Exploring New & Emerging Braille Technologies

PATIENT NEWSLETTER JUNE 2019

EYE HEALTH EYE TECH ABCDEFGHIJKLM Learn More About Dilated Exploring New & Emerging NOPQRSTUVWXYZ Eye Exams Braille Technologies #1234567890 Braille is a representation of the al- Computer, smartphone, and tablet us- phabet, numbers, punctuation marks, ers with acquired vision loss may be and symbols made from “cells” of unaware of the value or use of braille dots. There are 6-8 possible dots in a in these devices. For example, many cell, and one cell makes a single let- of these technologies can connect ter, number, or punctuation mark. to braille displays so that text on the When vision rehabilitation is needed, screen can be read as tactile char- learning braille can be useful. It can acters on displays and then read by also help when someone has recent- touch. Electronic refreshable braille ly acquired vision loss or if low vision displays can create dots in braille cells is present. Recent efforts have been by raising and lowering plastic or met- made to develop newer, portable, and al pins to correspond to dots in letters more affordable devices to encourage or numbers. The only way to be completely readers into the world of braille. sure your eyes are healthy is to On the Horizon have a comprehensive dilated eye An important goal for inventors has exam from an eye care profession- been to create braille displays for de- al. Drops are placed in both eyes vices that are cheaper without reduc- to allow the pupil to open almost ing the durability of displays or the fully and more light to enter the feel of the dots. Several projects are eyes. Once dilated, each eye is ex- promising, including the Orbit Read- amined using a special magnifying lens. This lens gives a clear view of er 20 and the Holy Braille full tablet the eye, including the retina, mac- braille display. The Orbit Reader 20 is ula, and optic nerve. a braille-reading device that is similar to the original Kindle device. It is de- During dilated eye exams, your signed specifically to read, with a few doctor looks for signs of common secondary add-on features using spe- vision problems and eye diseases, cific software. The Holy Braille project many of which have no early warn- is developing and creating a full-page ing signs. Comprehensive dilat- braille and tactile graphic display de- ed eye exams are recommended vice. The goal is to create a flat screen once a year beginning at age 60, A Brief History Lesson tablet that can basically come alive but African Americans are advised with a full page of braille or bar graphs to have annual exams starting at Braille was first used in printed maga- age 40 because of their higher risk zines or books, but it was often cum- that users can touch on the screen. of glaucoma. People with diabetes bersome for users because it required These devices—and others that are must also have dilated eye exams embossed paper that was large in size. still in development—promise to make at least once a year. Talk to your Over time, braille penetrated the elec- braille more accessible to a larger optometrist about if and when tronic world, with the first braille dis- group of users. With greater access to your eyes should be dilated. plays appearing in the mid-1970s. In lower-cost braille reading technology, 1987, the Braille ‘n Speak was released it’s possible that braille will become a as the first portable notetaker. It used more viable alternative in the future EYE-Q a braille-style keyboard for inputting for people with low vision or recent About how wide is the data instead of the traditional QW- Q: vision loss. human eye? ERTY keyboard. See answer on back.

INSIGHTS EYE CANDY EYE-Q ASK THE DOCTOR EYE SPY EYE DROPS EYE FOOD EYE TECH EYENATOMY SCEYENCE EYE TECH EYENATOMY Man Vs Dog: A Look at The Increasing Utility of Retina Scanning Vision Differences

retina can’t be forged. Also, a scan can only be accessed from a living human because the retina decays so quickly after death. Retinal Vs Iris Scans Although some smartphone apps claim to use retina scanning, the reality is they use iris scanning. This type of scan is different from retinal scans. Iris scanning uses video camera technology with subtle near infrared light to get Anyone who is a dog lover knows images of the intricate structures of the that they see the world differently Biometric verification technologies can iris (colored part of the eye), but these than humans, but why? The reason identify someone using one or more patterns can change over time. The ret- lies within the light receptors of the distinguishing biological traits. Some ina’s network of blood vessels remains eyes called cones and rods. of the most common unique identifiers stable throughout a person’s life. In ad- include fingerprints, DNA, and signa- Dogs have fewer cone receptors dition, retinal scans can differentiate than humans, meaning they can’t tures. Retinal scanning is an emerging between identical twins. They are about see as many colors. Human cones type of biometric verification approach 70 times more accurate than iris scans. can detect 3 colors while dog cones that is extremely accurate. The error can only detect 2. It’s tough to know rate for fingerprint identification is Emerging Capabilities exactly what colors dogs see, but sometimes as high as 1 in 500, but ret- As retinal scanners have become easier it’s probably similar to what we see at dusk. inal scans have an error rate of just 1 in to use and more affordable, the tech- 10,000,000. Retinal scans have mainly nology is increasingly being used to Human eyes have fewer rods than been used to gain physical access to safeguard critical computers. In addi- dogs. This means dogs can see specific locations or buildings. These tion, they are being tested to help di- much better at night. Dogs also devices are usually used in places that agnose other chronic health conditions have a layer of eye tissue that humans lack called the tapetum lucid- require very high degrees of security, (Table). This is because health problems um, which reflects light into the ret- such as high-level government build- can show up in your eyes early in some ina. It boosts night vision for dogs ings like the CIA and FBI facilities and diseases. As the technology continues even more and it’s why their eyes for military or correctional facilities. to advance, these scans may be used to shine in the dark. It turns out that dogs see much more than just black How It Works supplement other tests as a non-inva- sive way to improve medical care. and white. Retinal scans map the unique patterns of the retina. During a retinal scan, us- Table: Retinal Scans & Your Health ers must remove glasses, stare at a specific point, and hold their head still for Retinal scans may potentially be used to 10-15 seconds so that the scanning de- help diagnose and monitor several chronic vice can complete the scan. Once the health conditions, such as: scanner captures a retinal image, spe- • Atherosclerosis cialized software compiles the unique • Chicken pox features of the network of retinal blood • Congestive heart failure vessels into a template. Retinal scan • Leukemia algorithms will not let a user enroll or • Lyme disease verify until the system captures an im- • Lymphoma age of sufficient quality. A retinal scan • Malaria is difficult to fake because the human • Sickle cell anemia • Syphilis Cosmetic lenses may cause blindness

2 INSIGHTS EYE HEALTH

More Time Outdoors L

How Nature Might Impact Your Vision Exposure to 10,000 lux of light for 2–4 hours a day can be key for protecting children First Aid Eye Care from myopia. A typical sunny day oﬀers this much light. Indoors a typical classroom Tips for Kids has around 500 lux.2 It’s important to teach kids about what to do if they suffer eye injuries. Here are some helpful tips from the National Eye Institute QUALITY OF LIFE IMPACT for some unique situations: Children who are at risk of A view of nature can reduce stress developing myopia, who spend among highly stressed children.

14 hours per week outdoors, The more plants, green views, and access 1 Problem: “I got sand (or dust) in might delay the onset of myopia. to natural play areas, the more positive the results were for lower stress levels.3 my eye!” Solution: Don’t rub the eyes. Wash them out with water or saline.

Problem: “I got hit in the eye with a ball (or rock or elbow)” Solution: Use a gentle cold compress on the eye for 15 minutes to reduce swelling and relieve pain. If swelling or pain persist, take the child to a doctor.

Problem: “A chemical (or clean- ing fluid or battery acid) splashed Ideas to Get You & Your Kids Outside! in my eye!” + Let your child explore their imagination with sidewalk chalk. Solution: Wash the eyes out + Bring toys outside, such as playsets and building blocks. with water or saline for at least + Set up an obstacle course with old tires, boxes, crates, and tree stumps. 10 minutes and take the child to + For the evening try bowling with a playground ball and water bottles. the doctor immediately after this (Bonus you can light up those water bottles with glow sticks) washout period. + Take advantage of trail ﬁnding or augmented reality apps to discover new and fun ways to explore outside with your children. + Plant and maintain a garden with your kids.

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1. Sherwin JC, Reacher MH, Keogh RH, Khawaja AP, Mackey DA, Foster PJ. The association between time spent outdoors and myopia in children and adolescents: a systematic review and meta-analysis. Ophthalmology. 2012 Oct;119(10):2141-51. 2. Zhou Z, Chen T, Wang M, Jin L, Zhao Y, Chen S, et al. (2017) Pilot study of a novel classroom designed to prevent myopia by increasing children’s exposure 3. Wells, N.M., and Evans, G.W. “Nearby Nature: A Buﬀer of Life Stress Among Rural Children.” Environment and Behavior. Vol. 35:3, 311-330.

2 3 INSIGHTS SCEYENCE How Better Sleep Hygiene Eye Charts: Helps the Eyes A Closer Look Better Sleep Suggestions “Sleep hygiene” is a term that refers to a variety of different practices and habits that are needed to have good sleep quality and daytime alertness. To practice good sleep hygiene, it’s critical to make healthy sleeping patterns a bigger priority. The Centers for Disease Control and Prevention recommend the following to improve sleep health: • Go to bed at the same time each Insufficient sleep is a big problem for night and wake up at the same many people. Studies show that one- time each morning, including third of Americans get fewer than 6 weekends. hours of sleep per night. Not getting enough sleep has been linked to many • Make the bedroom quiet, dark, The eye chart measures the different diseases and health condi- and relaxing, and keep the tem- sharpness of your vision, or visual tions, but it can also hurt your eye- perature comfortable. acuity. If you don’t wear glasses sight. According to studies, the eyes or contacts, your eye doctor will • Remove electronic devices (TVs, use the results to find out if you need at least 5 hours of sleep each computers, and smart phones) may need them. If you already night to properly replenish and revive from the bedroom. wear corrective lenses, the eye themselves to work at their full poten- chart test results will help deter- tial. • Avoid large meals, caffeine, and mine if your glasses or contacts prescription needs to change. Lack of sleep can sometimes lead to alcohol before bedtime. less serious vision problems like in- • Exercise during the day to help The most commonly used eye voluntary eye spasms, a condition you fall asleep more easily at chart is the Snellen chart. It usual- called myokymia. These spasms cause ly shows 11 rows of capital letters. night. The first line has one very large twitches in your eyes that won’t go Your eyes stay busy all day long, letter, and each row after that has away. Although they’re not painful and more letters that are smaller in don’t cause vision damage, they can meaning the only time they have a size. Standing 20 feet from the be frustrating and may disrupt your chance to replenish themselves is chart, you will be asked to read daily routine. Over time, lack of sleep during sleep. Practicing good sleep from it without your glasses or hygiene can help you get a good contacts. You cover one eye and can lead to more severe eye problems. read out the smallest line of let- night’s sleep and ensures the eyes Poor Sleep & More Serious Eye Problems ters you can see. The test is done will get the rest they need so you can on each eye. If you have 20/20 Lack of sleep may lead to popping of continue to have healthy vision. vision, you have normal visual blood vessels in the eyes due to con- acuity. tinuous straining. Another more serious problem from lack of sleep is dry eye, which can lead to pain, light sensitivity, itching, redness, or blurred vision. Long-lasting sleep deprivation may also cause anterior ischemic optic neuropathy (AION), a serious eye condition that tends to affect older people and those with a history of sleep apnea. If the optic nerve is damaged from AION, you can have vision loss.

4 INSIGHTS EYE HEALTH LED Lighting: Assessing Eye Risks Eye Cosmetics & Hygiene

infrared light that is created benefits your health. Near-infrared light, such as the light generated by candles or fires, primes the cells in the retina for rest, repair, and regeneration. LED lighting is a key source of the electromagnetic radiation that we’re exposed to daily. Even brief periods of exposure to too much blue light can damage the retinal pigment epithelium, which can lead to photoreceptor cell death. When too many of these cells die, the result can Women often wear eye cosmet- Light-emitting diode (LED) lights are be vision loss. ics like mascara, eyeliner, and up to 95% more energy efficient than Protect Yourself incandescent bulbs and are cost sav- eye shadow to emphasize and ing to consumers. In addition to light- There are steps you can take to protect highlight their eyes to look and ing houses, office buildings, schools, yourself from potential damage from feel more attractive. Although overexposure to LED lighting. When stores, and streets, LEDs have be- eye cosmetics can boost self-es- shopping for light bulbs, look at their come the dominant technology for teem, they can also move around back-lighted tablet displays, such as color rendering index (CRI). Incandes- the face and across the eyelids, iPads and e-readers, and large tele- cent bulbs, candles, and sunlight have vision sets. However, recent studies a CRI of 100. When buying LED bulbs, which can lead to eye film insta- suggest LEDs generate blue light that look for those with a CRI of 97, which bility and dry eye. is isolated from all the other colors on is the closest they will come to natural the light spectrum. This can damage light. Proper eyelid hygiene is import- the retinas and may ultimately contrib- LEDs are most dangerous at night be- ant, especially for people at risk ute to vision loss. cause there is no counterbalancing of of dry eye and those who wear Comparing Light Sources red light. Consider using incandescent contact lens. Eyelid scrubs and bulbs or candles if the night’s activi- warm compress products are Natural light gives off all the colors of ties do not require intense amounts of two ways for clean your eye- the rainbow in a somewhat continuous light. An alternative is to use crystal manner whereas typical “white” LED clear “vintage” incandescent bulbs or lids and lashes. Practicing good lights consist of a fluorescent coating. low-voltage halogen bulbs. If you must lid hygiene can also help. Talk This coating transforms part of the be exposed to blue light after dark, to your doctor about the safest blue light into longer wavelengths, cre- think about using blue-light blocking and most effective strategies to ating a yellowish light. However,much glasses. Talk to your optometrist if you maintain lid hygiene and tear of the light emitted is still invisible blue have concerns about the effects of light, an aggressive high-energy, short LED lighting on your eyes. health. wavelength light that’s responsible for keeping people awake and alert. Blue Open Your Eyes 80% of what we learn is through our eyes. So open light is present in sunlight and a neces- your eyes and enjoy the world around you! sary ingredient for life, but it needs to be balanced by all other colors of light, particularly red, which is its opposite color of light. The heat generated by incandescent light bulbs is infrared radiation. This heat requires more electricity, but the

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© 2018 Novartis 8/18 US-DTM-18-E-1759 Ask if there were any changes since my 2 Some people are born with two different col- last exam. ored eyes. This condition is heterochromia. When should I return for my next exam?

EYE-Q Answer to Eye-Q (from page 1) 3 It’s impossible to sneeze with your eyes A: 1 inch across open. Your eyes and nose are connected Thank you to our sponsors: by cranial nerves, so the stimulation from CONTACT a sneeze travels up one nerve to the brain, Tara O’Grady then down another nerve to the eyelids, [email protected]

typically prompting a blink. Heather Kreidler [email protected]