Symptoms and ocular findings associated with administration of 0.01% atropine in young adults


Clinical relevance: This paper provides eye care practitioners with important information about the potential side effects of 0.01% atropine.

Background: Eye care practitioners routinely administer 0.01% atropine eye drops nightly to slow the progression of myopia, but nobody has assessed accommodative lag or facility, near phoria, intraocular pressure or comfort of drop administration.

Methods: All 21- to 30-year-old adults with no history of accommodative issues or therapy were eligible. During the baseline visit, participants underwent testing related to potential side effects. Participants then administered one drop of 0.01% atropine nightly to both eyes, and all tests were repeated 1 week later.

Results: The average ± standard deviation age of the 31 participants was 23.9 ± 1.6 years, 71% were female, and 81% were Caucasian. The only significant changes were an increase in photopic pupil size from 4.9 ± 0.8 at baseline to 5.1 ± 0.6 mm after 1 week (paired sample t-test, p = 0.002) and an increase of the average intraocular pressure of the two eyes from 15.6 ± 2.7 to 16.7 ± 3.1 mmHg (paired-sample t-test, p = 0.003), but neither of these changes was clinically meaningful. There were no other statistically significant differences before and after 1-week administration of 0.01% atropine for any of the vision, accommodation, reading speed or subjective side effects. When asked how likely they would be to take the atropine drops to delay the onset of myopia on a scale from 1 (definitely not) to 10 (definitely would), participants replied with an average of 8.2 ± 2.0 after taking atropine eye drops for 1 week (paired-sample t-test, p = 0.81).

Conclusion: Nightly administration of 0.01% atropine did not result in any clinically meaningful symptoms, so patients would be very likely to take the drops to delay the onset of myopia.

Cyphers B, Huang J, Walline JJ. Symptoms and ocular findings associated with administration of 0.01% atropine in young adults. Clin Exp Optom. 2022 Feb 20:1-11. doi: 10.1080/08164622.2022.2033603. Epub ahead of print. PMID: 35188076.

DLP Projector Rainbow Effect

The Projector Rainbow Effect can be a major annoyance to home theater owners. This is because it can significantly reduce the image quality and make the picture look blurry. In some cases, the projector rainbow effect can even be mistaken for a defect in the projector. The projector rainbow effect is visible on the projection screen as a series of red, green and blue bands that appear to be layered over each other.

In a digital light processing (DLP) projector that uses a single chip, a rotating color wheel in front of the monochromatic light source projects sequential images in different colors rapidly on the screen. The visual system of the observer combines the different colors into one image in the brain producing color motion pictures from a white light source. Unfortunately, the system is not perfect. Some individuals are not able to completely merge the different color images in their mind and individual colors are still perceived creating a “rainbow effect” around high contract images. The effect is made worse if the individual moves their eyes. Speeding up the rotation of the color wheel helps to lessen the effect but does not remove it entirely.

The reason this happens is that moving objects and colors are processed by two different parts of the visual system. The magnocellular pathway processes the movement and position of objects in the field of view and the parvocellular pathway processes the shape and color of objects in the field of view. These pathways begin in the retina eye and continue to the lateral geniculate in the thalamus portion of the brain. The retinal rod cells are more sensitive to movement and the cone cells are more sensitive to color. A slight mismatch in the signals the brain is receiving from the color pathway to the ones being received from the motion pathway lead to a perception of “rainbows”. This effect is similar to a video of someone speaking that is not exactly synced to the audio portion of them speaking.

About 40% of individuals notice this effect. This may be for several reasons; some individual may not pay attention to it, the type of media being viewed may exhibit less of the effect such a lower contrast and slower action, differing eye and brain anatomy that may have different lengths and quality of the magnocellular and parvocellular pathways and increased eye movements in some individuals when watching these projections.

Dry Eyelids

What causes dry eyelids?

The most common causes of dry eyelids are dry and cold weather, certain skin care products, environmental allergens, contact dermatitis and excessive eye rubbing. The skin around your eyes is very thin and more sensitive than the skin on the other parts of your body. So, it’s more prone to irritation. Everything from aging to allergens in the environment can make it red, dry and flaky.

What are the signs and symptoms of dry eyelids?

Flaking dry skin with redness and itching. The itching is usually a hallmark of an allergic reaction. Most often due to new cosmetic products or other allergens that come in contact with the skin.

How to treat dry eyelids?

It’s important to incorporate a dry lid treatment regimen into your daily routine. At night, apply a small amount of moisturizing ointment before bedtime to help trap moisture in your lids while you sleep. Also avoid using any cosmetic products on your eyelids. If the lids are red and itchy a small dab of 1% hydrocortisone cream or gel will help calm things down. This should only be used for a very short period of time as for a day or two. Steroid compounds that leak into the eye may raise your eye pressure if used for an extended period of time.

What are the home remedies to treat dry eyelids?

Small amounts of Vaseline on the lids to retain moisture will help the skin heal and remain hydrated. If the lids are red and irritated, cold compresses will also help bring the inflammation down. This can be made with an ice pack wrapped in a towel used for about 10 minutes two or three times per day. If the lid skin is split or cracked, a very small amount of zinc oxide as in desitin cream or ointment will help heal the fissure. Make sure to keep on the eyelid only and to avoid getting into your eyes.

Can dry eyelids become complicated?

Dry eyelids can become a more serious problem if the skin becomes infected. This will make the eyelid very red, swollen and painful. If this occurs, see your doctor as soon as possible to be treated with oral antibiotics.

When to see a doctor?

If symptoms do not resolve in a few days or get worse see your doctor for evaluation and treatment. If left untreated, dry eyelids may become chronic and lead to other complications such as infection and scarring. It’s important to seek medical help if your symptoms don’t improve in a few days.

Can stress cause dry eyelids?

Stress can trigger a release of corticotropin-releasing hormone, glucocorticoids, and epinephrine which are indirectly involved in flare ups of psoriasis, acne and dermatitis. While the exact mechanism of stress induced skin complications is not completely understood, we do know that stress has a long term deleterious effect on skin health and may contribute to dry eyelids in the absence of other causes.

Can I put olive oil or Vaseline on my eyelids?  

Small amounts of Vaseline directly on the lid and not in the eye should be OK. Olive oil is too thin and may run into the eye itself creating a burning sensation and blurred vision.

Cataracts and Driving Safely

As we age, our eyes undergo a number of changes. One common eye condition that affects older adults is cataracts. Cataracts are a clouding of the lens in the eye, and they can cause a number of problems, including decreased vision and even blindness. One particularly important issue for older drivers is how cataracts affect driving. Here we will explore how cataracts can impact driving safety and what you can do to stay safe on the road.

What is a cataract?

A cataract is a clouding of the lens in your eye. The cataract may form slowly over time, or it might happen suddenly as a result of eye trauma, medications, or changes due to diabetes. Clouded lenses can make driving more hazardous for older drivers because they interfere with their vision and also make it hard to see while driving at night or in poor weather conditions.

How do cataracts affect night driving?

Cataracts increase glare and reduce the sharpness of vision, causing the cataract patient to see halos around headlights or streetlights against a dark background. Drivers need to be aware that cataract patients may not be able to see them coming. Cataracts make it hard for cataract patients trying to find their position within a lane and put themselves in danger by changing lanes at night without being very careful about surrounding vehicles.

How do cataracts affect day driving?

Cataracts can also affect day driving, as they reduce the contrast in colors and make it hard to see objects in bright sunlight because of increasing glare. This can be a particular problem for older drivers, as they may have a harder time adjusting to changing light conditions. Cataract patients should take extra care when driving during the day, and should try wearing polarized sunglasses to reduce glare being reflected from the windshield.

What cataract symptoms should older adults look out for?

Older drivers who have cataracts often experience problems with night driving. If you notice that you are having a hard time seeing at night, or that it is harder to see objects in the dark, then cataracts may be affecting your driving safety. If you have cataracts that you suspect are affecting your driving ability, then you should make an appointment with an optometrist as soon as possible to determine the extent of your cataracts and whether you are a candidate for cataract surgery.

What cataract treatment is available?

Changing your eyeglass prescription may improve your vision if you have early cataracts. In more advanced stages, prescription eyeglass changes won’t improve your vision and cataract surgery will be necessary.

Cataracts are usually treated with cataract surgery, in which the cloudy lens of your eye is removed and replaced with an artificial lens. The surgery typically takes about 20 minutes, and cataract patients often see better almost immediately following cataract surgery.

What can cataract patients do to be safer drivers?

Drivers with cataracts should drive conservatively and should avoid driving at night or in poor weather conditions. They should only drive during the day with their best eyeglass or contact lens prescription and appropriate sun wear. Cataract patients should also get regular eye exams because cataracts may increase over time, causing more vision problems and making cataract patients more likely to be in car accidents.

Eye Yoga

Dr. Shedlo was recently quoted in Bustle for an article on “Eye Yoga”.

Then there’s the issue of eye strain. “If you have normal vision and don’t need glasses for the distance, your eyes need to change focus to see things up close,” says optometrist Dr. Norman Shedlo, OD. By staring at a screen all day, especially one that’s right in front of your face, Norman says your eyes have to work overtime to stay focused, which can lead to muscle fatigue.

Symptoms of eye strain or fatigue include redness, dryness, burning and itching, tearing, blurred vision, and even headaches. If you don’t take regular breaks while using screens, Shedlo says it can also lead to bigger problems down the road like nearsightedness. It’s all the more reason to do “eye yoga” exercises throughout the day to help keep your peepers healthy.