Tag Archives: eyes


When Should You Visit an Ophthalmologist?

As musicians, most of us rely on our eyes to read music, monitor audience response, and collaborate with colleagues. Vision is something that many of us take for granted until we begin to lose it. By the year 2020 it is estimated that 3.36 million people will have primary open-angle glaucoma (POAG) and about half will be unaware they suffer from this disease, even though early detection and treatment can prevent or delay vision loss. And, while diabetic retinopathy is a leading cause of blindness, many patients with diabetes do not receive evaluation and treatment in time to minimize vision loss.

Most people who require corrective vision visit their local optometrist annually or semi-annually to update their prescription. This type of examination, focused on the management of vision changes, is called a refractive examination. However, it is also important to periodically schedule an eye exam with a medical doctor specializing in eye care (or ophthalmologist) for a diagnostic eye examination. Only an ophthalmologist is qualified to provide the full range of eye care, from treating eye diseases with medicine to performing eye surgery to prescribing corrective lenses.

The American Academy of Ophthalmology recommends that healthy individuals with no signs or risk factors for eye disease get a baseline eye examination at age 40. This is a time when early signs of disease or changes in vision are likely to occur. People with certain risk factors—diabetes, high blood pressure, family history of eye disease, or those taking certain medications—should schedule earlier and more frequent exams.

The examination will likely include:

• Medical history

• Visual acuity

• Evaluation of your pupils’ response to light

• Evaluation of peripheral vision

• Ocular motility test to evaluate movement of the eyes

• Tonometry, or eye pressure test, for

• Use of a slit lamp to examine the front part of the eyes for cataracts, scars, or scratches to the cornea

• Examination of your retina and optic nerve for signs of disease

This initial examination will likely take about 45 to 90 minutes. The doctor may suggest additional testing using specialized imaging techniques. Based on the initial screening, the ophthalmologist will advise you as to how soon you should schedule your next examination.

In addition to a baseline exam at age 40, the American Academy of Ophthalmology suggests that you should visit an ophthalmologist immediately if you experience decreased vision, changes in vision, or physical changes to the eye.

10 Tips for Healthier Vision

1) Stop smoking. Smoking raises the risk of macular degeneration and speeds up damage when you do have the disease.

2) Wear sunglasses. Ultraviolet radiation from the sun increases your chances of developing macular degeneration. Look for sunglasses labeled UV 400 that also cover the sides of your eyes.

3) Exercise. As your heart strengthens it pumps more oxygen-rich blood to your eyes. Also, obesity puts you at higher risk of macular degeneration.

4) Monitor your blood pressure. High blood pressure can damage blood vessels and your heart’s ability to carry a steady stream of oxygen-rich blood to your eyes.

5) Use better lighting. Avoid fluorescent bulbs and other light sources that mimic the damaging rays of the sun. Incandescent and LED lights are safer. Use drapes and shades to cut glare.

6) Eat healthy. Leafy greens contain antioxidants and other nutrients that support eye health. Fish like salmon, trout, sardines, tuna, and mackerel are rich in omega-3s, which boosts eye health. Saturated and trans fats can increase macular degeneration damage.

7) Take supplements. Some vitamin and mineral formulas (AREDS and AREDS2) may slow macular degeneration. Consult your physician to find out if these are right for you.

8) Monitor your cholesterol. LDL “bad” cholesterol can build up in your eyes and form deposits called drusen that affect your vision.

9) Visit an eye doctor. Vision loss from macular degeneration does not
occur right away. Stay on top of it with regular visits, if you notice vision changes.

10) Look into vision rehabilitation. A team of specialists can work with you to make the most of the sight you have.

Dry Eyes

In the Spotlight: Help for Dry Eyes

Dry EyesDuring allergy season many people experience dry eyes. With age, it becomes more common and can be chronic. Whether you’re staring at a computer screen all day or reading music under stage lights, your eyes may begin to feel gritty and dry. The problem develops when the eye cannot maintain a healthy coating of tears.

There may be any number of causes: dry environment or workplace (wind or air conditioning); sun exposure, smoking or secondhand smoke exposure; cold or allergy medicines; or hormonal changes brought on by menopause.

People who work long hours staring at a computer screen are likely to blink less often and are more susceptible to dry eye. (Optimally, people should blink about 15 times a minute or every four seconds.) Those who have had Lasik or other refractive surgery, where their corneas have reduced sensation due to incisions or tissue removal, may also experience dry eye. Long-term contact lens wearers are also at risk.

More serious conditions—auto-immune diseases, such as lupus, rheumatoid arthritis, or thyroid disease—can contribute to the problem. Dry eyes can also be a symptom of Sjögren’s Syndrome, an autoimmune disorder associated with rheumatoid arthritis and other auto-immune diseases.

Any number of over-the-counter and prescription medications can reduce tear secretion.

While there is no cure for dry eye syndrome, you can find relief.

Here are some tips to help relieve dryness:

  • First, be sure to have regular eye exams. The American Optometric Association recommends that people aged 18-60 get eye exams every two years, as long as they are symptom-free. At-risk and symptomatic patients should have their eyes examined at least once a year and whenever they are experiencing problems.
  • Apply warm compresses on the eyes. Wet a clean cloth with warm water. Hold the cloth over your eyes for five minutes. Rewet the cloth with warm water when it cools. 
  • Control inflammation by cleaning lids with mild soap. (Ophthalmologists often recommend baby shampoo.) Apply cleanser on clean fingertips and gently massage your closed eyes near the base of your eyelashes. Rinse thoroughly.
  • Massage your eyelids to activate secretions.
  • Only use recommended eyelid cleaners.
  • Use artificial tear ointment or thick eye drops just before you go to bed.
  • Avoid using a hair dryer.
  • Run a humidifier to add moisture to the air.
  • Protect your eyes from sun and wind with sunglasses.
  • Consider adding more omega-3 oils to your diet (salmon, sardines, tuna, trout, anchovies, and flaxseeds). In studies omega oils appear to improve the eye’s Meibomian glands, which produce the oily part of tears. Fish oil may also reduce inflammation.
  • Try to avoid medications that deplete body fluids.
  • Ask your doctor about punctal plugs, which are placed in the tear ducts to retain lubrication.

If you have chronic dry eyes contact an ophthalmologist for evaluation. Left untreated, dry eye (keratoconjunctivitis) can lead to pain and more serious conditions such as ulcers, scars on the cornea, and partial impairment of vision. Permanent vision loss, however, is uncommon.

How to Take Care of Your Eyes

EDITOR’S NOTE: The following article is a result of research conducted across a number of health-related Web sites. The AFM does not endorse any specific remedy for eye problems and urges members to consult a medical practitioner before deciding on a course of action.

Eye problems are an often-overlooked health issue for professional musicians. The effort eyes make to read sheet music or follow the conductor while peering around an instrument can lead to a number of common, but treatable, complaints.

Unfortunately, opticians aren’t always sensitive to the specific concerns musicians have with their eyes. For instance, a one-size-fits-all approach to correcting vision may not work when there are so many different tasks eyes perform in an average day. A musician who logs off the computer, drives to work, performs for an evening, then goes home to watch the “Late Show with David Letterman” on TV, before reading in bed, ideally might need different glasses for each task. Fortunately, opticians who are used to treating increasingly widespread computer-related eye disorders suggest their advice can also help working musicians.

A typical complaint of professional musicians is eyestrain. Its cause is similar to that which leads to the same diagnosis in computer users. The eyes just aren’t meant to repetitively scan the small text of a music score or computer screen at a distance of two or three feet for long periods of time. Close focusing and repetitive scanning can even lead to a condition called “spasms of accommodation.” This is when the eyes’ overworked muscles spasm and are no longer able to adjust when a musician looks at something far away. Everything distant becomes blurry because the muscles have lost the ability to focus. Another more serious consequence of eyestrain is ocular migraine, a condition believed to be caused by a spasm of blood vessels brought on by eyestrain and which leads to visual disturbances. Opticians consider eyestrain a form of repetitive stress injury, which takes time to develop and a long time to treat.

Two other eye problems that commonly affect musicians were identified in a study conducted by Dr. Paul Alan Harris and published in a 1988 edition of The Journal of the American Optometric Association. Harris studied orchestra members in situ and found that peculiar working conditions led to diagnoses of astigmatism (abnormal curvature of the lens) and anisometropia (a large difference between the refractive power of the two eyes). Specifically, different vision problems arose depending on which instrument was played and where a musician sat. For instance, Harris found that a bass clarinetist, who habitually tilted his head back to play and looked left to view sheet music and conductor, had a significantly astigmatic right eye.

Whether you wear corrective lenses or not, there are several actions that can be taken to reduce the risk of eye trouble:

  • Wear the correct lenses to play. A pianist’s glasses that are good for reading books might not be suitable for reading a score. She’ll have to have another pair to read the music; if not, she’ll probably find herself leaning forward in order to get the notes in focus. Modern lenses have been developed that can help musicians. Three of these are “progressive bifocal” lenses, “trifocal” lenses, and “variable focus lenses,” sometimes called “computer glasses.” The days when only grandpa wore bifocals might be over; opticians are prescribing these multi-task lenses even for young children these days.
  • Lubricate your eyes. One trick to avoid eye problems is also very simple: blink! Concentrating on a score during a recital might mean a musician forgets to blink, and when the cornea dries out, eyes can start to ache. Musicians who wear contact lenses are prone to dry eyes, especially if seated close to air conditioning ducts in an orchestra pit, so they should either make liberal use of artificial tears, or wear their glasses when performing in the pit.
  • Adjust the music stand correctly. The top of your sheet music should ideally be at or just below eye level to avoid straining. If the stand must be below eye level, it is better to lower the eyes than tilt the head. Avoid eye problems caused by neck rotation by placing the stand directly in front of you. Also, if you have a choice between wearing glasses or contact lenses, the latter might be preferable as they allow for better peripheral vision which in turn can reduce the need for neck movement.
  • Find an optician who understands. A musician’s eyes are arguably as important as his or her hands. If you think you have work-related eye trouble, find an optician who is sensitive to this issue or who works with other musicians. One professional musician suggests going as far as to bring your instrument, music stand, clip light, and sheet music (preferably a complex score with lots of minute instructions) to the clinic so the optician can get to know your working conditions and individual needs.

Vision Protection: More Than Meets the Eye

There are plenty of obvious injuries that can result from repetitive music practice and playing. Carpal tunnel, tinnitus, and neck pain are just a few injuries musicians should look out for. One commonly overlooked problem area is the tool used to read music—the eyes.

Factors that put musicians’ eyes at risk for injury and strain include focusing on small notes on a page for long periods of time, frequent reading with inadequate light, dry eyes, and playing loud and high pitched notes on wind instruments, which can double eye pressure.

The eyes weren’t meant to repeatedly scan small text such as musical notes for an extended length of time. Doing so overworks the muscles in the eyes to the point where they begin to spasm and cause vision to blur. This is called eye strain and it can sometimes lead to ocular migraines

Prevention is the best way to curb eye strain. One simple way to relieve stress on your eyes is to blink or carry eye drops. When the cornea becomes dry, the eye begins to ache. Blinking lubricates them. If you wear contact lenses, you are more susceptible to dry eyes. Consider wearing your glasses to gigs or when you rehearse. Also, be mindful of having proper light and taking appropriate resting breaks when your eyes begin to fatigue.

Janet Horvath of Local 30-73 (St. Paul Minneapolis, MN), author of Playing Less Hurt: An Injury Prevention Guide, and associate principal cellist for the Minnesota Orchestra, says a major cause of eye strain stems from the strenuous, uncomfortable positions musicians sit or stand in when playing in a group or with a music stand. Horvath suggests, when practicing at home or with a group or orchestra, make sure the room is brightly lit; that you aren’t too far away from the sheet music; and that you aren’t craning your neck to see the pages.

If you practice with a music stand, be sure to adjust it to eye level or slightly below and place it where you won’t have to turn your body or crane your neck to see the notes. Maintaining a neutral head and neck position is a key element to reducing the occurrence of eye strain. If you share a music stand with another musician and are used to craning your neck to one side, try switching places to create a better balance. “Studies show there is a higher rate of astigmatism in musicians,” says Horvath. “Some musicians often have to play in chronically asymmetrical positions and the amount of eye movement and head movement when tracking an object, like notes on a page, should be balanced.”

Those who wear corrective lenses should consult an optometrist or ophthalmologist on what types of product is most helpful for a particular performance situation. Horvath actually brought along her stand and a page of sheet music to her eye doctor appointment to illustrate the distance at which her eyes had to work when playing with the orchestra. “If you can take the instrument, that’s even better,” says Horvath. “The doctor wouldn’t know it’s quite a few feet away, it’s not book reading distance and not long driving distance.”

Horvath recommends progressive lenses for musicians in their 40s and 50s. These “allin- one” lenses pack every scenario, reading, driving, and watching TV, into one convenient pair and lack the lines that bifocals and trifocals have.

Since space issues are a common problem in orchestras, it’s important to make your conductor and orchestra aware of any discomfort or difficulty seeing the sheet music. Work with your stand partner to find the best placement of the music, where it is comfortable for both of you. Sometimes, simply turning a chair in a different angle is preferable and works better than twisting your pelvis, core, or neck to view the sheet music. “The most important thing is figuring out your head and neck angle and how you are tracking the music,” says Horvath. “This is essential to avoid injury to body, spine, and shoulders too.”