Taking control of glaucoma: The importance of adherence to glaucoma treatment
Glaucoma is known as the “silent thief of sight”: people with glaucoma usually have no symptoms. The only intervention that has been proven to reduce the risk of vision loss in glaucoma is lowering the eye pressure. The most common way to lower eye pressure is with eye drop medications. Glaucoma treatments do not improve vision, but they do to help prevent vision loss from happening. What does it mean to be “compliant”?
Adherence (the newer term that is replacing “compliance”) with glaucoma treatment usually means taking your eye drops everyday and at the right times and coming to your glaucoma check ups. Your doctor needs to check your eye pressure regularly, as well as look at your optic nerves and measure your visual fields, to monitor your disease.
Why is it difficult to take eye drops everyday?
Some people with glaucoma only need 1 or 2 eye drops everyday to control their glaucoma, but some may need as many as 4 glaucoma medications, taken multiple times throughout the day. Imagine using 2 eye drops in the morning, 1 eye drop at noon, 1 at dinnertime, and 2 more in the evening, and doing this everyday for years and years, to help protect your sight. It is easy to see how people could miss some drops. Reasons can include forgetting them (or falling asleep before that bedtime drop), the cost of the medications, the side effects from the eye drops, and many others.
Why is adherence important for glaucoma patients?
In one word: blindness. The eye drops lower the eye pressure, which helps protect the eye from loosing vision from glaucoma. If a patient does not put in their eye drops, then the eye pressure will not be as low as it needs to be during that time and eye can be damaged. The damage from glaucoma is not reversible, so prevention is the goal. What can you do?
If you have glaucoma and you take eye drops, use them everyday and as close to the right time as possible. Also, see your doctor for your glaucoma check-ups. Ask about your eye pressure readings, your optic nerve appearance, and your visual fields, so that you know what’s going on with your disease. If you are having any trouble getting your drops in (for example, increased cost due to change in insurance, always forgetting the morning drop, red eyes drawing attention at work), then tell your doctor about it, so you can make changes in your treatment plan.
Friends and family members can help, too. If someone you care about has glaucoma, think about asking them if they need any help with their drops. Some ways you might help: look at videos to see eye drop techniques, put in the drops for them, provide gentle reminders, or go with them to doctor’s visits to be a “second set of ears” on instructions and recommendations.
Taking eye drops for glaucoma is not easy, but it does work. Most people who are treated for glaucoma do not go blind. Take control of your disease, by taking your eye drops and going to your glaucoma check-ups.
Ocular herpes is caused by the type 1 herpes simplex virus, and is a common, recurrent viral infection affecting the eyes. This type of herpes virus can cause inflammation and scarring of the cornea. Herpes of the eye can be transmitted through close contact with an infected person whose virus is active.
The National Eye Institute (NEI) says an estimated 400,000 Americans have experienced some form of ocular herpes, with close to 50,000 new and recurring cases occurring each year, ranging from a simple infection to a condition that can possibly cause blindness. There are several forms of eye herpes:
Herpes keratitis is the most common form of eye herpes and is a viral corneal infection. Ocular herpes in this form generally affects only the top layer which is called the epithelium, of the cornea, and usually heals without scarring.
Stromal keratitis occurs when the infection goes deeper into the layers of the cornea. This can lead to scarring, loss of vision and, occasionally, blindness. Although the condition is rare, the NEI reports that stromal keratitis is the leading cause of corneal scarring that subsequently causes blindness in the United States.
Iridocyclitis is a serious form of eye herpes where the iris and surrounding tissues inside the eye become inflamed, causing severe sensitivity to light, blurred vision, pain and redness.
Treatment for eye herpes depends on where the infection is located in the eye – in the corneal epithelium, corneal stroma, or iris, etc.
Some ocular herpes treatments could aggravate the outbreak and therefore should be considered on a case-by-case basis.
If the corneal infection is only superficial, it can normally be alleviated by using antiviral eye drops or ointments, or oral antiviral pills over a two to three week period. In some patients, both drops/ointments and pills are used. Steroid drops can help decrease inflammation and prevent corneal scarring when the infection appears deeper in the corneal layers. Steroid drops are almost always used in conjunction with and simultaneously with antiviral drops. For those relatively few eyes where, despite the best of treatment, the virus has caused vision-impairing scars, corneal transplantation surgery is often a highly successful solution.
Although eye herpes has no cure, treatment can help control outbreaks. Studies are underway to determine better methods for managing the disease.
1/27/15
Susan DeRemer
Vice President of Development
Discovery Eye Foundation
Imagination is a powerful thing. It can take you to great heights or take you into a downward spiral. I know. It’s done both to me. Thirty years ago I was diagnosed with keratoconus (KC) in both eyes. Then, I wasn’t sure what it was all about and my imagination took over spinning out all kinds of scenarios. Was I going to go totally blind? Would I be able to continue working? Would I still be able to drive? Was I scared then? Yes!
Imagination and KC
Over the years I’ve been through many of the ups and downs KC’ers face – uncomfortable lenses, vision changes, cornea abrasions, the piggyback system and pushing the limits of lens wear-time. The KC in my left eye deteriorated and a cornea transplant was the only option left. In the early 80s, my surgeon performed the transplant while listening to tracks from Michael Jackson’s album, Thriller. The transplant gave me the vision I needed stay in the workforce. I travelled for business, spent hours in front of a computer, belonged to a bowling league, walked on a glacier, climbed a fraction of the Great Wall, shed inhibitions in an acting class, answered crisis hotline calls, took “artsy” out-of-focus photos and gazed into the innocent, perfect eyes of my grandsons.
Everything wasn’t all rosy. There were highs and lows throughout those years because my other eye with KC kept going downhill before it stabilized. I still encountered all those difficulties KC contact lens wearers face when lenses are critical to functioning. But, I never let KC take over my life. Sometimes after I tried something new, I had to concede that vision challenges lessened the enjoyment and I labeled it “not for me” and moved on to something else.
I’m retired now and am sixty-nine. Now, my transplant cornea has filamentary keratitis and chronic dry eye so wearing a RGP lens is out. I’m at 20/200 in that eye but am still thankful for the good vision years. My other eye fluctuates between 20/50-60 with a RGP lens but comfortable wear-time is down to 3-4 hrs. Old anxieties have resurfaced. I live alone. Is driving my golf cart over? What am I going to do? “Explore your options,” my inner voiced commanded. So, I tackled the worst-case scenario first – what if I can’t wear any kind of lenses even scleral? I researched tools and services available to those with all kinds of vision problems. I visited the Southeastern Guide Dog Campus in Palmetto, FL in the US and learned all about Seeing Eye guide dogs. They’re amazing! My doctor started conversations about scleral lenses but that got put on hold.
Why? I was in the middle of a huge project. My imagination was taking me to great heights in this project. I was at the critical stages of writing a novel. It required my full attention. Fitting sessions and lens adjustment time would derail my momentum or even force me to take a detour off my route to my destination of having my novel catalogued in Books in Print. I didn’t need high functional vision to imagine scenes and characters. What I did need was a soft contact to act as a bandage to alleviate the pain of filamentary keratitis in my left eye. The soft lens worked! I published Juror 1389 – Dorsie Raines Renninger! Did vision challenges hinder me? Yes, at times. But, I pushed on and worked with what vision I had. I adapted – I bumped up MS Word font size way beyond 200%. I set an alarm clock to signal a stop after two hours of screen time. I removed my RGP lens and took eye-soothing breaks. I used various colors of paper for my research subjects so I could find notes easily. Thera® Tears were constant buddies. And, I asked for help! I formed a 1389 project team with good vision. They read. They highlighted mistakes to correct. I’m 100% certain any reader of Juror 1389 would never guess the author had vision challenges. Why would they? It’s of no importance to them. They’re only interested in what my imagination produced – a good story, a good read.
My message to all KCers is this – KC is a life altering condition not a life threatening condition. Don’t let keratoconus threaten your life or how you live it. Make these two words your mantra – Accept and Adapt. Make peace with what vision you have or will have. Accept it. Move on. Move towards being the best you can be in spite how out-of-focus the world looks to you. Life is not perfectly focused for anyone! Adapt – seek out tools and invent ways to change how you do things. Discover “what works” for you. Learn to ask for help. And remember, imagination is powerful. It has crisp, clear vision. It’s always there. Use it to visualize anything you want or what kind of life you want to live.
1/22/15
Gerry Trickle
Author, web content and greeting card verse writer
She is now working on her next novel – learn more at: www.gttrickle.com
In recognition of Glaucoma Awareness Month, here is a list of the top 20 things you should know in order to help save your vision as you get older. What is Glaucoma?
1. Glaucoma is not just one eye disease, but includes a group of eye conditions that are a result of damage to the optic nerve thus causing vision loss. While unusually high pressure inside your eye (known as intraocular pressure – IOP) is often the cause, this may not always be the case.
2. It is one of the leading causes of vision loss in the US, and left untreated can result in blindness. It is estimated that 2.2 million people in the US have glaucoma, but only half of them have been diagnosed. While it primarily affects those over 60, it affects all ages with 1 in 10,000 babies born with glaucoma in the US.
3. The two most common types of glaucoma are primary open-angle glaucoma and closed angle glaucoma. Fluid in the eye flows through and area between the iris and the cornea and drains through the trabecular meshwork – this area is the “angle.” Symptoms
4. Often call the “silent thief of sight,” open angle glaucoma, which affects 90% of those diagnosed, is not indicated by eye pain. There is a gradual loss of peripheral vison, generally in both eyes, and in the advanced stages there is tunnel vision.
5. The symptoms of closed angle glaucoma are easier to recognize and include eye pain, blurred vision, nausea and vomiting, vision issues in low light, halos around light sources and red eyes.
What to Expect From a Glaucoma Exam
6. Tonometry to measure your intraocular pressure. Your eyes will be numbed with eye drops making the procedure painless.
7. Dilated eye exam to look through your pupil to the back of your eye and the optic nerve.
8. Visual field test to check your peripheral vision.
9. Visual acuity to test your ability to see at a distance.
10. Pachymetry to determine the thickness of your cornea. Your eyes are numbed so this will be painless.
11. Gonioscopy to check the angle in the eye where the iris meets the cornea to help determine between open angle and closed angle glaucoma.
Treatment Options
12. Eyedrops are a common treatment options and may include more than one type. The importance here is to let your doctor know your complete medical history and comply completely with your doctor’s instructions to get the desired result. All include side effects and your medical history will allow your doctor to select the safest option. Some examples include:
Prostaglandins – they increase the outflow of the fluid in your eye and reduce internal pressure.
Beta Blockers – they reduce the production of fluid in the eye.
Carbonic anhydrase inhibitors – they reduce the production of fluid in the eye.
Cholinergic or miotic agents – they help increase the outflow of fluid from the eye.
Alpha-adrenergic agents – they reduce the production of fluid in the eye and increase the outflow of fluid.
13. Oral medications, such as carbonic anhydrase inhibitors, will be used if the eye drops cannot bring your eye pressure down on their own.
14. Surgery is an option if the medications or don’t work or you can’t tolerate them. In some cases you may need to continue using eyedrops. Surgeries include:
Trabeculoplasy – laser is used to unblock clogged drainage canals.
Viscocanalostomy – laser used to remove a small piece of the trabecular meshwork.
Aqueous shunt implant – small tube is inserted into the eye to improve drainage of the fluid.
Risk Factors
15. Age – you are 6 times more likely to get glaucoma if you are over 60.
16. Family history – you are 4-9 times more likely to get open angle glaucoma if someone else in your family has it.
17. Ethnicity – it plays a big factor in being diagnosed with glaucoma:
African Americans are at a higher risk than Caucasians of developing glaucoma; develop it earlier and experiencing permanent blindness.
Mexican-Americans have a greater incidence than Caucasians.
Asians are at increased risk for closed angle glaucoma, with people of Japanese descent being at higher risk for normal tension glaucoma.
18. Steroid use – long-term use increases the risk by as much 40%.
19. Medical conditions – such as diabetes, high blood pressure and hypothyroidism.
20. Other eye conditions – blunt injuries that “bruise” they eye (most commonly sports-related), retinal detachment and eye tumors, eye inflammation and certain eye surgeries are examples that increase the risk.
You can work to prevent, or at least lessen the effects of glaucoma on your vision by getting regular comprehensive eye exams, use any eye drops prescribed by your doctor to treat eye pressure according to their instructions, eat a healthy diets and wear eye protection to prevent eye injury.
For People With Low Vision There Is Spotlight Text – A New Way To Read
Spotlight Text is a new e-reading app specifically designed to address the needs of patients with eye disorders. Dr. Howard J. Kaplan, a retina surgeon in the Hudson Valley, started developing the app five years ago. Dr. Kaplan states, “When the first Amazon Kindle came out, a light bulb went off. If books are now digital, you can make the text of the book adapt to the reader instead of forcing the reader to adapt to the text. My patients were extremely frustrated with low vision devices such as desktop readers. Most found them very difficult to use and affordable.” Working with low vision experts at the Lighthouse Guild International, various text presentation methods were evaluated. “The app is based on real visual science and was built with the input of the top low vision specialists in the country, “ says Dr. Kaplan.
The greatest difficulty in creating the app proved to be getting access to e-books. Initially Dr. Kaplan approached the major e-content providers such as Amazon, Google, and Barnes & Noble. All of them considered the low vision market too small to address. During the 5 years, Bookshare, a Silicon Valley nonprofit, began to expand exponentially. Bookshare is dedicated to creating an accessible library for the print disabled.
How Spotlight Text Works, and What Makes it Different
The app is seamlessly tied into the e-book library of Bookshare. The library currently has 300,000+ titles including all current and recent NY Times bestsellers. It has a very extensive collection of textbooks for K-12 children. E-book downloads are free and unlimited for children, and Vets. There is a minimal joining/maintenance fee for adults. All patients that have any visual deficit that prevents them reading standard print are eligible to join. A physician, optometrist, therapist, or even librarian has to certify a patient by checking a single box on the form and signing their name. Bookshare then does the rest by contacting the patient and giving them an account. Bookshare functions due to an exception in US copyright law that allows the free distribution of copyrighted material in formats that are unique for patients with visual disabilities. The books are coded in DAISY, which is a sound file format. The App takes these files and renders them back to written text.
The user interface is designed such that an 80-year-old technophobe or a five-year-old child can easily use it (Apple-like minimalism). The app also synchronizes with Bluetooth Braille readers that convert the text to Braille. It can be connected to the HDMI port of any TV for unlimited screen size (hardwire or wireless through Apple TV). As you will see when you demo the app, text is now dynamic: in both teleprompter and marquee modes the text will move so that ocular movements are minimized. Marquee mode was specifically designed and tested to work for end-stage Retinitis Pigmentosa patients and any patient with only a remaining very narrow central visual field. Using VoiceOver all books are now audible books.
Social Entrepreneurship
Special iTunes links are created for vision nonprofits. If a patient clicks on those links and purchases the Spotlight Text App, 50% of sales profits are donated to the organization, including the Discovery Eye Foundation or the American Academy of Ophthalmology Foundation. Prior to being placed on the AAO’s website the app was evaluated by its Low Vision Rehabilitation Committee. It is the only app that the American Academy of Ophthalmology has ever endorsed.
The Future Dr. Kaplan hopes to return to the major providers of e-content and persuade them that low vision and blind users are a viable market for them.
“I believe universal accessibility is achievable, but it will take a coordinated and combined effort. Reading is such a vital part of all our lives, with e-books, everyone should be able to enjoy a good book.”
Last week, as we helped you prepare for a healthy 2015, we discussed exercise and physical activity. We gave you pointers on how to select and set-up a personalized healthy plan of action. But healthy eating plans along with being physically active are what lead to a healthy lifestyle. Today we will look at adding healthy eating to your exercise plan.
But first let’s review the three main points you need to keep in mind as you engage in any physical activity.
Include physical activity in your everyday life
• That means making it a priority, even if you have to schedule it on your calendar.
• Make it easy to do. Don’t forget that taking the stairs or walking up and down all the isles at the grocery store can be considered physical activity.
• Make it a social experience by finding an exercise buddy to help encourage you.
• Be sure it is interesting and fun. You may find it more fun if you listen to a book or music on your iPod.
• Make it an active decision to include physical activity throughout your daily routine and think of new ways to be active such as parking your car at the far end of the parking lot to make the walk to the store longer (and probably easier to find a parking space).
Try all of the four different types of exercise
We discussed endurance, strength, balance and flexibility training as your options. But there is no reason to stick with just one, think about mixing it up to reduce boredom and risk of injury while you increase your overall fitness.
Plan for breaks in your exercise plan
Life happens and there will be times, such as illness, injury or travel that will interfere with your normal physical activities.
• Don’t be too hard on yourself and don’t worry about the time you have missed.
• If you have stopped because of illness or injury, check with your doctor about when you can safely resume your regular routine.
• Remember why you started exercising.
• Contact your exercise buddy and have them help you get back on track.
• Try something new if you can’t get motivated to get back to the old routine. Be creative in thinking of new ways to exercise.
• If you are starting the same routine, start again at a comfortable level. Depending on how long you have not been exercising regularly, you may need to start at a slightly lower level than where you left off.
Healthy eating emphasizes:
• A diet of vegetables, fruits, whole grains and fat-free or low-fat dairy products.
• It can include lean meats, poultry, fish, beans, eggs and nuts.
• It is low in saturated fats, trans fats, cholesterol, sugars and added salt.
• It is a balance of the calories you get from foods and beverages vs. the physical activities you engage in to keep you at a consistent weight.
To help keep those healthy foods healthy here are some tips to keep in mind:
• Eating vegetables and fruits in a wide range of bright colors give your body a wider range of nutrients. Leaving the skins on, when possible, gives the nutrients and extra boost. Remember to wash all vegetables and fruits before eating.
• Fiber is a very important to your diet. Breakfast is a great time to enjoy whole-grained foods along with fruits.
• Cut the butter and salt by seasoning your foods with lemon juice, balsamic vinegar and herbs.
• While fresh food are much better for you, if you do use packaged foods, read the labels and chose items that are low in salt, saturated fat and trans fat.
• Use lean meat with excess fat removed and poultry with the skin removed. Do not sauté in butter or fry.
• Control your portion size to limit calorie intake. Also eat more slowly to give your system time to recognized when you are full. Here is a link to picture how large portions should be.
• Drink enough fluids to keep your body working properly. This is especially true in older adults because they don’t necessarily feel thirsty even if their body needs hydration. This liquids should not have added sugars and should be low-fat if dairy and low-sodium if broths.
• When eating out look for low-fat options, have dressings, sauces and butter served on the side so you can control how much you use.
• Select tomato-based sauce over cream-based or white sauce.
• Ask for small portions. If they are still large ask for a container to take part of it home BEFORE you start to eat.
• Ask to substitute low calorie options for sides like French fries.
Even with a well-planned diet you may think you need dietary supplements. However, combinations of supplements with any prescription or over-the-counter medicine could be harmful. Also so supplements can have unwanted or harmful effects before, during or after surgery. The best way to find out if you need any supplement is to talk with your doctor.
Hopeful this has helped you get a healthy start on 2015. The next thing to do – make an appointment with your eye doctor professional for your yearly comprehensive eye exam!
The eye works like a camera, specifically a digital camera. There is the front lens of the camera (cornea), the aperture (iris), the film (retina), and a cable to take the image to the brain (optic nerve). This “camera” also has an additional lens – the natural crystalline lens, which lies behind iris. This natural lens is flexible when we are young, allowing us to focus at distance then instantaneously up close. Around age 40-45, this natural lens starts to stiffen, necessitating the need for reading glasses for most people. This stiffening is the beginning of the aging process that eventually leads to formation of a cataract. We refer to the lens as a cataract when it becomes sufficiently cloudy to affect ones quality of vision. In general, cataract surgery is one of the safest and most successful of all surgeries performed. The basics of cataract surgery in eyes with keratoconus is very similar to non-keratoconic eyes.
Keratoconus (KC) affects this “camera” by causing the front lens (cornea) to bulge. This causes the optics to be distorted. In many cases, this can be corrected for withhard contact lenses (CL) or spectacles; in other cases a corneal transplant may be necessary. When it comes time for cataract surgery in the setting of KC, there are several factors that need to be considered.
Corneal Stability
The first thing to be considered is the stability of your cornea. In general, KC progresses more in your late teens to early twenties, and then stabilizes with age. A very exciting treatment for KC is collagen crosslinking. This treatment is meant to stiffen the cornea to prevent instability that is inherent to KC. This treatment promises to stop the progression of KC at a young age. Fortunately, with age, the cornea naturally crosslinks and stiffens, therefore when it comes time for cataract surgery, there is little chance of the progression of KC. Your doctor needs to choose the appropriate intraocular lens (IOL) to refocus your eye after surgery. Two of the most important factors in IOL selection are the length of your eye and the shape of your cornea. Long term CL wear can mold your cornea. It is important to assure that you stay out of your CLs long enough for your cornea to reach its natural shape. Depending on how long you have worn your CLs, it may take several months for the cornea to stabilize. This time can be challenging as your vision will be suboptimal (because you can’t wear CLs), and will be changing (as your cornea reaches its natural shape). When your cornea does stabilize, it is important to determine whether the topography (shape) is regular or irregular. This “regularity” is also known as astigmatism. If the astigmatism is regular, light is focused as a line – generally, this distortion can be fixed with glasses. However, if the astigmatism is irregular, light cannot be focused with glasses, and hard CLs are needed to provide optimal focusing. If you have had a corneal transplant, I generally recommend all your sutures to be removed to allow your new cornea to reach its natural shape.
IOL Selection
The second thing to be considered is the type of IOL. IOLs allow your doctor to refocus the optics of your eye after surgery. In many cases, the correct choice of IOL may decrease your dependence on glasses or CLs. There are several factors that are important when considering the correct IOL for a keratoconic patient. The amount and regularity of your astigmatism plays a very significant role in IOL selection. In general, there are four types of IOLs available in the US – monofocal, toric, pseudo-accomodating, and multifocal. In general I do not recommend multifocal IOLs in patients with KC. These IOLs allow for spectacle independence by spitting the light energy for distance and near, however, with an aberrated cornea (which is what happens in KC), these IOLs do not fare well. If there is a low amount of regular astigmatism or irregular astigmatism, your best bet is a monofocal IOL. This is the “standard” IOL that is covered by your health insurance. If you have higher amounts of astigmatism that your doctor determines is mostly regular, you may benefit from a toric (astigmatism-correcting) IOL. These IOLs can significant improve your uncorrected vision and really decrease your dependence on glasses. It is important to realize that monofocal and toric IOLs only correct vision at one distance. With a monofocal IOL you still can wear a CL to fine-tune your vision, however, with a toric IOL, in general you will need glasses for any residual error. There is a pseudo-accomodating toric IOL available, and this may be a good option if you are trying to decrease your dependence on glasses and correct some of your astigmatism. These IOLs are relatively new to the US market.
If You Had A Corneal Transplant
In the setting of a corneal transplant many of the same factors need to be considered – stability of the graft, choice of IOL, etc. In addition, the health of the graft has to be judged. Prior to cataract surgery in my patients with corneal transplants, I make sure to remove all of their sutures and give the cornea time to stabilize (just as if they were a CTL wearer). If you are a CL wearer, the same rule of being out of the TL until the topography is stable applies. The health of a transplant needs to be established prior to undergoing cataract surgery. The cornea has five main layers to it – the back layer (inside) is called the endothelium. This layer is responsible for “pumping” fluid out of the cornea, allowing it to stay clear. In all eyes there is a loss of endothelium cells with cataract surgery. I generally perform a “specular microscopy,” which allows me to visualize and quantify the corneal endothelium prior to surgery. This allows me to risk stratify you before your surgery. It is important to realize that corneal transplants have a lifespan and may have to be repeated in the future.
Keep in mind, there is some uncertainty in biometry (the process of selecting an IOL) in all eyes – this error can be higher in keratoconic eyes. This highlights why assuring stability is important. Equally important is picking the correct IOL for your situation. Also, keep in mind that I have discussed generalities in this article. Your individual case could be different. This is a conversation best left between you and your surgeon. In general, cataract surgery and keratoconus or a corneal transplant can be a very safe and effective way in restoring vision.
With the advent of the New Year, many people start making New Year’s resolutions which often include getting back in shape or losing weight. With that in mind, over the next few weeks we are going to be focusing on exercise and physical activity. Both are helpful in retaining good vision, regardless of your age. Physical Activity and Exercise
What us the difference between exercise and physical activity? Exercise is generally a planned physical activity that is structured and repetitive such as yoga, Pilates, weight training, tai chi or Zumba classes. Physical activity are things you do throughout the day that involve movement such as gardening, walking the dog, grocery shopping, vacuuming or taking the stairs instead of the elevator. Both provide benefits, and a combination of the two can help improve health and help you lose weight.
Regular exercise and physical activity are important for your physical and mental health, and over long periods of time, can provide you with long-term health benefits. They can also help you reduce the risk of developing some disease and disabilities that can happen as you grow older as well as being an effective treatment for arthritis, heart disease, diabetes and even eye disease.
Exercise and physical activity can benefit you in many ways:
Help improve your physical strength and fitness
Help improve your balance
Help manage and prevent diseases like diabetes, heart disease, osteoporosis, etc.
Help reduce depression
Help improve cognitive function
Types of Exercise and Physical Activity
Endurance
This includes activities that increase your breathing and heart rate:
Brisk walking, hiking or jogging
Dancing
Swimming
Biking or spinning
Sports such as tennis, squash or basketball
Yard work such as mowing the grass or raking
Climbing stairs
Strength
This includes activities that help you in everyday life such as climbing stairs, carrying groceries, etc.:
Lifting weights
Resistance training such as using a resistance band or Pilates
Balance
These activities help prevent falls:
Standing on one foot
Heel-to-toe walking
Tai Chi
Flexibility
These activities help you stay flexible and limber, which means more freedom of movement and better posture:
Shoulder, upper arm and calf stretches
Yoga
Pilates
Making Your Goals For Success
Now that you understand the importance of keeping fit, it is time to make a written plan to help you achieve your goals. These goals need to be specific, realistic and important to you to increase your chances for success. They also need to be fun and interesting to keep you engaged. Think about both short-term and long-term (where you want to be in 6 months or a year) goals. Things to consider when making your plans include:
What kind of activity you want to do
Why you want to do it
When you are planning to do it
Where you will do it
Any financial considerations such as equipment, shoes and clothing, gym membership, etc.
Writing down your exercise and physical activity goals is important as it will help you follow through with your and help you track your progress. Put them where you can see them, and review them regularly. Some people also find involving another person, such as an exercise buddy or trainer, can help keep them motivated.
It is also wise to consult your doctor about any change in exercise and physical activity. This particularly true if you have had any previous injury, surgery, health issue or are older. While doctors will not tell you to be sedentary, they may have safety tips or suggestions that will help keep you healthy and increase your enjoyment and success with your plan. Things you might want to ask your doctor include:
Are there any exercises or activities you should avoid
Let them know about any unexplained symptoms you might have such as chest pain or pressure, joint pain or stiffness, dizziness or shortness of breath
If you have any ongoing health concerns, how can these affect your exercise of physical activity
Let them know what your activity plan is and the goals to assure they are reasonable
Finding A Personal Trainer
If you are not used to exercising, are trying a new type of exercise, or need the motivational help, you may want to work with a persona fitness trainer. One of the best ways is to get a referral from someone you know who likes and has had success with their trainer. But it is also important you learn more about the trainer as they will relate to you and your goals. Here are some questions you might want to ask them:
Do they have a certification from an accredited organization
How much training experience do they have, including training people your age or medical condition
Will they be able to develop an exercise program based you your goals and what should you expect from their sessions
Will the trainer give you a list of references you can check
When making your final assessment consider how well the trainer listened to you and answered your questions. Also, if they have a sense of humor and are a good match to your personality.
These suggestions should get you started for a healthy 2015. Next Tuesday we will explore more ways to help you succeed.
On behalf of Discovery Eye Foundation, we would like to wish you the best this holiday season!
Because this is such a busy time of the year, we will not be posting to the blog, giving you more time to enjoy your family and friends.
We will resume posting on Tuesday, January 6th.
Susan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation
Uveitis is defined as inflammation of the uveal tissue. The uvea includes the iris, ciliary body, and the choroid of the eye. The iris is located in the anterior compartment of the eye and acts like the aperture of the camera, precisely filtering the amount of light entering the eye. The ciliary body, which is attached posteriorly to the iris, is involved in both the production of the aqueous fluid in the eye as well as the accommodation of the lens apparatus. The choroid is a dense layer of blood vessels that sits underneath the retina on the back wall of the eye, helping to nourish and remove metabolic waste products from the retina. Inflammation of any of these structures will consequently cause disruption of the visual pathway and over the long term can cause permanent visual loss. In fact, uveitis is the third most common cause of preventable blindness in the developed world.
Symptoms of uveitis include blurry vision, ocular pain, photophobia, redness, and floaters. These can be acute in nature, lasting a few days to weeks, and in some cases can be chronic, lasting weeks or months. Anyone with any of these symptoms should see their eye care provider as soon as possible, as faster treatment of uveitis has shown to result in better long term visual outcomes.
Uveitis can affect virtually any part of the eye, from front to back. Anterior uveitis or iridocyclitis is confined to the iris, ciliary body, anterior chamber, and cornea. Inflammation affecting the vitreous is termed intermediate uveitis, or pars planitis, and any inflammation affecting only the retina or choroid is termed posterior uveitis. The term panuveitis may be used when multiple layers of the eye are affected.
There are many possible causes of uveitis, including infection, inflammatory diseases, autoimmune diseases, and trauma. However, the majority of cases of uveitis, approximately half, are considered idiopathic, where no etiology is ever found. Trauma is the next most common cause of intraocular inflammation, accounting for approximately 20% of all cases. The remaining cases are secondary to a systemic disorder or localized ocular condition. Systemic etiologies can include inflammatory disorders such as sarcoidosis, infections such as tuberculosis and syphilis, as well as autoimmune diseases such as rheumatoid arthritis and lupus.
Treatment of uveitis is aimed at both blunting the intraocular inflammation as well as addressing any underlying systemic etiology. The most common treatment is the use of corticosteroids. These can be taken orally, or used topically as eye drops. In some cases, corticosteroids can be injected in or near the eye as well. If the uveitis is caused by an infection, such as tuberculosis or syphilis, the patient is also given antibiotics. Systemic corticosteroids can have major side effects when taken chronically, such as weight gain, hair loss, osteoporosis, hypertension, secondary diabetes, psychosis, and reduced growth in children. Because of these potential problems, the chronic use of systemic corticosteroids is not recommended. In cases of chronic uveitis that require long term treatment, immunosuppressive agents with less known side effects such as methotrexate, cyclosporine, and mycophenolate mofetil (Cellcept) are more commonly used. However, these biologic agents have their own set of potential side effects and therefore, it is recommended that a rheumatologist should also be involved in the care of the patient when using these agents. Topical and intraocular steroids localized to the eye can cause elevated intraocular pressure as well as cataracts. In most cases, elevated intraocular pressure can be controlled with topical glaucoma drops, but in some cases surgical intervention is required to prevent severe glaucomatous damage.
The most common type of uveitis is acute anterior uveitis or iridocyclitis. Many cases of anterior uveitis are idiopathic though almost half of all cases are associated with the HLA- B27 haplotype. Systemic diseases associated with HLA-B27 include psoriatic arthritis, ankylosing spondylitis, reactive arthritis, and inflammatory bowel syndrome. Signs of anterior uveitis include redness of the eye, sometimes termed ciliary flush. The conjunctiva can become extremely red, and when associated with ocular pain and photophobia, is a strong indicator of anterior uveitis. Inflammatory cells found in the anterior chamber are the hallmark of anterior uveitis, sometimes deposited on the corneal endothelium (keratic precipitates) or iris (Bussaca nodules). Patients with anterior uveitis are typically treated with topical corticosteroid and cycloplegic eye drops. A laboratory workup for systemic etiologies is usually not necessary unless the patient experiences a recurrent episode.
Inflammation affecting primarily the vitreous cavity is known as intermediate uveitis or pars planitis. Inflammatory cells in the vitreous, known as vitritis, are typically bilateral, and when severe, can be found clumped in the vitreous cavity (snowballs) or deposited on the inferior pars plana (snowbanking). Intermediate uveitis is typically idiopathic though sarcoidosis, multiple sclerosis, and Lyme disease are also possible causes. Certain malignancies such as lymphoma can also ‘masquerade’ as intermediate uveitis, and when seen in older patients, should be suspected and ruled out.
Posterior uveitis involves the retina, choroid, and/or the retinal vasculature, and usually is more difficult to treat than anterior uveitis.
This patient with Cat-scratch disease, caused by infection with Bartonella henselae, is an example of posterior uveitis. Note the characteristic star-like pattern of exudate in the macula along with optic nerve swelling.
In many cases, patients with posterior uveitis will exhibit characteristic exam findings that help narrow the differential diagnosis. For instance, an area of active retinitis next to an old pigmented chorioretinal scar is highly suggestive of toxoplasmosis. The most common symptom in patients with posterior uveitis is blurred vision. One of the more typical findings in posterior uveitis is macular edema, which is usually treated with periocular or intraocular corticosteroids.
In summary, uveitis is a visually threatening inflammatory condition that should be diagnosed and treated immediately. It is important to determine as best as possible the etiology of the uveitis and treat appropriately. In general, most patients with uveitis have good visual recovery with the proper management. However, in some cases, severe damage can occur, either due to the inflammation itself (usually chronic) or as a side effect of therapy (corticosteroids).
Jullia A. Rosdahl, MD, PhD
