Appendix (I)

PROTECT YOUR GOOD VISION

Practicing good vision habits can reduce strain on your visual system and therefore reduce the likelihood of fatigue or adverse adaptations such as short-sightedness. You should also have your eyes examined regularly so as to detect any vision changes that you may not be aware of. This will enable any pro-active or preventive measures to be taken.

1. Take regular breaks during study, VDU work and other sustained close demand tasks. These rest periods do not need to be long, e.g. five minutes every hour or so. Position your reading table so that when you look up, you can see an object into the distance at least say 3 metres away. Periodically, every five to ten minutes, look up and focus for a couple of seconds into the distance and then continue the close work. Try to develop this as a habit, something that you do naturally. Children can use a bookmark to remind them when the five minutes are up (e.g. every 2^nd to 3^rd page etc). Book-shelf tables do not allow for the situation above and should not be used.
2. Consider the working distance. Don't work too close to the near task. Your eyes should each be atleast at a knuckle-to-elbow distance from your book when reading and writing. Sitting up and reading on a desk encourages a better reading distance than reading in bed. If you find it necessary to hold the reading material at a closer than normal distance to see adequately, you must have an eye examination to determine the reason for this.
3. Good lighting of the work task is important. For maximum efficiency, use general illumination of the room to enable you to see up into the distance every five to ten minutes, as described above. Any additional light should come from above and to the side depending on handedness (e.g. from left side for a right-handed person).
4. Good posture promotes the knuckle-to-elbow reading distance and equal use of the two eyes. Avoid reading in bed or other inappropriate positions which necessitate holding material too close, or other than perpendicular to line of sight. If you must read in bed before sleeping, sit up, look away every 5 to 10 minutes and try to minimise the reading time. Before sleeping, remember to focus far and close several times, and to stretch the eye muscles by rolling your eyes (moving them in a circular motion) and blinking.
5. Tilt your book and work surface whenever possible to achieve its presentation at right angles to the line of sight. A slope-top desk is a valuable aid to good vision function, since it presents the task in a desirable position and also helps to support the body in a balanced posture. A bookstand is the next best option. A bookstand is economical and can be made by the home handyman. We stock these bookstands and advise on the angles needed when making them. Using a desk and bookstand for reading instead of lying in bed also enables you to practice the advice in paragraph (1) above.
6. Do not sit any closer to the TV than you have to. The further you are, the better you are able to shift your focus away form the set. To enable this, use adequate room lighting. It is important to note that vision develops better with active tasks such as sports and reading; thus children should be encouraged to prefer these tasks to watching TV.
7. For very young children, there are videotapes available, which go through a child's visual and overall development in a yearly fashion up to age 5. Children can be encouraged to take up the type of activities shown in these tapes which can be loaned from our clinics at a nominal cost.
8. Balance high-demand near tasks (e.g. computer work and reading) with out-door activities requiring adequate distance viewing e.g. tennis, bike-riding etc. Relax when possible outdoors.
9. Avoid doing a lot of close work during acute illness. High fevers appear to put the visual system at risk of significant damage, especially when it is forced to do a lot of close work.
10. Avoid reading or any other sustained near activity while travelling by car. This puts extra strain on the focusing and coordination of the eyes.
11. For best performance when writing, one must be able to see the pencil tip. The thumb and the two next fingers allow for most effective use of a pencil.
12. Eye Exercises: A variety of exercises can be prescribed depending on the purpose. Many of them aim more to strengthen one's ability in coordinating the ocular muscles or in focussing at closer distances. This allows for greater endurance in the eye tasks concerned. Some exercises bring about greater flexibility in the visual system. This reduces discomfort in the eye muscles and allows for quick changes in focusing and accurate eye movement. Generally speaking, the latter type of exercises are more useful in cases where there is over-use of the visual system, leading to fatigue. Conversely, the former type of exercises, are of greater benefit where there is lack of development of particular eye skills, or an under-use of the visual system.
13. Performance Lenses ("Relaxing" Glasses): Reading glasses are frequently of value in preventing eyestrain and improving performance. They are like a tool for the task of sustained near looking. They are used as a means of preventing stress-induced vision problems, and to enable maximal visual performance (or most efficient use of the eyes) for near tasks. They are usually low-power lenses, which may blur far seeing. Bifocals may be considered, the upper portion with a compensatory power or no power, if vision for both far and near is demanded. Lately, a number of differently designed lenses have been developed that allow for work to be done at a range of distances. (e.g. Access, Office etc) They are especially useful for VDU work and can be used by both the young and old. The power in these lenses changes progressively and thus there are no dividing lines as in bifocals.
14. If you have glasses, be sure you understand how they should be used. Keep them clean, by washing them regularly with lukewarm water and dishwashing liquid. Ensure they are always fitting properly and not tilted to one side.
15. The general health also needs to be looked at as this influences the state of the visual system. A good diet including sufficient vitamin A and iron are essential. Poor focussing can easily develop if there is a lack of iron. Sufficient bodily exercise would also be important, as this would aid one's ability to concentrate, which is important in eye work. It is also important to reduce nervous stress before attempting a lot of near work. One can perform any type of work more comfortably over longer periods of time when one is more relaxed. This also applies to the visual system.

(iii) A healthy diet, should be emphasised. Iron is particularly important. Rich sources of iron include liver, beef, beans, lentils, spinach etc. Refer to healthy eating for details of what constitutes a good diet.

(iv) Cleanliness or hygiene of the affected tissues is essential in cases of infection. The eyecare practitioner may recommend antibiotic drops in cases of acute infective conjunctivitis. The effect of these drops can be increased by first rinsing the eye with sterile saline. This can be purchased from any chemist in the form of an aerosol pack.

Unfortunately, eye drops are not effective in clearing chronic conjunctivitis, as the cause is generally an infection of the sinuses or nasal passages. The only effective treatment is avoidance of those environmental factors that pre-dispose to nasal/sinus infections. As this is not always possible, nasal hygiene can also be promoted by regular rinsing of the nasal passages with sterile saline. This can be freshly prepared at home for economical reasons. We regularly recommend this to patients in our clinic who suffer from chronic conjunctivitis and have signs of nasal/sinus infection. See appendix (II) below on NASAL RINSING for a copy of the handout that we give to our patients.

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