As a follow-up to my recent article about macular dengeration, here's five basic but powerful actions you can take to help prevent or reduce the severity of the disease:
* Stop smoking -- smoking decreases the amount of oxygen in the blood stream.
* Wear quality sunglasses -- High-quality glasses reduce ultra-violet light exposure. More suggestions here.
* Lose excess weight/exercise - obesity is a major risk factor for the above conditions, including macular degeneration.
* Maintain normal blood pressure -- High blood pressure is a major risk factor for both systemic and other eye conditions (arterial and vein occlusions, etc.)
* Eat foods rich in anti-oxidants-- Two anti-oxidants in the macula are lutein and zeaxanthin, abundant in green leafy vegetables -- especially kale, collard greens, and spinach. See my previous article for more ideas.
Many patients are concerned when an older relative develops macular degeneration, and worried that they may also develop it.
WHAT IS MACULAR DEGENERATION?
Macular degeneration (also known as ARMD - age-related macular degeneration) is a condition that affects the macula of the eye as one ages. The macula is, by far, the most sensitive part of the retina, and where the clearest central vision takes place.
Imagine looking through a lens with a big smear of vasoline in the center....
Many people as they age develop a harmless amount of drusen in the eye. But an excessive accumulation can cause blurred or distorted vision in the central eye area. That is diagnosed as "dry" macular degeneration.
Some people also develop a growth of blood vessels under the macula, which can leak or hemorrhage, causing more severe visual distortion. This is referred to as "wet" macular degeneration.
Unfortunately, reduction and distortion of vision from macular degeneration has not been considered treatable or preventable until recent years.
WHAT ABOUT PREVENTION?
There is much controversy and confusion about whether the effects of macular degeneration can be prevented or lessened.
Recent research suggests that excessive exposure to the sun may contribute to macular degeneration, from the ultraviolet light waves and the resulting oxidative products that build-up in the eye.
What you can do:
1. Wear a good quality pair of sunglasses that totally blocks and filters rays (note: please wear a reputable brand, and avoid inexpensive or "knockoffs" -- they can cause more harm than good). If you have any doubts about the quality of your sunglasses you may bring them by our office to inspect them. We now have an ultraviolet meter that can measure how effective your lenses are in blocking these harmful rays.
2. Consider foods, vitamins and supplements high in anti-oxidants. It is hypothesized that natural anti-oxidants in the diet may have a protective effect against damaging wavelengths.
A study of patients with mild macular degeneration who took anti-oxidants in the form of a pill, delayed the onset, and lessened the eventual severity of the disease. (ARED's study)
Two things to look for: Lutein and Zeaxanthin -- abundant in green leafy vegetables like kale, collard greens and spinach. Many supplements also include these anti-oxidative compounds.
Vitamins B6 and B12 (folic acid) and Omega 3 and 6 fatty acids may help protect against macular degeneration.
There are differences in opinions about the benefits of taking vitamins and supplements. To read more about this, refer to my blog "Do Vitamins and Supplements Really Work?"
Keep in mind, the data is still inconclusive about the cause and effect of sunlight and diet on macular degeneration. But there's no doubt that limiting sun exposure and eating foods high in anti-oxidants are smart lifestyle choices in general -- and may well help limit or delay macular degeneration.
CAN MACULAR DEGENERATION BE TREATED?
There is no treatment available for dry macular degeneration. However there is evidence that taking the above anti-oxidants may delay or prevent its progression. Chemicals have been discovered that can reduce new blood vessel growth, and have shown success in improving reduced vision in wet macular degeneration. Injections of these chemicals will not bring vision back to normal levels, but may lessen the severity of the loss of vision.
There are many conflicting opinions about the benefit of vitamins to supplement diet.
Some studies conclude that vitamins may lower the risk of heart disease or lower certain cancer rates. I know many people who have a daily ritual of taking multiple tablets and powders, or take high doses of vitamin C at the earliest signs of a cold or flu.
Yet recent studies by the government-funded Women's Health Initiative, tracking 150,000 women over eight years, found no significant difference in lifespan or rates of cancer and heart disease between those who took multivitamins, and those who didn't.
Other studies have concluded that no manufactured vitamin or supplement can match the effectiveness of nutrients obtained from eating whole foods.
The fact is, different studies can give contradictory results. I have read articles in journals strongly citing the superior vision or comfort of a new contact lens or solution -- only to see the study was performed by someone representing the manufacturer.
I personally believe in the natural diet way of achieving health. But I also advise patients who believe in supplements to continue to take them, if there are no harmful side effects.
RINSE IMMEDIATELY, FOR AT LEAST 20 MINUTES
Don't delay, trying to figure out what got in your eye, or seeking more advice first. The longer a foreign substance remains in the eye, the greater the risk of damage. Why 20 minutes? Eyes must be completely fliushed. Even the smallest lingering particle can do damage.
Of course, if you wear contacts, remove them first.
WHAT TO RINSE WITH?
Sterile saline is best, followed by distilled water. Otherwise, use tap water from your faucet. Or get in the shower and let a stream of lukewarm water run into the affected eye.
CALL US FOR ADVICE, ONLY AFTER RINSING
Depending on what got into the eye and how you feel, you may need further treatment.
A NOTE ABOUT SUBSTANCES
The most damaging substances are alkaline-based, such as bleaches, detergents, or cleaning agents.
Many contact lens wearers have told me that they mistakenly used a cleaner instead of a wetting drop or saline, and paid a painful price! The good news is that acidic substances, like cleaners, are neutralized more quickly and the effects more superficial.
I have 2 brand new instruments to improve patient care.
Corneal Pachymeter - this instrument measures the exact thickness of the cornea. Knowing the thickness of the cornea is critical in deciding if a patient is a candidate for Lasik surgery. Lasik corrects prescriptions by selectively and precisely reshaping the cornea, by thinning specific areas. This procedure can cause problems, if the cornea is thinned below a certain failsafe point.
Another benefit of pachymetry is making it easier to determine your risk of developing glaucoma.
The instrument that measures eyeball pressures was calibrated for a normal thickness cornea. Guidelines have been developed to adjust the reading to compensate for corneal thicknesses that are thickner or thinner than usual. Recent research has determined that people with thicker corneas are more resistant to developing glaucoma, whereas, those with thinner corneas are more likely to develop glaucoma.
Corneal Topographer - I am looking forward to getting this instrument as it maps the entire topography of the cornea. This is invaluable in fitting rigid contact lenses and in determining unusual corneal contours. It can differentiate between different types of astigmatism, and help in getting more accurate prescriptions for those with irregular types. This is the instrument of choice in determining the prescence of keratoconus, and for monitoring its progression.
The American Optometric Association recommends:
Children:
Birth to 24 months: at 6 months of age
2 to 5 years: at 3 years of age
6 to 18 years: Before first grade and every 2 years thereafter
Adults:
18 to 60 years: every 2 years
61 years and older: annually
If a child has certain risk factors, such as prematurity, oxygen at birth, a difficult or assisted labor with low Apgar scores, or if an adult has diabetes, hypertension, a family history of ocular disease, a history of cancer (especially lung or breast cancer), as well as many other conditions, more frequent eye examinations are recommended. Certain medications may affect the eye or vision, and patients taking these require more frequent eye examinations.
My own office policies and recommendations are:
Children: I feel comfortable examining children's eyes at age 4 or 5. Pediatricians usually screen for the eye diseases that may affect a newborn and can detect eye problems that tend to develop in the early years.
Things to look out for in infants and young children that may be a problem:
1. Cloudy cornea, or cloudiness in the pupil of the eye.
2. Tearing of one or both eyes.
3. Sitting very close to a television or holding books very close to the eyes.
4. Improper alignment of the eyes. (appear crossed) Many children are born with a fold of skin in the inner corneas
of the eyes that gives a false impression of crossed eyes. This fold diminishes as they grow and the eyes will develop a normal appearance.
If eye problems are suspected before age 4, a Pediatric Optometrist or Ophthalmologist should be consulted. They have special training and equipment to properly examine and treat problems in very young children.
I think that children and teenagers should be examined on a yearly basis, as these are the years that a prescription is most likely to change rapidly. It is not uncommon to see rapid increases in myopia from the 4th or 5th grade until the 9th grade. If I see a large change in prescription, I recommend to see the child in 3 to 6 months, depending on how much of a change.
Adults (ages 20 to 60): I follow the AOA recommendation of 2 year intervals. Exceptions are patients who have the above mentioned risk factors. I would also like to see an adult sooner than 2 years if their prescription changed more than normal or in an unusual way. Sometimes a patient may develop one of the normal aging problems (examples - cataracts, early signs of macular degeneration, etc.) prior to age 60 and I would want to see them sooner than 2 years.
The chance of developing certain eye diseases increase (cataracts, glaucoma, macular degeneration) when a person is over 60 years old, so I would like to see them annually.
Contact lenses wearers are much more likely to develop eye problems and need to be examined more frequently. A contact lens wearer should be seen annually, or more frequently if sleeping overnight in lenses, or if they have conditions making them more likely to develop eye problems.
PREGNANCY AND THE EYE
Many pregnant patients ask about what changes in their eyes or their vision could occur during pregnancy. They may have read articles that dry eyes, prescription changes, puffy eyelids, migraine headaches, and increased light sensitivity commonly occur. Should they delay purchasing new glasses or contact lenses until after their pregnancy?
It is true that the body undergoes many physiological changes, including hormonal changes that could affect the eyes. In fact, studies have shown that almost every structure of the eye undergoes some change during pregnancy.
I have found that these temporary changes do not affect the great majority of patients. Most do not notice changes in their prescriptions, and they are able to maintain normal contact lens wear. A few patients became less comfortable wearing contact lenses and either stopped wearing or reduced their wearing time.
If it is time for your eye examination, I would definitely recommend that you come in during your pregnancy. If you are not due for an eye examination, but you notice any changes in your vision or any new symptoms with your eyes you should call and set up an appointment.
If you experience discomfort with your contact lenses, I would suggest either reducing or stopping contact lens wear until after giving birth.
If you're an eye drop user, these two tips will help ensure they work!
TIP #1: ONE DROP ONLY
Sometimes I see my patients squirt multiple eye drops of fluid into their eyes. I then see most of the fluid spill out and run down their cheeks.
I recommend using only one drop per eye. That's all the eyelid can hold. No need to waste drops - especially when using expensive medication.
TIP #2: PRESS YOUR LOWER LID
In the inner corner of the eyelids are the puncta. These are openings where tears drain out. There is one in the top and one in the bottom. Most tears flow into the punctum of the lower lid.
After you apply your medication (one drop only) press your forefinger into your lower lid, against the base of your nose. That will close off the punctum, allowing the medication deeper penetration of the eye before it drains out.
This technique is especially useful for glaucoma medications and topical steroids for internal eye inflammations.
Many patients use Visine to "get the red out" of bloodshot eyes. Is that a good idea?
First, a little background. The eyes become red when blood vessels dilate to fight the source of irritation -- whether wind, infection, allergy, dryness, smoke, crying, inflammation, alcohol, anything really.
Visine and similar medicated drops contain a "vasoconstrictor" chemical that shrinks the blood vessels that cause "rednesss," for about 45 minutes.
Such products mask the symptoms of irritation, but don't address the cause. In fact, prolonged use may even increase redness --a situation called "rebound hyperemia." The more you use them, the more you need them.
Dr. TRACY'S TIP:
There's no harm in using Visine or similar products sparingly -- say, for a photo shoot, an important meeting or public appearance.
But please don't use them on a regular basis.
If red eyes are a reoccurring problem, I'd prefer to see you to diagnose and eliminate the cause -- whether it be lubricants for dry or irritated eyes, antibiotics for infection, steroids for inflammation, or other solutions.
Oh, and one more tip -- applying a cold washcloth to your eyes for 30 minutes will shrink swollen blood vessels significantly. A chemical-free and relaxing technique!
Patient: "Doctor, sometimes my eyes seem to tear and water."
Doctor: "You have dry eyes."
This paradoxical response tends to confuse patients until the logic behind the answer is explained.
TWO TYPES OF TEARING
There are two types of tearing. One is baseline tearing -- a constant release of tears from the
lacrimal gland, located in the inner area of the upper lid.
The second type is "reflex tearing," a sudden outflow set off by irritation, emotions, bright lights, etc. that protects the eye by diluting or flushing out the offending substance.
Aging and some medications or medical conditions can reduce baseline tearing to the point that the eye tissues get dehydrated and irritated, provoking the reflex tearing that offers relief.
MAIN CATEGORIES AND TREATMENT OPTIONS
Dry eyes can be classified into three main categories, each of which require a different level of treatment.
Mild -- occasional dryness or grittiness. Symptoms can be relieved by over-the-counter re-wetting drops (also called artificial tears), used as needed.
Moderate -- symptoms occur regularly. Re-wetting drops used on a regular schedule (e.g. every 2 or 4 hours; the frequency will vary with the patient) may eliminate or greatly reduce symptoms. Symptoms may vary according to environmental conditions like humidity levels or type of heating or a/c unit.
Severe -- Constant irritation and burning with dehydrated eye tissues, sometimes accompanied by ailments like rheumatoid arthritis or Sjogren's Syndrome. These patients may need stronger prescription medication, both topical and oral, and the constant use of rewetting drops in the daytime and a thicker ointment at night.
CAN DIET HELP?
There is some evidence that an increase in Omega 3 fatty acids may help improve the quality of the tear film and reduce dye eye symptoms. Omega 3's can be found in flax seed, cold water fish (salmon, anchovies, sardines) and supplements.
FIRST STEP: EVALUATION
Before treatment can be started, an evaluation of one's health history should happen, to help determine the nature of the dry eye.
1. Evaluation - determine the extent of the dry eye
2. Medical - is there a medical condition that is causing the dry eye?
3. Ocular - is there a problem with tear production of any of the layers? Are there any lid or lash problems that may add to the irritation?
4. Medications - determine if one is taking any medications (anti-histamines, birth control pills, etc) that may contribute to the problem
5. Environmental - is the heating or cooling system removing humidity from the air?
WHICH BRAND OF ARTIFICIAL TEARS IS BEST?
Many companies offer different types of artificial tears, but no one brand is considered superior. It's more a trial and error to find the drop that works the best for you. Symptoms of dry eye can be treated and relieved, but it is rare that a permanent cure can be found.
Patients often tell me that they don't see as well at night, and have trouble driving. Here's the technical reason: pupils enlarge under dim lighting conditions. That allows blurrier peripheral rays to enter the eye, which detracts from clear images and increases glare.
Here are tips to minimize these effects:
1. Keep your prescription up-to-date. Even the slightest blur, otherwise not noticeable in daylight, can become annoying in dim lighting.
2. Keep your lenses clean. Dirt and scratches distort light rays that cause glare and blurring, especially at night.
3. For contact lenses: use lubricating/re-wetting drops. Contacts accumulate deposits and dry out by nighttime.
4. When driving:
-. Keep your windshield clean, to reduce glare from light scattered by dirt and film.
- Keep your headlights clean, for better road illumination.
- Use the night setting on your rear-view mirror, to minimize distracting head lights from behind
- Concentrate on the road marking lines (center or shoulder), to reduce glare and reflection.
- Direct A/C (or heating) vents away from your face, to prevent moving air from drying your eyes.
- If you wear contact lenses, use lubricating drops before you start (remember, eye drops may blur your vision for several minutes before taking effect).
Here we go again. Another alert about an eye infection associated with the use of a contact lens solution. The CDC (Center of Disease Control) reports an outbreak of a serious eye infection, and found an association with Complete Moisture Plus TM Multi-Purpose Solution.
If you use this solution you should:
1. Stop using it immediately and discard the bottle, including any unopened ones.
2. Discard your current pair of soft lenses AND storage container
3. Stop by our office for an Opti-Free Replenish care kit (the most effective multi-purpose solution on the market)
If you've been using CompleteR and are experiencing any sign of an eye infection - eye pain, eye redness, blurred vision, sensitivity to light, sensation of something in the eye, or excessive tearing - please make an appointment with an eye doctor immediately.
This infection is caused by a micro-organism called Acanthomeba, and although extremely rare, can have devastating consequences if not treated early.
Do allergies bother your eyes? (you're not alone; an estimated 80 million Americans are affected). The good news: new anti-allergy medications are making it easier to relieve symptoms.
1. Pataday: this new, more concentrated version of Patanol only requires one dosage a day - an especially big advantage for contact lens wearers. The manufacturer is offering a $10 rebate on their website.
2. Zaditor (similar to Patanol) is now available without a prescription - though it does require twice a day dosing to be effective. Another medication in this same category that was recently changed to over the counter (no prescription required) availability is Alaway.
(If this article sounds familiar, it's because we it first ran in our newsletter last Spring. But worth repeating this time of year!)
Spring is here - and for some of my patients, that means allergies and symptoms ranging from mild congestion and nasal drip, to swelling, tearing and itching.
Fortunately, good treatments have been developed to provide relief:
For mild allergies, cold compresses on the eyelids can help. So can over-the-counter lubricating drops, which help flush out irritating particles. Artificial tears containing a mild anti-histamine are also now available. The "-A" after the brand name indicates the drops contain an anti-histamine (e.g. Opcon-A, Vasocon-A, Naphcon-A).
Moderate allergies can usually be controlled with more powerful prescription anti-histamine drops, which have a longer-lasting effect than those available over the counter.
Severe allergies require stronger prescription drops, combining anti-histamines and mast cell inhibitors if taken just before allergy season, they can even prevent the onset of reactions. For acute attacks (severely swollen and red lids with extreme itching), the temporary use of prescription steroids may be needed.
Keep in mind, other conditions can also cause these symptoms - although the more itching, the more
likely allergies are the cause.
Please consult with me so we can make a definite diagnosis and the best treatment plan, including prescription medication if called for. (Remember, most of these medications cannot be used while wearing your contact lenses.)
Contact us if you have any questions!
Many patients ask me about Lasik surgery. I'm naturally conservative when it comes to surgery; I think that altering any body tissues should never be taken lightly.
Lasik is considered elective surgery and there are risks. Much of the marketing and public relations downplay or ignore the risks and side effects. You're much more likely to hear from successful patients than from those experiencing problems.
That said, there are several factors I consider when discussing Lasik with patients:
Realistic expectations: Even with the best testing and surgeons, perfect prescriptions are not asssured, and glasses or contact lenses may still be needed.
Prescription: Good candidates should have stable prescriptions that haven't changed much in several years. Even so, there are no guarantees that your prescription won't change years after surgery. I've also found that myopia (nearsightedness) comes out better than farsightedness and moderate to high amounts of astigmatism. Patients with very high prescriptions have a higher risk of side effects, and there's more tendency for the prescription to change over time.
Type of visual system: I find that some patients have very "precise" vision, and small changes and variances affect them greatly. These patients are more likely to be disappointed by Lasik. Patients who can tolerate a range of prescriptions have a higher chance of being pleased with the results, even if not perfect.
Anatomical considerations: patients with dry eye and/or large pupils are much more likely to experience post-surgical symptoms.
Dependence on precise vision for work: A micro-surgeon who needs precise depth perception to perform his duties would have more trouble than a singer should the results be less than perfect.
Age: Although Lasik is approved for anyone over age 18, many younger patients' prescriptions continue to change in their twenties. I think that mid to late 20's should be the earliest age to consider surgery.
Separate prescription: If you need a separate prescription for close-up work than for distance, as becomes common after age 40, Lasik can correct only one of these. Unless one has even more risky monovision surgery, one pair of glasses will still be needed.
When I'm sure the patient is a good candidate for Lasik and has realistic expectations, I recommend they have it performed by an experienced surgeon, preferably with credentials as a corneal or anterior segment specialist.
It's true: the right foods can help your eyes stay healthy and your vision sharp. All of the following foods are rich in either anti-oxidants, which may delay cataracts and macular degeneration, or Omega 3 fatty acids, which may relieve dry symptoms and improve cholesterol and tri-glyceride levels:
1. Kale (the richest souce of anti-oxidants). Collard greens and spinach are also great.
2. Berries (terrific for anti-oxidants, vitamin C, and fiber)
3. Algae-eating fatty fish, especially salmon (high in Omega 3 fatty acids)
4. Broccoli, cauliflower and other cruciferous vegetables (anti-oxidant effects)
5. Citrus fruits like oranges, apricots (high in Vitamin C)
6. Garlic, onions, shallots, chives (high in anti-oxidants)
7. Teas, especially green teas (for the anti-oxidant effect)
8. Nuts (Vitamin E)
9. Eggs (yolk contains Lutein, an anti-oxidant)
10. Carrots (rich in beta carotene that converts to vision-enhancing Vitamin A)
Age-related macular degeneration is the leading cause of blindness in the USA. In macular degeneration, the light-sensing cells of the macula (the central portion of the retina) mysteriously malfunction and may over time cease to work.
Cigarette smoking, sun exposure, high blood pressure, and high cholesterol can increase the risk.
Which means that diet and exercise can make a difference in helping stave off the disease:
1. Quit smoking: it can contribute to earlier onset and more severe symptons
2. Diet: eat plenty of foods or supplements that contain Lutein (kale, collard greens, spinach, etc.), and Omega 3 fatty acids (salmon is especially good)
3. Moderate alcohol intake
4. Exercise regularly and control weight
5. Manage blood pressure and lipid levels (cholesterol, tri-glycerides, HDL's, LDL's)
6. Avoid excessive ultraviolet light by wearing quality sunglasses
1. Keep your prescription up to date. Strain from computer use sets in faster when your eyes are already straining.
2. Position the screen just below your line of sight. Looking downwards decreases dryness and facilitates blinking.
3. Don't put the screen too close to you. The closer the screen, the more work it takes to hold a focus.
4. Try to match the brightness of the room to that of the screen. Too much contrast can strain the eyes.
5. Avoid screen glare, which can be extremely harsh and distracting.
6. Keep your screen free of dust or smudges. The smallest smudge can cause excessive eyestrain.
7. Blink! The eyes will dry less and viewing will be more comfortable.
9. Take regular breaks: Every 20-30 minutes look away from the screen and as far into the distance as possible.
SEE CLEARLY METHOD
Lately the airwaves have been bombarded with ads for the See Clearly Method, which claim that by using their powerful techniques, the need for glasses will be eliminated - in fact, that eyeglasses contributes to worsening of the eyes.
Is there any truth to the claims? Is the See Clearly Method a serious option for eyeglass wearers?
I decided to inquire about their methods, and started by calling them as a "layperson."
The friendly receptionist said that all of the conditions I mentioned could be cured, citing several scientifically impossible explanations.
I requested and received a free video that attempted to explain their methods. The video was very professionally done, with Marianne Hartley as their spokesperson, and well-written in language that would sound convincing to a layperson.
I have wondered how such outrageous claims could be allowed on the airwaves. Whether it's for getting out of debt, weight loss, hair growth, the scam is usually the same - a free video that are marvels of marketing and prose than entice the non-professional viewer to send in their money.
In the case of See Clearly, I know of two patients who purchased the first installment. One said that she did not have time to try the techniques, even though she had purchased and received it months earlier. The other used the techniques in the tape and, although he experienced no improvement in vision, his eyes felt better.
The first lawsuit against the See Clearly Method has been filed in Iowa where the state's attorney general alleges that a combination of misleading and unfair marketing tactics is being used to sell the kits. The alleged illegal tactics include exaggerated claims of effectiveness, false implications of scientific validity, and misleading consumer testimonials in advertising. The suit asks the court to halt the unfair and deceptive practices, assess civil penalties and provide appropriate reimbursement for consumers.
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