Halo Vision: Should You Be Worried? with Nicole Bajic, MD

Podcast Transcript

John Horton:

Hey there and welcome back to the Health Essentials Podcast. I'm John Horton, your host. If your view of the world has seemed a bit more angelic of late, well today's show is for you. We're going to be chatting about halo vision, a spot-on term for when you see bright rings around lights that you're looking at. We're going to talk about what causes the condition, when it should be treated and some simple steps that you can take to maybe help prevent it.

Joining us is ophthalmologist Nicole Bajic, one of the many trusted experts at Cleveland Clinic who visits the podcast to help us better understand our health. So now, let's put a spotlight on halo vision and find out what's going on.

Dr. Bajic, welcome back to the podcast. Great to have you.

Dr. Nicole Bajic:

Thank you so much for having me. It's always a pleasure.

John Horton:

Now one of the things, we always like to get to know our docs a little bit when they come on here, and when I was watching your bio video, I saw that you mentioned that you were kind of destined to be an eye doctor. So, tell us a little bit about that.

Dr. Nicole Bajic:

Oh, that's funny. So, I guess it started in the womb, huh? My mother was a scrub nurse and she scrubbed for a lot of ophthalmology cases, and she did so while she was pregnant with me. When she delivered, all the ophthalmology residents came and brought me a little teddy bear. And one of the residents that brought me that first teddy bear is the one who gave me my first job. So, it really came around full circle.

John Horton:

That is a very small world and just I love stories like that. So obviously then, you are the person we need to talk to here because you have literally a lifetime plus of experience with eyes it sounds like. So, let's get right into it with halo vision. So, what happens to create those glowing circles that appear around headlights and streetlights and any other illuminated object that you see?

Dr. Nicole Bajic:

Some degree of those halos are totally normal. We all experience that at nighttime, when we're seeing those streetlights, that halo of light around the central source of light. And a lot of the reasons for that is because of the shape of our cornea. So just a quick primer, the cornea is the windshield of the eye. It's a clear window and it's a little softer of a cone shape, and it's steeper centrally and flatter in the periphery. And we call it a prolate shape. And so that's part of the reason why we see that natural halo effect around lights. However, in some patients, it can be exaggerated or a little bit off kilter into like a cone-ish shaped or other types of shapes. And that can be potentially due to pathology.

John Horton:

So, a lot of this sounds like then, it has to do with defraction and angles and all that math stuff that we learned in school. And with how light is kind of entering your eye?

Dr. Nicole Bajic:

Yeah. So again, it depends on how light is entering the eye and how it gets reflected. And so, we call the funny ways that light can be dispersed, aberrations. And it's just a fancy name for the failure of light rays to all converge at the same point. And it depends on the shape and curvature of the eye. And sometimes, with different pathologies, like with cataracts or things that are wrong with the cornea, that can make those light rays enter and change in a more dramatic fashion, which can obviously affect the quality of the image that we see.

John Horton:

Is there a reason why it happens more at night?

Dr. Nicole Bajic:

I think, especially with the contrast that you're seeing, it's a darker background and then, you have a brighter light, and so things can be a lot more obvious. There's also a phenomenon called night myopia, where the eye naturally dilates more and so you have more peripheral light rays entering and it hits the further periphery of the lens inside the eye, which can cause a significant change, for people to be a little bit more nearsighted. So, it can make some of that a little bit more dramatic.

John Horton:

You said that halos are something that pretty much anybody can experience, but I take it there's sometimes when you see halos where there there's a cause and something going on in your eye. What are some of the things that you should look for there?

Dr. Nicole Bajic:

Of course, some degree of halos is natural. Some degree can be due to corrective lenses like glasses. But yes, some are due to pathology. So, one of the most common is after having a LASIK® or maybe PRK®, so laser eye surgery to help correct a natural prescription in the eye. Part of that is due to the light rays hitting where the edge of the treated surface of the cornea has been. And so that can cause some of those aberrations for patients. In addition, you can get it from cataracts, so that's that natural clouding of the lens inside the eye. That can happen with the aging process.

Again, you can have it with significant amounts of astigmatism. Astigmatism is just a fancy word for your eye's not shaped perfectly round, and so it might be a little bit oblong. And that can, of course, affect how light rays are entering and transmitting through the eye. You can also get it from something called angle-closure glaucoma. So that's where the drainage pathway in the eye gets closed off, pressure builds very high inside the eye, and you can get clouding of the cornea. And that can be responsible for some of the halos that people see. Typically, that's going to be accompanied by headache, nausea, vomiting, eye pain. But again, if something's happening acutely, make sure you come in to see an eye doctor for that.

John Horton:

Pain would definitely be a signal to come in, I'm guessing, if you have pain in your eye.

Dr. Nicole Bajic:

Absolutely. But you'd be surprised. Some people can be a wait and see if it goes away type of person. And that can be really dangerous when it comes to your eyes. So that's why I stress it.

In addition, people can also get halos with something called keratoconus, where the cornea becomes much more cone-shaped and that can cause a lot of irregular astigmatism. And so that affects how light rays enter the eye much more dramatically causing a much more obvious halo effect. Fuchs' dystrophy so that's a corneal condition where you have little dimples on the inner surface of the cornea and that can affect how light's coming through can also cause corneal edema, which is just swelling in the cornea. Which again would affect how light is able to get transmitted through. And then finally, multifocal lenses. So, we've got a lot of fancy technology these days, which is great. However, it does not replace Mother Nature. And so, these multifocal lenses, which help us see at multiple focal lengths, can cause some splitting of light coming into the eye. And that's what causes those aberrations that can make us see the halo effect.

John Horton:

What about dry eyes, too? I know that's something a lot of people struggle with. Is that something that could lend a little bit of a halo effect when you're looking at things?

Dr. Nicole Bajic:

Absolutely. That's a great point. So dry eye is very common. It's a spectrum, of course. So, the majority of patients with dry eye might not experience the halos, but it can certainly affect things, especially when someone has much more significantly dry eye, just because the surface of the eye is not well lubricated. The air tear film interface is the most important optically for how those lights or light rays are transmitted into the eyes. So, any deviation from normal can certainly cause a halo effect.

John Horton:

Yeah, it's amazing. Every time we talk, I'm always just taken with just how much is going on in your eye. And I don't think we think about what just an incredible, I guess, device your eyes are. But there's just a lot happening.

Dr. Nicole Bajic:

Oh, yes. I didn't realize I'd be using so much physics in my line of work, but it's a fascinating thing.

John Horton:

We went over a bunch of possibilities, things you could have if you do see halos. When is the point where you absolutely need to go in and see your eye doctor and say, hey, I'm seeing these things, what's going on?

Dr. Nicole Bajic:

Sure. So, in general, everyone over age 40 should be getting an annual eye exam, that's the formal recommendation from the Academy of Ophthalmology, the American Academy of Ophthalmology. And so, we should already be looped in with an ophthalmologist or optometrist, making sure that we're getting checked out. However, I know that time can get away from many of us. And so especially if you're seeing something new and it's noticeable and bothersome, make sure you get that checked out. Because if there is something going on, you really want to get that diagnosed sooner rather than later because time can truly be vision.

John Horton:

And it sounds like you said some of the key things you should look out for would be pain, blurred vision. Anything else that's just a real kind of telltale sign that you need to get in immediately?

Dr. Nicole Bajic:

Sure. So, it's hard to say because so many different things can be presented differently. But obviously, out of what I mentioned, the angle-closure glaucoma is the most concerning one, and that can present with headaches, nausea, vomiting, eye pain, like we discussed in the blurred vision. So, cluster of any of those symptoms, make sure that you're coming in to get checked out. Especially if it's been some time since you've seen an eye doctor.

John Horton:

OK. And I'm assuming then that there are a lot of treatment options available if you do come in and you have a condition that's causing the halo effect

Dr. Nicole Bajic:

So yes and no. We've come a long way and there are a lot of fantastic treatments in order to take care of the various things that can go wrong in our eyes. However, as amazing as medicine is these days, there are so many things that we just cannot catch up to Mother Nature, we can't replace Mother Nature, what they gave us. So, there are things that we can do to help improve the symptoms. For many people, this will resolve it. However, there are some conditions where we can try and improve it; however, it might not completely resolve the symptoms.

John Horton:

OK. Well, Dr. Bajic, we always like to leave our listeners with some things that they can do to deal with some issues. So, what can we do at home to improve our eye health and maybe avoid or hold off those halos popping up

Dr. Nicole Bajic:

Sure. So, one of the most important things you can do, not just for your eye health, but for the health of the rest of your body, is if you're a smoker, stop. Smoking is terrible for our bodies, and it can also speed up the rate of cataract formation. In addition, it's really important that when we're outside, especially on bright sunny days, that you're wearing sunglasses with 100 percent UV protection. This might also be labeled as UV 400. So again, 100 percent UV or UV 400, because that's the most protective for our eyes. And I like to tell.

John Horton:

Don't go through life squinting.

Dr. Nicole Bajic:

Yeah. A lot of the sunglasses that might be given out as a little freebie, those might not have that kind of protection. So, I like to tell people, if you're not sure, there should be some sort of labeling on the package or like a sticker or something written somewhere. Because the companies would like to brag about it if it's got that feature. So, make sure you're looking out for it.

In addition, things that we should all be doing are eating lots of dark leafy greens because those have vitamins that are known to be good for your eyes. Some patients might see eye vitamins over the counter. I get this question all the time. should I be taking these eye vitamins? In terms of the popular eye vitamins on the market, those are typically the perfect ratio of vitamins made specifically for macular degeneration. But there hasn't been a clear benefit shown in the literature for people who do not have macular degeneration. So, I would say unless you have a clear diagnosis of macular degeneration and your eye doctors recommended it, you can just stick with dark leafy greens, and those are helpful. And it's really great to get your vitamins from your food to begin with, not to mention the fiber that you get from it, too.

With more extensive research, we're starting to see now that the gut microbiome does have a link to eye health, which is so interesting. And one of the things that we can all do, there's some research out from one of our very own Dr. Phoebe Lin, suggesting that fermentable fiber can be key to decreasing risk of inflammatory conditions like uveitis in the eye. So, fiber, we should all be getting fiber, we're all not getting enough fiber. And it can have a lot more dramatic effects on the body, even our eye health that many of us don't even, or we're just starting to come to realize what that link is. So those are my big recommendations there.

John Horton:

That is a fascinating tidbit you just threw in there. It's hard to believe that your gut is connected to your eyes, but I guess our whole body is kind of interconnected and just if you live healthy, good things happen.

Dr. Nicole Bajic:

Yeah. It seems very cliché, being like “diet and exercise are really important for your entire body,” but the more research we do, the more we're coming to find out just how true that is. So as much as you can, trying to be mindful of what you're putting into your body, that's going to pay off in the future. In ways you might not even realize.

John Horton:

The key thing is to make sure you schedule your appointment if you think you have anything going on with your eyes and make it a regular occurrence.

Dr. Nicole Bajic:

Absolutely. It should be a regular occurrence, just like you get your dental cleaning. You're actually supposed to get it twice a year, but at least go see your eye doctor once a year. And that way, if something goes wrong, with an emergency situation potentially, you already have someone to call. It's so much easier to get in when you're already established with someone. So, for some people, I'll say, what they like to do is make all their annual appointments around their birthday month. And if that's what makes it easier, then I recommend doing that. Anything to get you in and make sure you're getting seen.

John Horton:

Great advice as always. Thank you so much for joining us and look forward to having you back on the show.

Dr. Nicole Bajic:

Thanks so much for having me.

John Horton:

So, if you're seeing glowing rings around lights, it's a good idea to schedule an appointment with your eye doctor to know why they're appearing. In other words, consider those halos a sign. Until next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts, or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.