid and tend to result from an infection in an oil gland.
The most noticeable difference between a chalazion and a stye is that a chalazion tends to be painless. A stye is usually very painful and may cause the eye to feel sore and scratchy.
Wearing glasses instead of contact lenses can help a chalazion heal.
A chalazion usually requires very little medical treatment and tends to clear up on its own within a few weeks.
In the meantime, it is important to avoid squeezing or popping the chalazion, as this can increase the risk of an eye infection.
However, there are several safe ways to promote drainage and speed up the healing process. These include:
Warm compresses
Applying a warm compress to the affected eye can help soften any hardened oil blocking the gland ducts. This helps the ducts open and drain more effectively, which can relieve irritation.
To make and use a warm compress:
Soak a soft, clean cloth or cotton pad in a bowl of warm water.
Wring out any excess liquid.
Apply the damp cloth or pad to the eyelid for 10–15 minutes.
Continue wetting the compress often to keep it warm.
Repeat this several times a day until the swelling goes down.
Gentle massage
Gently massaging the eyelids for several minutes each day can help the oil ducts drain more effectively.
Before doing so, ensure that the hands are clean to reduce the risk of infection.
Once the chalazion begins to drain, keep the area clean and avoid touching it with bare hands.
Over-the-counter treatments
A number of over-the-counter products can help treat a chalazion or stye. These may reduce irritation, prevent infection, and speed up the healing process.
Some of these products include ointments, solutions, and medicated eye pads. A pharmacist can provide advice.
Things to avoid
To prevent further discomfort or irritation, it is best to avoid wearing eye makeup or contact lenses until the chalazion heals.
A person should speak to a medical professional if their chalazion does not go away after a month.
Consider seeing an eye doctor, an ophthalmologist or optometrist, if a chalazion does not drain and heal within 1 month.
The healthcare professional will ask about symptoms and examine the area to rule out other conditions. They may also prescribe anti-inflammatory eye drops or ointments to reduce discomfort and speed healing.
For some people, a doctor may give a steroid injection to reduce swelling. This will depend on the location, size, and number of chalazia present.
If there are signs of a bacterial infection, the doctor may recommend a course of oral antibiotics.
For a person with a severe or persistent chalazion, a doctor may recommend surgery to drain it. This typically takes place in the doctor’s office using local anesthesia.
Chalazia can sometimes recur. If this happens often, the doctor may need to take a biopsy of the lump.
A biopsy involves removing a small sample of tissue, which the doctor will examine for signs of a more serious condition.
Cleansing the eye area every day can help prevent a chalazion from developing or recurring.
Using eyelid scrubs or premoistened cleansing wipes to keep the oil glands from becoming blocked.
Other chalazion prevention tips include:
not rubbing the eyes
ensuring that the hands are clean before touching the eyes
protecting the eyes from dust and air pollution, for example by wearing sunglasses when outdoors or safety goggles when using machinery, such as power tools
replacing eye makeup every 6 months to prevent bacterial growth.
A chalazion is a painless lump that can develop on the eyelid.
Although chalazia can cause irritation and discomfort, they are usually harmless and clear up on their own within a few weeks. Occasionally, a chalazion may become infected and develop into a stye.
See an eye doctor, an optometrist or ophthalmologist, if the eye area becomes particularly swollen or painful, or if the chalazion does not respond to home treatment.
A daily eye-cleansing routine may help keep a chalazion from recurring.
Your eyes are an important part of your health. Most people rely on their eyes to see and make sense of the world around them. But some eye diseases can lead to vision loss, so it is important to identify and treat eye diseases as early as possible. You should get your eyes checked as often as your health care provider recommends it, or if you have any new vision problems. And just as it is important to keep your body healthy, you also need to keep your eyes healthy.
Eye Care Tips
There are things you can do to help keep your eyes healthy and make sure you are seeing your best:
Eat a healthy, balanced diet. Your diet should include plenty or fruits and vegetables, especially deep yellow and green leafy vegetables. Eating fish high in omega-3 fatty acids, such as salmon, tuna, and halibut can also help your eyes.
Maintain a healthy weight. Being overweight or having obesity increases your risk of developing diabetes. Having diabetes puts you at higher risk of getting diabetic retinopathy or glaucoma.
Get regular exercise. Exercise may help to prevent or control diabetes, high blood pressure, and high cholesterol. These diseases can lead to some eye or vision problems. So if you exercise regularly, you can lower your risk of getting these eye and vision problems.
Wear sunglasses.Sun exposure can damage your eyes and raise your risk of cataracts and age-related macular degeneration. Protect your eyes by using sunglasses that block out 99 to 100% of both UV-A and UV-B radiation.
Wear protective eye wear. To prevent eye injuries, you need eye protection when playing certain sports, working in jobs such as factory work and construction, and doing repairs or projects in your home.
Avoid smoking. Smoking increases the risk of developing age-related eye diseases such as macular degeneration and cataracts and can damage the optic nerve.
Know your family medical history. Some eye diseases are inherited, so it is important to find out whether anyone in your family has had them. This can help you determine if you are at higher risk of developing an eye disease.
Know your other risk factors. As you get older, you are at higher risk of developing age-related eye diseases and conditions. It is important to know you risk factors because you may be able to lower your risk by changing some behaviors.
If you wear contacts, take steps to prevent eye infections. Wash your hands well before you put in or take out your contact lenses. Also follow the instructions on how to properly clean them, and replace them when needed.
Give your eyes a rest. If you spend a lot of time using a computer, you can forget to blink your eyes and your eyes can get tired. To reduce eyestrain, try the 20-20-20 rule: Every 20 minutes, look away about 20 feet in front of you for 20 seconds.
Eye Tests and Exams
Everyone needs to have their eyesight tested to check for vision and eye problems. Children usually have vision screening in school or at their health care provider’s office during a checkup. Adults may also get vision screenings during their checkups. But many adults need more than a vision screening. They need a comprehensive dilated eye exam.
Getting comprehensive dilated eye exams is especially important because some eye diseases may not have warning signs. The exams are the only way to detect these diseases in their early stages, when they are easier to treat.
The exam includes several tests:
A visual field test to measure your side (peripheral) vision. A loss of peripheral vision may be a sign of glaucoma.
A visual acuity test, where you read an eye chart about 20 feet away, to check on how well you see at various distances
Tonometry, which measures your eye’s interior pressure. It helps to detect glaucoma.
Dilation, which involves getting eye drops that dilate (widen) your pupils. This allows more light to enter the eye. Your eye care provider examines your eyes using a special magnifying lens. This provides a clear view of important tissues at the back of your eye, including the retina, macula, and optic nerve.
If you have a refractive error and are going to need glasses or contacts, then you will also have a refraction test. When you have this test, you look through a device that has lenses of different strengths to help your eye care professional figure out which lenses will give you the clearest vision.
At what age you should start getting these exams and how often you need them depends on many factors. They include your age, race, and overall health. For example, if you are African American, you are at higher risk of glaucoma and you need to start getting the exams earlier. If you have diabetes, you should get an exam every year. Check with your health care provider about if and when you need these exams
Nearly everyone on the planet will experience an eye health issue in their lifetime and more than a billion people worldwide do not have access to eye care services.
To address the bigger picture at the country and global level, we need to be aware of our own eye health, and so our theme for 2021 is all about #LoveYourEyes.
#LoveYourEyes is all about being aware of your own eye health and if you able, to get a sight test or recommend others do the same.
Our eyes can also tell us so much about our general health – soon we’ll have more information about how to #LoveYourEyes and learn more about your own eye health.
FOR WORLD SIGHT DAY 2021, EVERYONE COUNTS
In the month leading up to World Sight Day, we want to get over 1 million people to pledge to have a sight test or care for their eyes. So, whoever you are, we are asking you get involved.
PLEDGE YOUR SIGHT TEST
If you are an individual, you’ll be able to pledge to test your eyes or care for your eyes.
If you are an eye care professional or organisation, you’ll be able to pledge all the tests you do in the month leading up to World Sight Day here
The term ocular hypertension usually refers to any situation in which the pressure inside the eye, called intraocular pressure, is higher than normal. Eye pressure is measured in millimeters of mercury (mm Hg). Normal eye pressure ranges from 10-21 mm Hg. Ocular hypertension is an eye pressure of greater than 21 mm Hg.
Although its definition has evolved through the years, ocular hypertension is commonly defined as a condition with the following criteria:
An intraocular pressure of greater than 21 mm Hg is measured in one or both eyes at two or more office visits. Pressure inside the eye is measured using an instrument called a tonometer.
The optic nerve appears normal.
No signs of glaucoma are evident on visual field testing, which is a test to assess your peripheral (or side) vision.
To determine other possible causes for your high eye pressure, an eye doctor (a medical doctor who specializes in eye care and surgery) assesses whether your drainage system (called the “angle”) is open or closed. The angle is seen using a technique called gonioscopy. This technique involves the use of a special contact lens to examine the drainage angles (or channels) in your eyes to see if they are open, narrowed, or closed.
No signs of any ocular disease are present. Some eye diseases can increase the pressure inside the eye.
Ocular hypertension should not be considered a disease by itself. Instead, ocular hypertension is a term that is used to describe individuals who should be observed more closely than the general population for the onset of glaucoma. For this reason, another term to refer to a person with ocular hypertension is “glaucoma suspect,” or someone whom the eye doctor is concerned may have or may develop glaucoma because of elevated pressure inside the eyes. An eye exam may show a glaucoma-damaged optic nerve.
As mentioned above, increased intraocular pressure can result from other eye conditions. However, within this article, ocular hypertension primarily refers to increased intraocular pressure without any optic nerve damage or vision loss. Glaucoma is diagnosed when characteristic optic nerve and vision changes occur; typically with elevated eye pressure but occasionally with normal pressure.
As of the year 2013, an estimated 2.2 million people in the United States had glaucoma and more than 120,000 are legally blind because of this disease. These statistics alone emphasize the need to identify and closely monitor people who are at risk of developing glaucoma, particularly those with ocular hypertension.
Studies estimate that 3-6 million people in the United States alone, including 4%-10% of the population older than 40 years, have intraocular pressures of 21 mm Hg or higher, without detectable signs of glaucomatous damage using current tests.
Studies over the last 20 years have helped to characterize those with ocular hypertension.
Recent data on people with ocular hypertension from the Ocular Hypertension Treatment Study have shown that they have an average estimated risk of 10% of developing glaucoma over 5 years. This risk may be decreased to 5% (a 50% decrease in risk) if eye pressure is lowered by medications or laser surgery. However, the risk may become even less than 1% per year because of significantly improved techniques for detecting glaucomatous damage. This could allow treatment to start much earlier, before vision loss occurs. Future studies will help to further assess this risk of glaucoma development.
Patients with thin corneas may be at a higher risk for glaucoma development; therefore, your eye doctor may use a measuring device, called a pachymeter, to determine your corneal thickness.
Ocular hypertension is 10-15 times more likely to occur than primary open-angle glaucoma, a common form of glaucoma. That means that out of every 100 people older than age 40, about 10 will have pressures higher than 21 mm Hg, but only one of those people will have glaucoma.
Over a 5-year period, several studies have shown the incidence of glaucomatous damage in people with ocular hypertension to be about 2.6-3% for intraocular pressures of 21-25 mm Hg, 12-26% for intraocular pressures of 26-30 mm Hg, and approximately 42% for those higher than 30 mm Hg.
In approximately 3% of people with ocular hypertension, the veins in the retina can become blocked (called a retinal vein occlusion), which could lead to vision loss. Because of this, keeping pressures below 25 mm Hg in people with ocular hypertension and who are older than age 65 is often suggested.
Some studies have found that the average intraocular pressure in African-Americans is higher than in whites, while other studies have found no difference.
A 4-year study showed that African-Americans with ocular hypertension were 5 times more likely to develop glaucoma than whites. Findings suggest that, on average, African-Americans have thinner corneas, which may account for this increased likelihood to develop glaucoma, as a thinner cornea may cause pressure measurements in the office to be falsely low.
In addition, African-Americans are considered to have a 3-4 times greater risk of developing primary open-angle glaucoma. They are also believed to be more likely to have optic nerve damage.
Although some studies have reported a significantly higher average intraocular pressure in women than in men, other studies have not shown any difference between men and women.
Some studies suggest that women could be at a higher risk for ocular hypertension, especially after menopause.
Studies also show that men with ocular hypertension may be at a higher risk for glaucomatous damage.
Intraocular pressure slowly rises with increasing age, just as glaucoma becomes more prevalent as you get older.
Being older than age 40 is considered to be a risk factor for the development of both ocular hypertension and primary open-angle glaucoma.
Elevated pressure in a young person is a cause for concern. A young person has a longer time to be exposed to high pressures over a lifetime and a greater likelihood of optic nerve damage.
Ocular Hypertension Causes
Elevated intraocular pressure is a concern in people with ocular hypertension because it is one of the main risk factors for glaucoma.
High pressure inside the eye is caused by an imbalance in the production and drainage of fluid in the eye (aqueous humor). The channels that normally drain the fluid from inside the eye do not function properly. More fluid is continually being produced but cannot be drained because of the improperly functioning drainage channels. This results in an increased amount of fluid inside the eye, thus raising the pressure.
Another way to think of high pressure inside the eye is to imagine a water balloon. The more water that is put into the balloon, the higher the pressure inside the balloon. The same situation exists with too much fluid inside the eye—the more fluid, the higher the pressure. Also, just like a water balloon can burst if too much water is put into it, the optic nerve in the eye can be damaged by too high of a pressure. See Images 1-2.
People with very thick but normal corneas often have eye pressure measuring at the high levels of normal or even a little bit higher. Their pressures may actually be lower and normal but the thick corneas cause a falsely high reading during measurements.
Ocular Hypertension Symptoms
Most people with ocular hypertension do not experience any symptoms. For this reason, regular eye examinations with an eye doctor are very important to rule out any damage to the optic nerve from the high pressure.
When to Seek Medical Care
Questions to Ask the Doctor
Is my eye pressure elevated?
Are there any signs of internal eye damage due to an injury?
Are there any optic nerve abnormalities on my examination?
How often should I undergo follow-up examinations?
Exams and Tests
An eye doctor performs tests to measure intraocular pressure as well as to rule out early primary open-angle glaucoma or secondary causes of glaucoma. These tests are explained below.
Your visual acuity, which refers to how well you can see an object, is initially assessed. Your eye doctor determines your visual acuity by having you read letters from across a room using an eye chart.
The front of your eyes, including your cornea, anterior chamber, iris, and lens, are examined using a special microscope called a slit lamp.
Tonometry is a method used to measure the pressure inside the eye. Measurements are taken for both eyes on at least 2-3 occasions. Because intraocular pressure varies from hour to hour in any individual, measurements may be taken at different times of day (e.g., morning and night). A difference in pressure between the 2 eyes of 3 mm Hg or more may suggest glaucoma. Early primary open-angle glaucoma is very likely if the intraocular pressure is steadily increasing.
Each optic nerve is examined for any damage or abnormalities; this may require dilation of the pupils to ensure an adequate examination of the optic nerves. Fundus photographs, which are pictures of your optic disk (the front surface of your optic nerve), are taken for future reference and comparison.
Gonioscopy is performed to check the drainage angle of your eye; to do so, a special contact lens is placed on the eye. This test is important to determine if the angles are open, narrowed, or closed and to rule out any other conditions that could cause elevated intraocular pressure.
Visual field testing checks your peripheral (or side) vision, typically by using an automated visual field machine. This test is done to rule out any visual field defects due to glaucoma. Visual field testing may need to be repeated. If there is a low risk of glaucomatous damage, then the test may be performed only once a year. If there is a high risk of glaucomatous damage, then the test may be performed as frequently as every 2 months.
Pachymetry (or corneal thickness) is checked by an ultrasound probe to determine the accuracy of your intraocular pressure readings. A thinner cornea can give falsely low pressure readings, whereas a thick cornea can give falsely high pressure readings.
Ocular Hypertension Treatment Self-Care at Home
If your eye doctor prescribes medicines (see Medical Treatment and Medications) to help lower the pressure inside your eye, properly applying the medication and complying with your doctor’s instructions are very important. Not doing so could result in a further increase in intraocular pressure that can lead to optic nerve damage and permanent vision loss (i.e, glaucoma).
Medical Treatment
The goal of medical treatment is to reduce the pressure before it causes glaucomatous loss of vision. Medical treatment is always initiated for those people who are believed to be at the greatest risk for developing glaucoma (see When To Seek Medical Care) and for those with signs of optic nerve damage.
How your eye doctor chooses to treat you is highly individualized. Depending on your particular situation, you may be treated with medications or just observed. Your doctor will discuss the pros and cons of medical treatment versus observation with you.
Some eye doctors treat all elevated intraocular pressures of higher than 21 mm Hg with topical medicines. Some do not medically treat unless there is evidence of optic nerve damage. Most eye doctors treat if pressures are consistently higher than 28-30 mm Hg because of the high risk of optic nerve damage.
If you are experiencing symptoms like halos, blurred vision, or pain, or if your intraocular pressure has recently increased and then continues to increase on subsequent visits, your eye doctor will most likely start medical treatment.
Your intraocular pressure is evaluated periodically using guidelines similar to these:
If your intraocular pressure is 28 mm Hg or higher, you are treated with medicines. After 1 month of taking the drug, you have a follow-up visit with your eye doctor to see if the medicine is lowering the pressure and there are no side effects. If the drug is working, then follow-up visits are scheduled every 3-4 months.
If your intraocular pressure is 26-27 mm Hg, the pressure is rechecked in 2-3 weeks after your initial visit. On your second visit, if the pressure is still within 3 mm Hg of the reading at the initial visit, then follow-up visits are scheduled every 3-4 months. If the pressure is lower on your second visit, then the length of time between follow-up visits is longer and is determined by your eye doctor. At least once a year, visual field testing is done and your optic nerve is examined.
If your intraocular pressure is 22-25 mm Hg, the pressure is rechecked in 2-3 months. At the second visit, if the pressure is still within 3 mm Hg of the reading at the initial visit, then your next visit is in 6 months and includes visual field testing and an optic nerve examination. Testing is repeated at least yearly.
Follow-up visits may also be scheduled for the following reasons:
If a visual field defect shows up during a visual field test, repeat (possibly multiple) examinations are performed during future office visits. An eye doctor closely monitors a visual field defect because it may be a sign of early primary open-angle glaucoma. That is why it is important for you to do your best when taking the visual field test, as it may determine whether or not you have to start on medications to lower your eye pressure. If you get tired during a visual field test, make sure to tell the technician to pause the test so you can rest. That way, a more accurate visual field test can be obtained.
A gonioscopy is performed at least once every 1-2 years if your intraocular pressure significantly increases or if you are being treated with miotics (a type of glaucoma medication).
More fundus photographs (which are pictures of the back of the eye) are taken if the optic nerve/optic disk changes in appearance.
Medications
The ideal drug for treatment of ocular hypertension should effectively lower intraocular pressure, have no side effects, and be inexpensive with once-a-day dosing; however, no medicine possesses all of the above. When choosing a medicine for you, your eye doctor prioritizes these qualities based on your specific needs.
Medications, usually in the form of medicated eyedrops, are prescribed to help lower increased intraocular pressure. Sometimes, more than one medicine is needed. See Understanding Glaucoma Medications.
Initially, your eye doctor might have you use the eyedrops in only one eye to see how effective the drug is in lowering the pressure inside your eye. If it is effective, then your doctor will most likely have you use the eyedrops in both eyes. See How to Instill Your Eyedrops.
Once a medicine is prescribed, you have regular follow-up visits with your eye doctor. The first follow-up visit is usually 3-4 weeks after beginning the medicine. Your pressures are checked to ensure the drug is helping to lower your intraocular pressure. If the drug is working and is not causing any side effects, then it is continued and you are reevaluated 2-4 months later. If the drug is not helping to lower your intraocular pressure, then you will stop taking that drug and a new drug will be prescribed.
Your eye doctor may schedule your follow-up visits in accordance with the particular drug you are taking, because some medicines (e.g., latanoprost [Xalatan], travoprost [Travatan], bimatoprost [Lumigan]) may take 6-8 weeks to be fully effective.
During these follow-up visits, your eye doctor also observes you for any allergic reactions to the drug. If you are experiencing any side effects or symptoms while on the drug, be sure to tell your eye doctor.
Generally, if the pressure inside the eye cannot be lowered with 1-2 medicines, you might have early primary open-angle glaucoma instead of ocular hypertension. In this case, your eye doctor will discuss the appropriate next steps in your treatment plan.
Surgery
Laser and surgical therapy are not generally used to treat ocular hypertension, because the risks associated with these therapies are higher than the actual risk of developing glaucomatous damage from ocular hypertension. However, if you cannot tolerate your eye medications, laser surgery could be an option, and you should discuss this therapy with your eye doctor.
Next Steps Follow-up
Depending on the amount of optic nerve damage and the level of intraocular pressure control, people with ocular hypertension may need to be seen from every 2 months to yearly, even sooner if the pressures are not being adequately controlled.
Glaucoma should still be a concern in people who have elevated intraocular pressure with normal-looking optic nerves and normal visual field testing results or in people who have normal intraocular pressure with suspicious-looking optic nerves and visual field testing results. These people should be observed closely because they are at an increased risk for glaucoma.
Prevention
Ocular hypertension cannot be prevented, but through regular eye examinations with an eye doctor, its progression to glaucoma can be prevented.
Outlook
The prognosis is very good for people with ocular hypertension.
With careful follow-up care and compliance with medical treatment, most people with ocular hypertension do not progress to primary open-angle glaucoma, and they retain good vision throughout their lifetime.
With poor control of elevated intraocular pressure, continuing changes to the optic nerve and visual field that could lead to glaucoma might occur.
Support Groups and Counseling
Educating people with glaucoma is essential for medical treatment to be successful. The person who understands the chronic (long-term), potentially progressive nature of glaucoma is more likely to comply with medical treatment.
Numerous handouts about glaucoma are available, two of which are listed below.
“Understanding and Living with Glaucoma: A Reference Guide for People with Glaucoma and Their Families,” Glaucoma Research Foundation, (800) 826-6693.
“Glaucoma Patient Resource: Living More Comfortably with Glaucoma,” Prevent Blindness America, (800) 331-2020.
Media file 2: Elevated eye pressure is caused by a build-up of fluid inside the eye because the drainage channels (trabecular meshwork) cannot drain it properly. Elevated eye pressure can cause optic nerve damage and vision loss.
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People often have “gender reveal” parties for their babies. You’ll see balloons in grocery stores that say, “It’s a boy!” or “It’s a girl!”
But what if it’s neither? Or both?
Most parents don’t consider their children being anything other than a boy or a girl, so you, the gender questioning individual, must figure that out for yourself.
In such a gendered society, it’s tough to figure out if you’re non-binary or transgender. But after this article, you’ll have a little more insight on how to know if you’re non-binary, not transgender.https://googleads.g.doubleclick.net/pagead/ads?client=ca-pub-6236251396557429&output=html&h=300&adk=1554445590&adf=2712664100&pi=t.aa~a.799919054~i.11~rp.4&w=360&lmt=1624536242&num_ads=1&rafmt=1&armr=3&sem=mc&pwprc=3791326851&psa=0&ad_type=text_image&format=360×300&url=https%3A%2F%2Fallaboutgender.com%2F2018%2F07%2F04%2Fhow-to-know-if-youre-non-binary%2F&flash=0&fwr=1&pra=3&rh=270&rw=324&rpe=1&resp_fmts=3&sfro=1&wgl=1&fa=27&adsid=ChAI8NrQhgYQpeCf1b3moos9EjsAzzL_KkYELX1EvCEUe8i9sWGSmCIyBuIkwlsGOF4_w6LnqvMbgI_3POgYKLqx2Og1prs1qM7h4YAHjQ&dt=1624536241364&bpp=73&bdt=10831&idt=-M&shv=r20210621&cbv=%2Fr20190131&ptt=9&saldr=aa&abxe=1&prev_fmts=0x0&nras=2&correlator=868996826105&frm=20&pv=1&ga_vid=1840203765.1624536239&ga_sid=1624536239&ga_hid=93619842&ga_fc=0&u_tz=60&u_his=5&u_java=0&u_h=640&u_w=360&u_ah=640&u_aw=360&u_cd=24&u_nplug=0&u_nmime=0&adx=0&ady=1597&biw=360&bih=512&scr_x=0&scr_y=537&eid=21066433%2C21065725%2C31061421&oid=3&pvsid=3132395881117058&pem=551&ref=https%3A%2F%2Fwww.google.com%2F&eae=0&fc=1408&brdim=0%2C0%2C0%2C0%2C360%2C0%2C360%2C568%2C360%2C568&vis=1&rsz=%7C%7Cs%7C&abl=NS&fu=128&bc=31&jar=2021-06-24-12&ifi=2&uci=a!2&btvi=1&fsb=1&xpc=dkVkqCoUWn&p=https%3A//allaboutgender.com&dtd=814
(Conversely, if you think you might be transgender click here)
Let’s begin with some definitions, shall we?
What does it mean to be non-binary?
Let’s start with the word “non-binary” itself. A non-binary individual is someone who identifies outside of a binary.
A binary is a categorization with only two options. Salt and pepper are a binary. Black and white are a binary. Man and woman, too, are a binary.https://googleads.g.doubleclick.net/pagead/ads?client=ca-pub-6236251396557429&output=html&h=300&adk=1554445590&adf=1124583932&pi=t.aa~a.799919054~i.21~rp.4&w=360&lmt=1624536242&num_ads=1&rafmt=1&armr=3&sem=mc&pwprc=3791326851&psa=0&ad_type=text_image&format=360×300&url=https%3A%2F%2Fallaboutgender.com%2F2018%2F07%2F04%2Fhow-to-know-if-youre-non-binary%2F&flash=0&fwr=1&pra=3&rh=270&rw=324&rpe=1&resp_fmts=3&sfro=1&wgl=1&fa=27&adsid=ChAI8NrQhgYQpeCf1b3moos9EjsAzzL_KkYELX1EvCEUe8i9sWGSmCIyBuIkwlsGOF4_w6LnqvMbgI_3POgYKLqx2Og1prs1qM7h4YAHjQ&dt=1624536241364&bpp=33&bdt=10830&idt=-M&shv=r20210621&cbv=%2Fr20190131&ptt=9&saldr=aa&abxe=1&prev_fmts=0x0%2C360x300&nras=3&correlator=868996826105&frm=20&pv=1&ga_vid=1840203765.1624536239&ga_sid=1624536239&ga_hid=93619842&ga_fc=0&u_tz=60&u_his=5&u_java=0&u_h=640&u_w=360&u_ah=640&u_aw=360&u_cd=24&u_nplug=0&u_nmime=0&adx=0&ady=2500&biw=360&bih=512&scr_x=0&scr_y=537&eid=21066433%2C21065725%2C31061421&oid=3&pvsid=3132395881117058&pem=551&ref=https%3A%2F%2Fwww.google.com%2F&eae=0&fc=1408&brdim=0%2C0%2C0%2C0%2C360%2C0%2C360%2C568%2C360%2C568&vis=1&rsz=%7C%7Cs%7C&abl=NS&fu=128&bc=31&jar=2021-06-24-12&ifi=3&uci=a!3&btvi=2&fsb=1&xpc=fVrlr3HalY&p=https%3A//allaboutgender.com&dtd=902
But there are more spices than just salt or pepper. There’s an infinite shade of gray between black and white. And, you guessed it, there are more ways to express yourself than just “man” or “woman.”
So a non-binary individual is simply someone who does not consider themself a man or a woman. They can feel most comfortable in between the two, switch from a man to woman and vice versa, or identify in multiple different ways.
At the end of the day, though, a non-binary individual does not feel solely like a man or solely like a woman, as cisgender people do. https://googleads.g.doubleclick.net/pagead/ads?client=ca-pub-6236251396557429&output=html&h=300&adk=1554445590&adf=1438455242&pi=t.aa~a.799919054~i.27~rp.4&w=360&lmt=1624536242&num_ads=1&rafmt=1&armr=3&sem=mc&pwprc=3791326851&psa=0&ad_type=text_image&format=360×300&url=https%3A%2F%2Fallaboutgender.com%2F2018%2F07%2F04%2Fhow-to-know-if-youre-non-binary%2F&flash=0&fwr=1&pra=3&rh=270&rw=324&rpe=1&resp_fmts=3&sfro=1&wgl=1&fa=27&adsid=ChAI8NrQhgYQpeCf1b3moos9EjsAzzL_KkYELX1EvCEUe8i9sWGSmCIyBuIkwlsGOF4_w6LnqvMbgI_3POgYKLqx2Og1prs1qM7h4YAHjQ&dt=1624536241364&bpp=37&bdt=10830&idt=38&shv=r20210621&cbv=%2Fr20190131&ptt=9&saldr=aa&abxe=1&prev_fmts=0x0%2C360x300%2C360x300&nras=4&correlator=868996826105&frm=20&pv=1&ga_vid=1840203765.1624536239&ga_sid=1624536239&ga_hid=93619842&ga_fc=0&u_tz=60&u_his=5&u_java=0&u_h=640&u_w=360&u_ah=640&u_aw=360&u_cd=24&u_nplug=0&u_nmime=0&adx=0&ady=3446&biw=360&bih=512&scr_x=0&scr_y=537&eid=21066433%2C21065725%2C31061421&oid=3&pvsid=3132395881117058&pem=551&ref=https%3A%2F%2Fwww.google.com%2F&eae=0&fc=1408&brdim=0%2C0%2C0%2C0%2C360%2C0%2C360%2C568%2C360%2C568&vis=1&rsz=%7C%7Cs%7C&abl=NS&fu=128&bc=31&jar=2021-06-24-12&ifi=4&uci=a!4&btvi=3&fsb=1&xpc=x1ztlru187&p=https%3A//allaboutgender.com&dtd=973
Now to clear up some points of confusion that may result from these definitions:
A non-binary individual is not to be confused with an intersex individual. An intersex individual is someone who was born with various male or female sex characteristics. For example, someone can have a vagina and a Y chromosome.
Intersex people are biologically between male and female. However, a person’s body parts or sex characteristics does not always dictate how this person will identify. So if you’re intersex, you can still identify as a man or a woman. Or neither.https://googleads.g.doubleclick.net/pagead/ads?client=ca-pub-6236251396557429&output=html&h=300&adk=1554445590&adf=2496288911&pi=t.aa~a.799919054~i.33~rp.4&w=360&lmt=1624536243&num_ads=1&rafmt=1&armr=3&sem=mc&pwprc=3791326851&psa=0&ad_type=text_image&format=360×300&url=https%3A%2F%2Fallaboutgender.com%2F2018%2F07%2F04%2Fhow-to-know-if-youre-non-binary%2F&flash=0&fwr=1&pra=3&rh=270&rw=324&rpe=1&resp_fmts=3&sfro=1&wgl=1&fa=27&adsid=ChAI8NrQhgYQpeCf1b3moos9EjsAzzL_KkYELX1EvCEUe8i9sWGSmCIyBuIkwlsGOF4_w6LnqvMbgI_3POgYKLqx2Og1prs1qM7h4YAHjQ&dt=1624536241441&bpp=34&bdt=10908&idt=35&shv=r20210621&cbv=%2Fr20190131&ptt=9&saldr=aa&abxe=1&prev_fmts=0x0%2C360x300%2C360x300%2C360x300%2C360x512%2C360x90&nras=7&correlator=868996826105&frm=20&pv=1&ga_vid=1840203765.1624536239&ga_sid=1624536239&ga_hid=93619842&ga_fc=0&u_tz=60&u_his=5&u_java=0&u_h=640&u_w=360&u_ah=640&u_aw=360&u_cd=24&u_nplug=0&u_nmime=0&adx=0&ady=4424&biw=360&bih=512&scr_x=0&scr_y=795&eid=21066433%2C21065725%2C31061421&oid=3&pvsid=3132395881117058&pem=551&ref=https%3A%2F%2Fwww.google.com%2F&eae=0&fc=1408&brdim=0%2C0%2C0%2C0%2C360%2C0%2C360%2C568%2C360%2C568&vis=1&rsz=%7C%7Cs%7C&abl=NS&fu=128&bc=31&jar=2021-06-24-12&ifi=5&uci=a!5&btvi=5&fsb=1&xpc=IX3TR3yRTb&p=https%3A//allaboutgender.com&dtd=2165
Because it’s not the body that dictates gender identity, but simply how a person feels within their body.
And if you’re reading this, you’re probably feeling some type of way about the body you were born into. Let’s dig into that a little deeper.
Cis is shorthand for cisgender, or someone whose biological sexual characteristics matches up with the traditional gender identity for that body.
So when you see someone with boobs, wide hips, no Adam’s apple, long hair, etc, you’d think that person is woman.
And when you see someone with broad shoulders, short hair, muscles, body hair, etc, you’d think that person is man.
But you can have those biological characteristics and not be a man, because, again, a body does not dictate gender identity.
How we express ourselves can be in different ways in the gender spectrum. Short hair and painted fingernails can no longer be assigned to just one gender or the other. Both genders are taking it up, or no gender at all.https://googleads.g.doubleclick.net/pagead/ads?client=ca-pub-6236251396557429&output=html&h=300&adk=1554445590&adf=46347350&pi=t.aa~a.799919054~i.53~rp.4&w=360&lmt=1624536285&num_ads=1&rafmt=1&armr=3&sem=mc&pwprc=3791326851&psa=0&ad_type=text_image&format=360×300&url=https%3A%2F%2Fallaboutgender.com%2F2018%2F07%2F04%2Fhow-to-know-if-youre-non-binary%2F&flash=0&fwr=1&pra=3&rh=270&rw=324&rpe=1&resp_fmts=3&sfro=1&wgl=1&fa=27&adsid=ChAI8NrQhgYQpeCf1b3moos9EjsAzzL_KkYELX1EvCEUe8i9sWGSmCIyBuIkwlsGOF4_w6LnqvMbgI_3POgYKLqx2Og1prs1qM7h4YAHjQ&dt=1624536241513&bpp=34&bdt=10980&idt=45&shv=r20210621&cbv=%2Fr20190131&ptt=9&saldr=aa&abxe=1&cookie=ID%3Df9a156dba5ba4796-229463c7b67a00ca%3AT%3D1624536240%3ART%3D1624536240%3AS%3DALNI_MY5oTEv9924UoE2zMnqUuc3iT2_6Q&prev_fmts=0x0%2C360x300%2C360x300%2C360x300%2C360x512%2C360x90%2C360x300&nras=8&correlator=868996826105&frm=20&pv=1&ga_vid=1840203765.1624536239&ga_sid=1624536239&ga_hid=93619842&ga_fc=0&u_tz=60&u_his=5&u_java=0&u_h=640&u_w=360&u_ah=640&u_aw=360&u_cd=24&u_nplug=0&u_nmime=0&adx=0&ady=6628&biw=360&bih=512&scr_x=0&scr_y=2683&eid=21066433%2C21065725%2C31061421&oid=3&psts=AGkb-H8j1td-CXV2SpfHIyALNISMLnoHz32d6KzFDJh_yweLs0p3W5ZzlfrLuF_RTn9fehRSIiDJ0QMbiPZnXFfnkCCGN8oJU-SRzShC%2CAGkb-H8m_OwEXV_lurVwh7w-hvejwwRVf1BVRGBwduZWFlElS78t3KORWTnnmC1vf-suudvTSRCk5MPLlUnQBA%2CAGkb-H9ObkuvoJ3ZaakHEfUO99sJHe-9YeOLlSwaI7WeWdyj01g8Wjdw9eT3PQQT6QFVdRgJNJRDm9gIYksnng%2CAGkb-H8Uo06nd22MDTWyTbwJN3EDzwB1w6kMQWw7YIrT69MHUCIRuLdfF4ArBkv8f1HJhGv8lP6cEc7l8syqzQ%2CAGkb-H-6zbNfJtj8ikgVlZUJA5Hqrzum4GdJX1v7bEE5kNndG0GQtahUj6mG0RQQhChGXJuwqt32VHFLzdkLnw&pvsid=3132395881117058&pem=551&ref=https%3A%2F%2Fwww.google.com%2F&eae=0&fc=1408&brdim=0%2C0%2C0%2C0%2C360%2C0%2C360%2C568%2C360%2C568&vis=1&rsz=%7C%7Cs%7C&abl=NS&fu=128&bc=31&jar=2021-06-24-12&ifi=6&uci=a!6&btvi=6&fsb=1&xpc=RybFYeG4Ps&p=https%3A//allaboutgender.com&dtd=44438
So with that let’s talk about practical ways you can know if you’re non-binary:
You don’t feel comfortable on either gender binary. You don’t want to be seen as a man, you don’t want to be seen as woman. You don’t like she/her or he/him pronouns. All in all, you feel someplace in the middle of male and female.
You feel as if you have to be reminded that you’re a man or woman.
You feel weird when someone calls you he/him or she/her. Something about they/them pronouns honor you, or you feel the best knowing that you’re not being seen as a male or female.
You’ve changed your appearance to be more androgynous.
Things you’re already doing that might indicate you’re non-binary:
Shortening or changing your name so that it’s gender neutral.
Using “They/them” when describing the gender of people you don’t know. This might be because you wish someone called you by those neutral pronouns.
Wishing there were more gender-neutral bathrooms in this world.
Wishing parts of your body were different (less pronounced, fuller — especially in an androgynous way).
Wearing baggy, ill-fitting clothing that hides your body and secondary sex characteristics (breasts, hips, thighs, neck, etc).
Speaking less because of voice dysphoria. (I get misgendered the SECOND I open my mouth.)
Eating less. It’s sad to say, but some causes of eating disorders is latent gender dysphoria. Transgender and genderqueer individuals are about 5 times more likely to develop eating disorders than cisgender LGBTQ or heterosexual individuals.
Wishing you had a different name or pronouns.
Wanting the masculinization/feminization of hormone treatment. While you don’t have to completely masculinize/feminize yourself, some people do hormone treats to make their body more androgynous.
Things to help figure out if you’re non-binary:
Change your hairstyle. Cut it, grow it, shave it, dye it.
Experiment with makeup. Or don’t. Buy some eyeliner and lipstick. Throw the ones you do have away. Or, hey, if you want to, give yourself a beard with some mascara. Whatever works!
Try on different clothing. Raid a sibling’s closet, a parent’s wardrobe, or try stuff on at goodwill. Do you like what you see?
Ask people to call you different pronouns or names. Sometimes that’s all you need to reaffirm your gender. If you’re not in a place where you can ask people that, websites like Pronoun Changing Room can help you out.
Specifically, start asking people to use “they/them” pronouns with you.
The absolute best way to figure out if you’re non-binary: navigate your euphoria and dysphoria.
Euphoria is when something feels good. Dysphoria is when something feels bad (especially in relation to your gender).
Try to notice each time you feel good when gendered one way and feel bad gendered another way.
If you find non-gendered traits make you feel better than gendered traits, you’re most likely non-binary.
For example: You don’t like being called “sir/ma’am,” (or maybe neither elicits a response from you). You do feel good, though, when someone uses they/them pronouns with you. You feel uncomfortable in male or female bathrooms but are always relieved to find a gender-neutral bathroom.
Give yourself some time. It’s hard to understand euphoria and dysphoria in the moment (as other environmental/contextual factors can influence those feelings in the moment), but looking back and perhaps writing down a few key experiences may give insight to your gender identity.
A lot of this sounds like how to know if you’re trans (as a lot of these behaviors are also found on the transgender article).
At the end of the day, a lot of the same feelings of dysphoria for transgender and non-binary individuals stem from the same body issues. A lot of people who think they’re trans eventually realize that they’re non-binary and vice versa.https://googleads.g.doubleclick.net/pagead/ads?client=ca-pub-6236251396557429&output=html&h=300&adk=1554445590&adf=276673348&pi=t.aa~a.799919054~i.77~rp.4&w=360&lmt=1624536451&num_ads=1&rafmt=1&armr=3&sem=mc&pwprc=3791326851&psa=0&ad_type=text_image&format=360×300&url=https%3A%2F%2Fallaboutgender.com%2F2018%2F07%2F04%2Fhow-to-know-if-youre-non-binary%2F&flash=0&fwr=1&pra=3&rh=270&rw=324&rpe=1&resp_fmts=3&sfro=1&wgl=1&fa=27&adsid=ChAI8NrQhgYQpeCf1b3moos9EjsAzzL_KkYELX1EvCEUe8i9sWGSmCIyBuIkwlsGOF4_w6LnqvMbgI_3POgYKLqx2Og1prs1qM7h4YAHjQ&dt=1624536241594&bpp=30&bdt=11061&idt=31&shv=r20210621&cbv=%2Fr20190131&ptt=9&saldr=aa&abxe=1&cookie=ID%3Df9a156dba5ba4796-229463c7b67a00ca%3AT%3D1624536240%3ART%3D1624536240%3AS%3DALNI_MY5oTEv9924UoE2zMnqUuc3iT2_6Q&prev_fmts=0x0%2C360x300%2C360x300%2C360x300%2C360x512%2C360x90%2C360x300%2C360x300&nras=9&correlator=868996826105&frm=20&pv=1&ga_vid=1840203765.1624536239&ga_sid=1624536239&ga_hid=93619842&ga_fc=0&u_tz=60&u_his=5&u_java=0&u_h=640&u_w=360&u_ah=640&u_aw=360&u_cd=24&u_nplug=0&u_nmime=0&adx=0&ady=11249&biw=360&bih=512&scr_x=0&scr_y=7277&eid=21066433%2C21065725%2C31061421&oid=3&psts=AGkb-H8j1td-CXV2SpfHIyALNISMLnoHz32d6KzFDJh_yweLs0p3W5ZzlfrLuF_RTn9fehRSIiDJ0QMbiPZnXFfnkCCGN8oJU-SRzShC%2CAGkb-H8m_OwEXV_lurVwh7w-hvejwwRVf1BVRGBwduZWFlElS78t3KORWTnnmC1vf-suudvTSRCk5MPLlUnQBA%2CAGkb-H9ObkuvoJ3ZaakHEfUO99sJHe-9YeOLlSwaI7WeWdyj01g8Wjdw9eT3PQQT6QFVdRgJNJRDm9gIYksnng%2CAGkb-H8Uo06nd22MDTWyTbwJN3EDzwB1w6kMQWw7YIrT69MHUCIRuLdfF4ArBkv8f1HJhGv8lP6cEc7l8syqzQ%2CAGkb-H-6zbNfJtj8ikgVlZUJA5Hqrzum4GdJX1v7bEE5kNndG0GQtahUj6mG0RQQhChGXJuwqt32VHFLzdkLnw%2CAGkb-H8SnqIXJEyV_0GPYo0fvtZdNyqIDxgsu2NRAzyMSqJi6VF0kk9feoi7Yk-s-caiFr4wekxvxrfieAVPAck4&pvsid=3132395881117058&pem=551&ref=https%3A%2F%2Fwww.google.com%2F&eae=0&fc=1408&brdim=0%2C0%2C0%2C0%2C360%2C0%2C360%2C568%2C360%2C568&vis=1&rsz=%7C%7Cs%7C&abl=NS&fu=128&bc=31&jar=2021-06-24-12&ifi=7&uci=a!7&btvi=7&fsb=1&xpc=fXYqE5Mm5C&p=https%3A//allaboutgender.com&dtd=M
But I’d say the biggest indication that you’re non-binary rather than trans is that you don’t want to be seen as either male/female or man/woman. Your pronouns and gender presentation may reflect that. Or they might not.
Thing To Remember:
You can feel non-binary and look like a traditional man or woman.
You don’t have to use they/them pronouns to be non-binary. You can use any pronoun you want.
Pretty much, the only criterion to being non-binary is feeling like you’re not a man or woman. (E.g., “I’m not a man or woman, I’m a human” or “I’m just me.”)
At the end of the day, you decide how you feel. But hearing other people’s stories helps validate things you’re feeling or help you realize that you’ve been feeling some type of way this whole time.
I really like Charlie’s video describing what it feels like to be non-binary.
“I don’t go walking around thinking about how gosh darn neutral I am. It’s…a thing I get reminded of. When I see something for men or women it reminds me I’m neither of those.”
I think Charlie hits the nail. You can be androgynous and feel an affinity to male or female. But if you feel like neither you’re probably non-binary.
Jeff Miller’s video being transmasculine: being assigned female at birth but identifying more with masculine presentation and things, while not feeling like a “man.” As he says, gendered language like “man,” “dude,” “bro” makes them uncomfortable.
A video compilation by Ryan Cassata which includes a buuuunch of non-binary individuals saying what it is that makes them non-binary. Most of the responses describe feeling neutral to gender or simply not feeling male or female.
A popular non-binary bean, Ashley Wylde, describes how it feels to be non-binary. They say that being non-binary feels like having blonde hair or brown eyes. Their gender, or lack of gender, feels pretty normal.
(Please check out more great content from these YouTubers on their channels! Give ’em all the love and views they deserve).
In conclusion…
You can resonate with someone else’s coming out story or you can totally feel like your experience is unique. That’s okay.
You don’t have to rush to any conclusions. Just take your time, read up on other coming out stories and experiment with your gender until you find something you’re the most comfortable with.
Eyes are often considered the “window into the soul,” but in eye care they are more commonly used as a window into the patient’s overall health. Eyes can change in many ways as you get older, but some of these changes can indicate other health issues you otherwise might not notice.
Today, we’re going to unpack this little white outline of your cornea and look at what this condition is, how common it is, and what it could mean to your overall health.
What is Corneal Arcus?
Corneal arcus, otherwise known as arcus senilis for seniors or arcus juvenilis for those under 40, is typically an age-related condition that creates a deposit of cholesterol, phospholipids, and triglycerides in an “arc” on either the top or bottom side of the iris, inside the cornea. Over time, the arc can grow to encircle the entire iris, creating a white, gray, blue, or yellowish “outline.”
If corneal arcus develops as a result of aging, it is usually not a cause for concern. However, in individuals younger than 40, corneal arcus could indicate higher than normal cholesterol or triglyceride levels.
Higher cholesterol and triglyceride levels could indicate an increased risk of cardiovascular disease and stroke.
What Should You Do?
There is no cure for corneal arcus, as the condition itself isn’t actually harmful to your eyes or eye health. However, if you notice a white, yellow, gray, or blue ring or outline forming around your iris, you should visit your optometrist for an eye exam. Your optometrist can help you determine if your symptoms are benign or if they indicate a larger issue developing.
You may also be recommended to have your blood checked for abnormal levels of cholesterol and triglyceride. Your doctor may recommend lifestyle changes like diet and exercise. Some patients have decided to look into corneal tattooing to cover up the arc, but this is not recommended or encouraged by the medical community.
If you’ve noticed a symptom similar to corneal arcus in your eyes, with us today and we can help you determine what’s best for you and your health!
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