Four Tips For Buying Sunglasses

4/29/14

May will be here this week, and in Southern California we are looking at bright, sun-filled days with temperatures in the upper 80s and low 90s. This means that thousands will be heading to the beaches or their own backyards to enjoy the warm weather.

Now is the perfect time to review one of the biggest contributing factors to vision loss – sun exposure. And it’s not just about sunglasses, but also brimmed hats.

from esty.com
from esty.com

First let’s talk about sunglasses. There are three things to think about when selecting your sunglasses:
1. Lens tint
2. UV protection
3. Glare
4. Frames

Lens Tint
There is a misconception that the darker your sunglass lens, the better protection for your eyes. No true. The color or darkness of your lens is personal preference and often based on the activity you are doing while wearing sunglasses or the sun conditions. At the beach in bright sunlight you are subject to more reflective light and may prefer dark amber, copper or brown lens, if you are on the ski slopes when the skies are overcast you may prefer yellow or orange lens to increase contrast and fight “flat light.” If you are looking to increase contrast on a partially cloudy day, and if you don’t mind distorted color perception, you might prefer amber or rose lenses.

Other considerations include mirrored sun lenses that can block 10-15% more of the sun’s visible rays, or photochromic lenses that darken automatically when you go outside and then quickly become lighter when you come inside.

UV Protection
While darker lenses don’t offer better eye protection, controlling the UV exposure does. Research has found links that extended exposure to UVA and UVB rays can result in eye damage such as cataracts, photokeratitis and macular degeneration. By wearing sunglasses that block these harmful rays your eyes should remain healthier as you age. Also know that some parts of the country receive more UV rays than others – here is a wonderful chart from The Vision Council to let you see how your location rates.

Glare
Another problem when out in the sun, and especially driving, is glare. Making sure your lenses are polarized is a great help. They work by only letting in specific amounts of light at certain angles and reducing the brightness of that light.

Because I am light sensitive I find I use polarized lenses when I am reading outside is helpful. The reflected light from the page of a book can cause me to squint or fatigue my eyes if I read for a long period of time. The only other option is using a paper-ink e-reader which also helps cut down on glare.

Another way to deal with glare is the use of an anti-reflective (AR) coating on your lenses. It reduces eye stain by preventing light from reflecting off lens surfaces. When applied to the back of your lenses it can help with problems when the sun is behind you or to your side.

Frames
Not all light hits your eyes from directly in front. It can come through the top, sides and bottom of your frames. The smaller the frames, the more unfiltered light makes its way to your eyes. This is where a brimmed hat can help keep the sun coming in from the top while also providing protection for your face.

Fitovers - Auroa in Claret
Fitovers – Auroa in Claret

To provide you with the maximum protection, “fit-over” sunglasses, that you can wear over your regular prescription glasses, are a great idea and more economical. Cocoons Eyewear and Fitovers Eyewear are two of several companies that make them. They filter the light from the top, sides and even below to give you the maximum protection and come in a wide variety of lens colors. It is also nice not to have to get new sunglasses when your eyeglass prescription changes.

Whatever frames you choose make sure they fit properly and will not keep sliding down your nose or fall of when being active. You may even want to purchase a band-style foamed neoprene retainer that attaches at both temples, sometimes known as a gator.

Also remember, it is not just the direct sunlight you need to worry about. Water reflects up to 100% of the harmful UV rays, dry sand and concrete up to 25% and even grass reflects up to 3%.

Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Following the Rainbow

4/15/14

Last week we reviewed the rainbow of fruits and vegetables you can eat to help with eye health.  But you don’t need to limit yourself – enjoy a rainbow of nuts, whole grains and beans as well.

Photo by zcool.com.cn - whole grains
Photo by zcool.com.cn


A reason some people avoid nuts is the number of calories found in nuts. However, a report published in the American Journal of Clinical Nutrition found that adults who incorporate nuts into their diets don’t have to limit their consumption. A review of 31 studies about eating nuts found that people who added nuts to their diets and who replaced other foods with nuts lost more weight, an average of almost one and half pounds.  Nuts have also been shown to be beneficial for stress reduction, heart health, various cancers, cholesterol, brain health and eye health.

Eating more whole grains makes your diet healthier because they are filled with nutrients including protein, fiber, B vitamins, antioxidants, and trace minerals (iron, zinc, copper, and magnesium). A diet rich in whole grains has been shown to reduce the risk of heart disease, type 2 diabetes, obesity, and some forms of cancer.

Beans, lentils and other nutritious legumes are the best sources of lean vegetarian protein. They made up of high-quality carbohydrates that are rich in fiber, zinc, vitamin B6, folate, magnesium, iron, and potassium. These protein-packed, low-fat nutrients can help with osteoporosis; improve heart-health, colon and bowel health; reduce the risks of cancer and age-related macular degeneration; control blood sugars, fight free radicals and even help with weight loss.

RED

 

  • Red adzuki bean
  • Pinto beans
  • Kidney beans
  • Pecans
  • Buckwheat
  • Amaranth
  • Quinoa
  • Barley

ORANGE/YELLOW

  • Almonds
  • Cashews
  • Millet
  • Chickpeas
  • Butter beans

GREEN

  • Lentils
  • Mung beans
  • Pistachios
  • Pumpkin seeds
  • Lima beans
  • Edamame
  • Sunflower seeds

BLUE/PURPLE

  • Flaxseeds
  • Walnuts
  • Chestnuts
  • Black beans
  • Quinoa
    • Black and wild rice
    • Rye

    WHITE

    • Soy beans
    • Garbanzo beans
    • Rice
    • Barley
    • Sesame seeds
    • Navy beans
    • Oats
    • Quinoa

    To learn more about the benefits of specific nuts, whole grains and beans, go to The World’s Healthiest Foods.  The site is filled with nutritional information, history and recipes for a wide variety of foods from around the world.

    Susan DeRemerSusan DeRemer, CFRE
    Vice President of Development
    Discovery Eye Foundation

    Eat A Rainbow

    4/8/14

    When planning what to eat, think of a rainbow.  Eating brightly colored fruits and vegetables helps to give your body the nutrients it needs.  These same nutrients are the disease-fighting components that give fruits and vegetables their array of colors.

    by Sarah DeRemer - rainbow
    by Sarah DeRemer

    Eating a variety of colors can help –

    • Strengthen your immune system
    • Lower risk for certain cancers
    • Help ward off type 2 diabetes
    • Maintain heart heath
    • Improve memory
    • Reduce the risk for some eye diseases

     

     

    Red

    The pigments that make some foods red are known as anthocyanins and lycopene.  These are the compounds that fight free radicals and prevent oxidative damage to cells, important to preserving eye health, keeping our hearts healthy and helping to fight cancers. Heat concentrates lycopene levels so cooked tomatoes and tomatoe sauces have higher concentrations than raw fruit.

    Add red to your meals by tossing a handful of raspberries, strawberries, goji berries or pomegranate seeds into your cereal, slicing roasted beets or red bell pepper into a salad, or adding cooked red adzuki or kidney beans to a rice dish.

    Here are examples of red fruits and vegetables:

    • Red apples
    • Adzuki beans
    • Beets
    • Red cabbage
    • Cherries
    • Cranberries
    • Goji berries
    • Pink grapefruit
    • Red grapes

    • Red peppers
    • Pomegranates
    • Red potatoes
    • Radishes
    • Raspberries
    • Rhubarb
    • Strawberries
    • Tomatoes
    • Watermelon

    For a recipe filled with lycopene, try a zesty Orange and Tomato Salsa, one of three salsa crudas using brightly colored fruits.

    Orange & Yellow

    Orange fruits and vegetables contain beta-carotene, a powerful antioxidant that promotes eye health, can delay cognitive aging and protect the skin from sun damage.  Beta-carotene also converts to vitamin A, which is important for night vision and the health of your immune system.  Orange foods also contain vitamin C, another antioxidant that boost the immune system, but also protects against cardiovascular disease.  Yellow fruits and vegetables contain lutein, another nutrient important for healthy vision.

    Some of the sources you can enjoy include:

    • Sweet potatoes
    • Carrots
    • Pumpkin
    • Apricots
    • Cantaloupes
    • Summer squash
    • Citrus fruit

    • Papayas
    • Peaches and nectarines
    • Sweet corn
    • Yellow peppers
    • Mangoes
    • Pineapple
    • Yellow tomatoes

    To incorporate more orange/yellow foods into your diet, replace French fries with crisp, baked sweet potato slices, keep dried apricots, pineapple or mangoes handy for a ready-to-eat snack or add sweet potatoes to black beans or chili for a color and texture boost.

    To get your day off to a great start, try an Apricot-Orange Breakfast Smoothie.

    Green

    Green fruits and vegetables are colored by natural plant pigment called “chlorophyll” and are rich in lutein and zeaxanthin,  pigments that may help your eyes filter damaging light rays, thus protecting against macular degeneration, the leading cause of vision loss in people over 65. Green fruits and vegetables are also a good source of vitamins C & K, fiber, folate and magnesium which contain anti-cancer properties as well as helping promote strong bones and teeth.

    Some examples of the green group include:

    • Green apples
    • Artichokes
    • Asparagus
    • Avocados
    • Green beans
    • Broccoli
    • Brussels sprouts
    • Green cabbage
    • Cucumbers
    • Green grapes
    • Celery

    • Green Pepper
    • Honeydew melon
    • Kiwi
    • Kale
    • Lettuce
    • Limes
    • Green onions
    • Peas
    • Green pepper
    • Spinach
    • Zucchini

    A delicious way to eat your greens is a Summer-time Asparagus, Strawberry and Spinach Salad.

    Blue & Purple

    Blue and purple fruits and vegetables are rich anthocyanins, lutein, zeaxanthin, resveratrol and vitamin C.  These nutrents help protect cells and heal your body. Research suggests they play active roles in promoting eye and heart health, preventing premature aging, reducing inflammation, decreasing cancer cell growth and improving memory.

    Foods such as blueberries, figs, eggplants, plums and grapes get their gorgeous hue from the phytochemical anthocyanin (also found in red foods). Anthocyanins act as powerful antioxidants that protect cells from damage and may help reduce the risk of heart disease, stroke and cancer. Studies have even shown that eating more blueberries is linked with improved memory function and healthy aging.

    Be sure to help yourself to plenty of blue/purple foods, such as

    • Blackberries
    • Blueberries
    • Eggplant
    • Figs
    • Juneberries
    • Plums

    • Prunes
    • Purple grapes
    • Raisins
    • Purple cabbage
    • Bilberries
    • Acai berries

    Here is another easy yet eye-healthy dish from our Eye Cook webpage, Eggplant and Tomato Pasta .

    White

    White fruits and vegetables are colored by pigments called anthoxanthins, which may help lower cholesterol and blood pressure.  Onions also have the flavonoid quercetin, known for its anti-inflammatory properties and cardiovascular health benefits.   As we know, being heart-healthy is also being eye-healthy.

    Some members of the white group, such as bananas and potatoes, are also a good source of potassium, while the hard-shelled coconut is considered a “superfood” because its natural water is loaded with vitamins, minerals, and electrolytes, while the raw coconut meat (flesh), which is found around the inside of a coconut shell contains high levels of lauric acid, for helping reduce cholesterol and promoting brain health.
    Some examples of the white group include:

    • Bananas
    • Cauliflower
    • Coconut
    • Garlic
    • Ginger
    • Jicama
    • Mushrooms

    • Onions
    • Parsnips
    • Pears
    • Potatoes
    • Radishes
    • Shallots
    • Turnips

    This recipe for Dark Chocolate Fondue, not only has cream of coconut, but is wonderful when dipping bananas!

    Susan DeRemerSusan DeRemer, CFRE
    Vice President of Development
    Discovery Eye Foundation

    What Are The Differences In The Immune System of An Age-related Macular Degeneration Patient?

    A symposium was held in Bethesda, Maryland at the National Institutes of Health on March 6, 2014.  The purpose was to bring together clinicians and researchers from a wide variety of background to discuss the recently discovered differences in the function of the immune system in patients with age-related macular degeneration (AMD) and how it relates to aging.  These differences are important to understand because they may lead to new therapeutic approaches to treat people which are high risk for AMD.

    Courtesy of National Eye Institute, National Institutes of Health - immune system
    Courtesy of National Eye Institute, National Institutes of Health

    • Three researchers associated with the Discovery Eye Foundation attended the one-day conference.  Cristina Kenney, MD, PhD, has worked in the field of AMD for over twelve years and is a leading expert on the genetics and molecular changes in the mitochondria as it related to the retinal cell death associated with AMD.
    • Lbachir BenMohamed, PhD, is an expert immunologist with a tremendous understanding of how the immune system responds to infections and stress.
    • Anthony Nesburn, MD, has been involved in AMD research at both the clinical and research levels.

    By attending this meeting, all three researchers gained insight into the importance of the immune system with respect to maintaining a healthy retina and slowing the progression of AMD.

    The highlights of the meeting were the following:

    1.  Emily Chew, MD (National Eye Institute) reviewed the clinical aspects of the disease stressing that there are many stages of AMD.

    The early stage of AMD is diagnosed based upon the medium-size drusen (about the width of an average human hair) that can be seen underneath the retina.  There may not be any visual changes in these patients.

    The intermediate stage of AMD is when subjects have larger drusen and some degree of retinal pigment epithelial cell drop out.  These patients may not have vision loss or other symptoms.

    The late stages of AMD which can be categorized into the dry form (geographic atrophy) which has significant loss of the retinal pigment epithelial cells and overlying photoreceptor cells.  Presently there in no treatment for this type of AMD.

    These individuals can have changes that cause decreased vision.  The second form of late AMD is the wet form (neovascular), which has growth of abnormal blood vessels beneath the retina that can cause significant loss of vision.  The treatments for this type of AMD are anti-VEGF medications that block the growth of these vessels and help maintain good visual acuity.

    2.  Anand Swaroop, PhD (National Eye Institute) reviewed the genetics of AMD and summarized the work of numerous laboratories.  It is now recognized that there are over 20 different genes associated with AMD.  These genes fall into the categories of those involved with Complement Activation, Cholesterol Pathway, Angiogenesis, Extracellular Matrix and Signaling Pathways.  Many of these genes have additive effects, meaning that if a patient has more than one high risk gene, then the likelihood of developing AMD increases.  While we have learned a lot about the genes that are important, we still do not have any gene therapies that can be used to treat AMD.

    3.  Six different speakers presented their data related to animal models of AMD and it was agreed that there is not a “perfect” model because most of the animals do not have a macula, the region of the retina that is affected the most by AMD.  However, there is still a lot to be learned by using the models that we do have because if we can better understand the basic pathways involved, then we can block or modify the pathways to prevent the damage.

    4.  Jayakrishna Ambati, PhD (University of Kentucky) presented data showing that there is a deficiency of an enzyme called DICER1 in the retinal pigment epithelial cells which leads to increased activation of inflammation via a protein complex called the inflammasome.  He described some of the signaling pathways which are involved in the inflammasome activation.  This is important because these pathways can become targets for treatment of the dry form of AMD.

    5.  Jae Jin Chae, PhD (National Human Genome Research Institute) also talked about the role that inflammation plays in the development of AMD.  The data presented reviewed the pathways involved with activation of the inflammasomes which is the first step in a cascade of events that result in inflammatory diseases.  They have identified a calcium-sensing receptor (CASR) which triggers the activation of the NLRP3, a key component of the inflammasome.  Understanding how this series of events works allows researchers to develop medications to block or interfere with the pathway and therefore decrease the levels of inflammation.  

    Dr. M. Cristina KenneyM. Cristina Kenney, MD, PhD
    Professor and Director of Ophthalmology Research
    School of Medicine, Dept. of Ophthalmology
    University of California, Irvine

    Is Omega-3 Important to Your Diet?

    Last week a study that appeared in the Annals of Internal Medicine (AIM) showed that fish oils such as omega-3 don’t reduce the risk of heart disease.  It caused quite a stir, as we have been told for years, by organizations like the American Heart Association that we needed to increase our intake of omega-3.  For some people that meant taking supplements instead of eating flax seeds, walnuts, sardines or salmon, just a few of the sources of omega-3. omega-3 sources

    In May of 2013 the results of the AREDS II study on eye supplements found that while lutein and zeaxanthin may be helpful in helping vision, omega-3 did not have a positive effect over five years.

    In both of these studies they are referring to omega-3 supplements.  This does not mean you should give up eating fish, or other sources of omega-3.  To derive the benefits of omega-3 you need to get it from the source –  directly from the food you eat, so it is still advised you eat fish as part of a healthy diet.

    If you do use supplements check with your doctor to make sure they are right for you.  A doctor can help you determine what, if anything you might need, making a decision based on your diet, medical history and any medications you might be taking.

    If you want to learn more about dietary supplements, here is a fact sheet from the National Institute of Health.

    Remember – supplements are what the name implies – something to supplement a well-rounded diet – they are not a substitution.

    Susan DeRemerSusan DeRemer, CFRE
    Vice President of Development
    Discovery Eye Foundation

    Low Vision Resources

    What to do when “There’s nothing more that can be done.”

    “I’m sorry, but there’s nothing more that can be done. There is no cure for your eye condition.”

    In your work as healthcare professionals and health educators, it’s likely you’ve encountered a significant number of adults and older adults who have been on the receiving end of this devastating news.

    When an eye care provider says, “There’s nothing more that can be done,” what he or she likely means is, “There’s nothing more I can do for you surgically.” But instead of saying, “There’s nothing more that I can do,” the discouraging message delivered to the patient is, “There’s nothing more that can be done.”

    Thus, in many cases, the discussion ends there. Patients will either exhaust their resources searching for an elusive cure or become resigned to a life that is restricted and defined by incurable vision loss.

    When receiving a diagnosis of vision loss, many adults who have managed to overcome a host of obstacles in their lives may now believe they are facing an obstacle with no viable solution. A natural, and understandable, initial reaction is to focus instead on the devastating losses that are seen as an inevitable accompaniment to blindness and low vision such as:

    • Loss of independence: “How will I prepare meals, clean my home, or shop? Will I become a burden to my family and friends?” 
    • Loss of confidence and self-worth: “All my life I’ve been physically active and self-reliant. Has my life as an independent person come to an end?” 
    • Loss of privacy: “I won’t be able to handle my finances independently. Will I have to surrender control of my life to someone else?” 
    • Loss of employment: “I’ll have to quit my job. How will I earn a living?” 

    It’s important to let your clients and patients know that there is indeed hope—and life—after vision loss. A wide range of vision rehabilitation services enable adults who are blind or have low vision to continue living independently. The term “vision rehabilitation” includes highly trained professionals and comprehensive services that can restore function after vision loss, just as physical therapy restores function after a stroke or other injury.

    Patient working with a low vision therapist
    Patient working with a low vision therapist

    Vision rehabilitation professionals include:

    Additional vision rehabilitation services can include:

    • Peer support and counseling: talking with peers, sharing common concerns and frustrations, and finding solutions to vision-related problems. 
    • Vocational rehabilitation: vocational evaluation and training, job training, job modification and restructuring, and job placement. 
    • Veterans’ services: vision rehabilitation and related support services for blinded veterans of all ages. 

    There are many resources available to help your patients and clients locate vision rehabilitation services. For example, the VisionAware Directory of Services allows you to browse by state and type of service, including counseling resources, support groups, low vision services, independent living skills, and orientation and mobility. The VisionAware “Getting Started” Kit provides tip sheets on specialized services and products that can assist with everyday life after vision loss.

    The National Eye Institute’s National Eye Health Education Program (NEHEP) also has low vision education resources. The video, Living with Low Vision: Stories of Hope and Independence, explains how, as a health professional, you can help your patients make the most of their remaining vision and improve their quality of life by referring them for vision rehabilitation services. Share it with your colleagues, too. You can find additional resources and ideas for promoting vision rehabilitation on the NEHEP Low Vision Program page.

     

    Maureen Duffy, CVRTMaureen A. Duffy, CVRT
    Social Media Specialist, visionaware.org
    Associate Editor, Journal of Visual Impairment & Blindness
    Adjunct Faculty, Salus University/College of Education and Rehabilitation

     

    Implantable Miniature Telescope Update

    The Macular Degeneration Partnership, a program of the Discovery Eye Foundation,  has received numerous questions about the implantable miniature telescope (IMT) since it was approved by the FDA in 2010.

    Implantable Miniature Telescope
    Implantable Miniature Telescope
    The IMT is becoming more widely available now. The IMT is a tiny telescope implanted inside the eye that may benefit older adults with advanced AMD. Smaller than a pea, this device is proven to restore sight and quality of life in eligible candidates. Unfortunately, the inclusion criteria to be eligible for the device are narrow.  Most importantly, the IMT can only be implanted into an eye that has not had a cataract removed yet.   We encourage you to review the below information to see if you or a loved one might be a candidate for this procedure. Approximately 2 million Americans have advanced forms of AMD, which is the leading cause of blindness in people over the age of 65. When an individual has severe wet macular degeneration, or dry AMD with geographic atrophy, it is sometimes called “end-stage AMD”. Patients with end-stage AMD have a central blind spot or missing area in their vision. But, despite the availability of drug treatments that slow the progression of AMD, the number of people with end-stage AMD is expected to double by the year 2050.

    Specifically, the telescope implant uses micro-optical technology to magnify images which would normally be seen in your “straight ahead,” or central, vision. The images are projected onto the healthy portion of the retina not affected by the disease, making it possible for patients to see straight ahead. The procedure is performed on one eye only, and involves removing the eye’s natural lens and replacing it with the tiny telescope implant. This is similar to the surgery performed to remove a cataract, which is a clouding of the natural lens. The other eye remains as is to preserve peripheral vision, which is important for balance and orientation. The surgery is done in an outpatient setting by a specially-trained ophthalmologist called a cornea/cataract surgeon. The telescope implant is FDA approved and available through Medicare.

    Although the telescope implant is not a cure for AMD, studies showed that in general patients were able to see 3 to 4 lines better on the eye test chart and demonstrated improved quality of life on the National Eye Institute Visual Functioning Questionnaire. Two multi-year clinical studies enrolled over 225 patients to evaluate the safety and efficacy of the telescope implant used in the CentraSight treatment program.   To be considered a candidate for the telescope implant, an ophthalmologist must first confirm that you:

    • Have irreversible, End-Stage AMD resulting from either dry or wet AMD
    • Are no longer a candidate for drug treatment of your AMD
    • Have not had cataract surgery in the eye in which the telescope will be implanted
    • Meet age, vision, and cornea health requirements

    Some people with end-stage AMD may not be a candidate for a telescope implant. Patients and their physicians will assess if the benefits of the procedure outweigh the potential risks to decide if this treatment option is right for them.

    CentraSight is the program that guides people with end-stage AMD through the telescope implant evaluation, surgery and rehabilitation process.  While the out-patient procedure is quick, patients also must commit to a comprehensive occupational therapy program to learn how to use their new vision (and way of seeing) in daily life. Click here to watch a video that shows how the implantable telescope works.

    “After surgery, one of the most important aspects of the telescope implant procedure is the rehabilitation,” said Dr. Marjan Farid, Associate Clinical Professor of Ophthalmology at the University of California-Irvine School of Medicine. “Specially trained optometrists and occupational therapists work with patients to teach them how to use their new vision because there are different techniques involved when you are sitting still (for example, reading or watching TV) than when you are moving around, such as walking or cooking.”

    The CentraSight treatment program is coordinated by retina specialists who treat macular degeneration and other back-of-the-eye disorders.  Before deciding to have the surgery, a special vision test is given in the office.  A device simulates what a person may expect to see once the telescope is implanted to determine if the potential improvement will meet the patient’s expectations. Once the telescope has been implanted by an eye surgeon, the patient will need to work with vision rehabilitation specialists (approximately 6 to 12 weeks) to learn how to use their new vision in their everyday activities. Risks include all those associated with cataract surgery, such as postoperative inflammation, raised intraocular pressure, corneal swelling, and the potential for comprised corneal health.

    “The first patient whom I implanted with this telescope over a year and a half ago states that she can now recognize the faces of her children and grandchildren,” said Dr. Farid. “For patients with AMD, face recognition of loved ones is a major improvement in the overall quality of their life.”

    CentraSight treatment centers are available across the nation. Patients can call 1-877-99-SIGHT to find one in their area.

    Judi Delgado headshotJudith Delgado
    Executive Director
    Macular Degeneration Partnership