Your Comprehensive Eye Exam

Being able to see clearly is important to all of us. But it is also something we have a tendency to take for granted until we notice changes in our vision. The point of the yearly comprehensive exam is to monitor your eyes before any problems arise, and address any concerns that could affect your vision later. Here is what to expect at your next comprehensive eye exam.

An eye exam involves an external examination of your eyes followed by a series of tests designed to evaluate your vision and check for eye diseases. Each test evaluates a different aspect of your vision and includes specific tests for visual acuity, pupil function, muscle function, visual fields, eye pressure and viewing the back of the eye through a dilated pupil.

External Exam
The external examination consists of inspecting the eyelids, surrounding tissues and the eyeball including the sclera (white part of the eye), iris and cornea.

Visual Acuity & Fields
Visual acuity is your eye’s ability to detect fine details and see an in-focus image at a certain distance. A Snellen chart and a phoropter are used. The standard definition of normal visual acuity is 20/20. The term 20/20 comes from even sized objects that can be seen by a “person of normal vision” at the specified distance. For example, if a person can see at a distance of 20 feet an object that normally can be seen at 20 feet, then they have 20/20 vision. If they can see at 20 feet what a normal person can see at 40 feet, then they have 20/40 vision. For the visual acuity test each eye is tested separately to gauge your side or peripheral vision.

Pupil Function
An examination of the pupil begins with inspecting your pupils for equal size, regular shape, reaction to light, and direct and consensual reaction (meaning the pupil of one eye constricts when the other eye is exposed to light).

Eye Muscle Function
Eye movement is assessed two ways. First by having you move your eye quickly to a target at the far right, left, top and bottom. Then by slow tracking which uses the ‘follow my finger’ test, which tests all the muscles that move your eye.

Eye Pressure Measurement
Intraocular pressure, or IOP, is measured using a tonometer to determine the fluid pressure inside your eye. This test provides information regarding your potential for glaucoma.

Viewing the Back of the Eye
Increasing the size of your pupil with eye drops (known as dilating your eyes) allows the doctor to have a larger view of the back of your eye, including the retina, as demonstrated by this diagram. This is very important for diagnosis and tracking of macular degeneration and diabetic retinopathy.

Eye Structure
A special, high-powered microscope, called a slit-lamp, is used to view the structures of your eye clearly and in detail, enabling early diagnosis of a variety of eye conditions such as cataracts, presbyopia and corneal injury.

Taking care of your eyes, especially as you become older, is very important. Changes in vision may be gradual, or fast, but in both cases, early diagnosis is key to successful treatment and retaining your vision. It is suggested that individuals 40 and over have a comprehensive eye exam every one to two years. Exceptions would be if you have diabetes, in which case you should see your eye doctor yearly; or there is a family history of eye diseases such as glaucoma, macular degeneration, or corneal diseases, which may require more frequent visits to your eye doctor. If you have any degree of sudden vision loss, eye pain, or significant irritation, contact your eye doctor immediately.

4/23/15

Susan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Driving and Age-Related Macular Degeneration

The issue of driving and age-related macular degeneration is a particularly sensitive one for seniors losing their vision. Driving means independence and most people want to hold on to their cars as long as possible. When is it time to stop?

A research survey by the Massachusetts Institute of Technology (MIT) Age-Lab and The Hartford Financial Services Group involved 3,824 drivers over age 50, asking them how and why they limited their driving.

The study found that two-thirds of the drivers self-regulated their activities in the car, restricting their driving for certain condition. Time of day was a common factor, with some people choosing to stay home at night or dusk. Bad weather conditions and heavy traffic were other conditions. Over time, drivers developed conscious strategies to compensate for failing vision, slower reflexes and stiffer joints.

Statistically, older drivers are actually very safe drivers, although over age 75, the accident rate per mile increases. The study found that health and medical conditions contributed far more to driving restrictions than age alone.

About ten percent of the nation’s drivers are over 65. However, by 2030, when one in five Americans are over age 65, this percentage will skyrocket. Consider that 23-40% of people over age 65 have macular degeneration – that ís a lot of drivers with a potential visual impairment.

Making the Decision

If your macular degeneration is causing a problem when you drive, you are most likely aware of it. Or, perhaps a friend or family member has pointed it out to you. Does this mean you should immediately stop driving? Not necessarily.

What you should do immediately is ask yourself some critical questions. How are you functioning when you drive during the day? What about dusk, dawn and cloudy days? Bright sunlight? At night?

Here are six important questions:

Do you have difficulties reading clearly and rapidly all the instruments on a carís dashboard?
Do you have difficulties reading road signs, or if you are currently driving, do you notice and understand the signs in time to react to them with comfort?
Do other cars on the road appear to “pop” into and out of your field of vision unexpectedly?
While on the road, do you drive well below the speed limit and slower than most cars around you?
Do you have difficulties positioning yourself on the road, with respect to other cars, lane markers, curves, sidewalks, parking spaces, etc.?
Do you find yourself feeling confused and/or disoriented on the road?

If you answered yes to any of the above questions, you may want to suspend your driving until you consult a specialist. If your answers indicate that you may have a problem under certain conditions (i.e., dim light or night) you may want to suspend your driving under those conditions until you consult a specialist further.

This questionnaire is from an excellent book, “Driving With Confidence, A Practical Guide to Driving With Low Vision” by Eli Peli and Doron Peli. Dr. Eli Peli is a Senior Scientist at the Schepens Eye Research Institute and Professor of Ophthalmology at Harvard Medical School. Their book contains a practical program to help you maximize your chances of retaining your driving privileges. It also provides a detailed description of driving vision regulations in every state as does the AAA website.

Other Useful Resources

AARP Driver Safety Program – Largest classroom driver refresher course specially designed for motorists age 50 and older. It is intended to help older drivers improve their skills while teaching them to avoid accidents and traffic violations.

AAA Safety Foundation for Traffic – Tips on driving and resources for other transportation options.

Summary

There are many ways to stay safe and maintain your independence. Just be attentive to your own abilities and find out all you can about your options.

4/21/15

Judith Delgado
Executive Director
Macular Degeneration Partnership
A program of Discovery Eye Foundation

Do I Need Vision Insurance?

With the rising costs of health insurance, many people are looking for ways to reduce their costs. Since not all insurance packages include vision insurance, many people wonder, do I need vision insurance?

Standard Vision Insurance

Vision insurance is a type of health insurance that entitles you to specific eye care benefits such as routine eye exams and other procedures, as well as a specified dollar mount or discount for the purchase of eyeglasses and contact lenses. It only supplements regular health insurance and is designed to help reduce your costs for routine preventative eye care and eyewear.

You can get vision insurance as part of a group, such as your employer, an association, etc., through a government program such as Medicare or Medicaid, or as an individual. It is often a benefit linked to your regular HMO (health maintenance organization) or PPO (preferred provider organization) health insurance.

There are two primary vision insurance plans available:

Vision Benefits Package – provides free eye care services and eyewear within a fixed dollar amount for which you pay an annual premium or membership fee and a small co-pay. It may also include a deductible.
Discount Vision Plan – provides eye care and eyewear at a discounted rate after you pay an annual premium or membership fee.

Both insurance plans generally include:

Annual eye exams
Eyeglass frames (usually once every 24 months)
Eyeglass lenses (usually once every 24 months)
Contact lenses (usually once every 24 months)
Discounted rates for LASIK and PRK

Here is where you can check for a list of some vision insurance providers.

Medicare and Medicaid

Different kinds of vision care are included in the US government programs, Medicare and Medicaid. These programs are for qualifying American age 65 and older, individuals with specific disabilities and people with low income.

The Types of Medicare For Vision:

Medicare Part A (Hospital Insurance) –Medical eye problems that require a hospital emergency room attention, but routine eye exams are NOT covered.
Medicare Part B (Medical Insurance) – Visits to an eye doctor that are related to an eye disease, but routine eye exams are NOT covered.
Medicare Part D (Prescription Drug Coverage) – Will help pay for prescription medications for eye diseases.

If you have Medicare Parts A & B you are generally eligible for the following vision coverage, however, there is a deductible before Medicare will start to pay, at which point you will still be paying a percentage of the remaining costs.

Cataract surgery – covers many of the cost including a standard intraocular lens (IOL). If you chose a premium IOL to correct your eyesight and reduce your need for glasses, you must pay for this added cost out-of-pocket.
Eyewear after cataract surgery – one pair of standard eyeglasses OR contact lenses.
Glaucoma screening – an annual screening for people at high risk for glaucoma, including people with diabetes or a family history, and African-Americans whom are 50 or older.
Ocular prostheses – costs related to the replacement and maintenance of an artificial eye.

There is also Medicare Supplement Insurance (Medigap) which is sold by private insurance companies to supplement only Medicare Parts A & B. It is intended to cover your share of the costs of Medicare-covered services including coinsurance, co-payments and deductibles. For more details about Medicare plans and coverage check their website or call 800-633-4227.

Medicaid is the US health program that gives medical benefits to low-income people who may have no or inadequate medical insurance. A person eligible for Medicaid may be asked to make a co-payment at the time medical service is provided. Vision benefits for children under the age of 21 include eye exams, eyeglass frames and lenses. Each state determines how often these services are provided and some states offer similar vision services to adults. To learn more about Medicaid eligibility requirements and vision benefits call your state’s Medicaid agency or visit their website.

Defined Contribution Health Plans

A way to lower your vison care costs is to take part in a defined contribution health plan (DCHP). You are given a menu of health care benefits to choose from where a portion of the fees you receive for health coverage come from money that is deducted from our paycheck before federal, state and social security taxes are calculated. Four types of DCHP are:

Cafeteria Plans – your employer takes a portion of your salary and deposits it into a non-taxable account for health care spending. The amount taken depends on the number and costs of the benefits you select.

Flexible Spending Accounts (FSA) – your employer takes a predetermined portion of your pre-tax salary and deposits it into health care account for you to pay medical expenses. But generally preventative care such as routine eye exams and are not reimbursable. Nor are eyeglasses and contact lenses reimbursable. You would need to verify with your employer. If you do not use all the money at the end of a 12 month period, the money goes back to your employer.

Health Reimbursement Arrangement (HRA) – this is similar to an FSA except you can use it for preventative care like eye exams and you do not lose the money if it isn’t spent within a certain time period as it can be carried from year to year.

Health Savings Account (HSA) – it can be employer-sponsored of you can set up one independently; however you must purchase a high-deductible health insurance plan to open an HSA and you cannot exceed the annual deductible of your health insurance plan. You cannot be enrolled in Medicare of be a depended on someone else’s tax return. You can use it for preventive care such as eye exams. You can learn more about HSAs by visiting the US Treasury’s website.

There are a variety of options when it comes to vision insurance. You just need to determine your needs and ask providers the correct questions.

4/14/15

Susan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

6 Ways Women Can Stop Vision Loss

Women account for 53% of the world’s population. However, 2/3 of the blind and visually impaired people in the world are women. While 80% of these women are in developing countries, women in developed countries like the US are still more likely to face vision loss than men.

Why are women more prone to eye disease than men?

Women are the caregivers in families, taking care of the health of family members over themselves. In addition, with many having jobs outside the home, they don’t feel they have the time to go to the doctor until something major happens, especially related to vision.

Women live longer than men are at greater risk for age-related eye diseases such as age-related macular degeneration (AMD), diabetic retinopathy, glaucoma and cataracts.

Women are more likely to develop several autoimmune diseases that can affect their eyes including, multiple sclerosis, lupus, rheumatoid arthritis and Sj?gren’s syndrome.

75% of new breast cancer diagnosed each year is estrogen-sensitive. A common part of estrogen-sensitive breast cancer treatment includes the prescription of tamoxifen. More studies are being done, but cataracts due to tamoxifen have been identified in about 10% of the patients taking the drug.

What can women do to lessen their chances for eye disease?

Know your family history as genetics play and important role in your eye health, so know what eye diseases run in your family. Let your eye doctor know so he can look for early warning signs that can help prevent of lessen the conditions in you.

Get routine comprehensive, dilated eye exams starting at the age of 40, to create a baseline for your doctor to work from. After that you can go every 2-4 years until the age of 60. At 60+ have a compressive, dilated exam every two years if you are symptom-free and low risk.

Eat healthy and exercise. It is important to maintain a healthy weight to reduce the risk of some eye diseases. Eating fresh fruits and vegetables is also important as they can contain carotenoids an some antioxidants that appear to help with vision retention. It should also be noted that in many studies, supplements did not show the same beneficial effects as whole foods.

Stop smoking! You not only increase your risk for cancer and heart disease, but smoking is the only thing besides advancing age that has been proven to be directly related to AMD.

Avoid ultraviolet light by wearing sunglasses (with wide-brimmed hats) and indoor glasses with UV protection. While everyone knows the sun is a source of UV light, so are electronic screens such as your TV, computer, tablet or smartphone. Prescription glasses and readers can have a clear UV coating put on them that will not distort your color vision. If you don’t need vision correction, there is eyewear with no correction that is coated to protect your eyes to avoid dry eye and retinal damage.

Use cosmetics and contacts safely. Always wash your hands first. Throw away old makeup and lens solutions. Do not share cosmetics or apply while driving. Make sure to clean your lenses thoroughly before putting them in your eyes.

Because women are relied upon to take care of the family, vision loss that can impact that responsibility can be devastating to the entire family. And later in life, when they may have outlived a spouse, the isolation and depression can destroy their quality of life as they try to cope on their own.

Reach out to women you know and remind them to take an active part in their own healthcare. Especially with regards to their vision, when women are at a higher risk of vision loss than men.

4/7/15

Susan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Three Generations of Saving Vision

In Discovery Eye Foundation’s spring e-newlsetter there was an article entitled Surgery for the Surgeon, where a leading ophthalmologist talks about convincing himself to have cataract surgery. That eye doctor was Dr. Nesburn, who was willing to share with us his family’s long tradition of saving vision.

Brainwashed by Medicine

“I was brainwashed from the age of 5,” says Dr. Anthony Nesburn, medical director of The Discovery Eye Foundation (DEF). “My dad would take me on rounds at the hospital and to his office. He introduced me to medicine at a really early age.”

Nesburn saving vision — Dr. Anthony Nesburn in UC Irvine lab

Dr. Henry Nesburn was an ophthalmologist in Los Angeles for more than four decades, and he passed his love of the specialty to his son. “I really looked up to my dad,” the younger Nesburn says. “He loved ophthalmology for the same reasons I do: You get to do medical diagnosis; you get to do wonderful surgery, where you keep people from going blind or restore vision; and you can work with people from newborns to the very elderly — they all need eye care.”

Nesburn received a telegram while he was an undergrad at UCLA, telling him he’d been accepted to Harvard Medical School. His mother started crying: “You’re going to Boston! We’re not going to see you anymore!” While he “was loathe to leave Southern California,” Harvard was too good to pass up.

Drafted by the Army out of his ophthalmology residency at Harvard in 1960, Nesburn joined the Navy instead. He followed in his father’s footsteps again, becoming a Navy flight surgeon. (Henry had volunteered during World War II.)

He went on to a Boston Children’s Hospital fellowship in infectious disease, working with Nobel laureate Dr. John Enders, whose work led to the polio vaccine and changed the face of virology. Nesburn then did his residency at Massachusetts Eye and Ear. “I was part of a special program that allowed us to do research, and I was running a research laboratory while I was a resident,” he says. “It gave me the start I needed.”

“At Mass Eye and Ear, I worked for an up-and-coming ophthalmologist and researcher to prove there was a substance that could treat herpes eye infections. We wrote a paper that included the very first antiviral ever described, and it was against herpes virus. It is the basis for today’s herpes antivirals,” Nesburn says. “I was hooked.”

He went back to Los Angeles and received NIH funding to continue his research on ocular herpes. In 1968, he joined his father’s practice half-time, spending the rest of his time doing research.

Two years later, he received a generous offer, when Rita and Morris Pynoos started DEF to fund his research. The Pynooses were grateful to Nesburn for diagnosing their son, Jon, with keratoconus (KC). “I was a second-year resident at Mass Eye and Ear, and Jon Pynoos was an undergraduate at Harvard. His parents went to see my dad, because Jon couldn’t see well, and no one could figure out what was wrong with his vision. My dad said, ‘Send him over to Tony; he’ll figure out what’s going on!’ I said to myself, ‘Holy mackerel! What happens if he has something really complicated? I’m just a newbie!’” Nesburn remembers. “Jon came in; I looked at him, and the keratoconus was so clear and easy to spot. I couldn’t imagine how his doctors didn’t see it. We got him contact lenses, and he was able to see again. When I came back to LA, the Pynooses wanted to do something to help.”

At first, DEF research focused on KC and the herpes research Nesburn was working on at the time. It soon broadened to include macular degeneration and retinal disease.

“My dad had to retire from the practice of ophthalmology at the age of 70, because of bad age-related macular degeneration (AMD). His mother and older sister had had it, as did several cousins. There was no treatment back then that helped,” Nesburn says.

“AMD is the most common cause of permanent vision loss in the elderly in the developed world. I could see where the need was,” he says. “We moved forward at DEF with two driving mantras: We wanted to do something significant in macular degeneration research and to find the cause of keratoconus.”

As a virologist in research and a corneal surgeon, Nesburn realized he needed a corneal biochemist to help with the KC research. He met Dr. Cristina Kenney at an Association for Research in Vision and Ophthalmology meeting. She joined DEF, and within 15 years, they found the chemical cause of keratoconus; they also got married.

Now nearly 80 years old, Nesburn spends most of his time “wearing three hats”: fundraising for DEF, lab research and clinical practice. His daughter, Kristin, is the third generation to join the family ophthalmology practice.

“While I’m still able, I want to try to make a difference in medicine, particularly in macular degeneration,” Nesburn says. “Macular degeneration affects so many people. This is where I want to put my energy. Luckily, as strong as it is in our family, I don’t have it … yet.

“As a researcher, my interest in putting together a program for macular-degeneration diagnosis and treatment has been because it’s a great public health problem. Yes, if I should ever get it, it might be able to help me or my family, but the first thing, as a scientist, is to try to get something to help humankind. I know it sounds sappy, but it’s true.”

3/26/15

Anthony B. Nesburn, MD, FACS
Medical Director, Discovery Eye Foundation
Professor & Vice Chairman for Research, Ophthalmology
Gavin Herbert Eye Institute, University of CA, Irvine

Medical Research Funding Needs Individual Donors

The Need for Medical Research Funding

About 1.75 million U.S. residents currently have advanced age-related macular degeneration with associated vision loss, with that number expected to grow to almost 3 million by the year 2020.

About 8.4 million individuals worldwide are blind from primary open-angle glaucoma, with that number expected to grow to almost 11 million by the year 2020.

About 22 million Americans have cataracts affecting their vision, with that number expected to grow to more than 30 million by the year 2020.

The economic impact of this increase of people with vision loss will be tremendous. But right now scientist are working on ways to treat and eventually cure many eye diseases. The only problem is the funding necessary to support this sight-saving research. Here is a look at the decline of medical research funding in the US and what you can do to help.

3/17/15

Susan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

February Is Low Vision Awareness Month

Help for People With Vision Loss

Here’s eye-opening news: Currently, 4.2 million Americans ages 40 and older are visually impaired. Of these, 3 million have low vision. By 2030, when the last baby boomers turn 65, the number of Americans who have visual impairments is projected to reach 7.2 million, with 5 million having low vision. For the millions of people who currently live or will live with low vision, the good news is there is help.

But first, what is low vision? Low vision is when even with regular glasses, contact lenses, medicine, or surgery, people have difficulty seeing, which makes everyday tasks difficult to do. Activities that used to be simple like reading the mail, shopping, cooking, and writing can become challenging.

Most people with low vision are age 65 or older. The leading causes of vision loss in older adults are age-related macular degeneration, diabetic retinopathy, cataract, and glaucoma. Among younger people, vision loss is most often caused by inherited eye conditions, infectious and autoimmune eye diseases, or trauma. For people with low vision, maximizing their remaining sight is key to helping them continue to live safe, productive, and rewarding lives. The first step is to seek help.

“I encourage anyone with low vision to seek guidance about vision rehabilitation from a low vision specialist,” advises Paul A. Sieving, MD, PhD, director of the National Eye Institute (NEI), one of the National Institutes of Health (NIH) and the federal government’s principal agency for vision research.

What is a low vision specialist? A low vision specialist is an ophthalmologist or optometrist who works with people who have low vision. A low vision specialist can develop a vision rehabilitation plan that identifies strategies and assistive devices appropriate for the person’s particular needs. “A vision rehabilitation plan helps people reach their true visual potential when nothing more can be done from a medical or surgical standpoint,” explains Mark Wilkinson, O.D., a low vision specialist at the University of Iowa Hospitals and Clinics and chair of the low vision subcommittee for the National Eye Health Education Program (NEHEP).

Vision rehabilitation can include the following:

Training to use magnifying and adaptive devices
Teaching new daily living skills to remain safe and live independently
Developing strategies to navigate around the home and in public
Providing resources and support

There are also many resources available to help people with low vision. NEI offers a 20-page, large-print booklet, titled What You Should Know About Low Vision, and companion DVD, featuring inspiring stories of people living with low vision. This booklet and DVD, among other resources, are available at
www.nei.nih.gov/lowvision.

With the aging of the population, eye diseases and vision loss have become major public health concerns in the United States. NEI is committed to finding new ways to improve the lives of people living with visual impairment. Aside from making information and resources readily available, NEI has dedicated more than $24 million to research projects on low vision, including learning how the brain adapts to vision loss; strategies to improve vision rehabilitation; and the development of new technologies that help people with low vision to read, shop, and find their way in unfamiliar places. Research like this will help people with low vision to make the most of their remaining vision and maintain their independence and quality of life.

2/17/15

The National Eye Health Education Program (NEHEP) of the National Eye Institute (NEI), a part of NIH, offers a 20-page, large-print booklet, titled What You Should Know About Low Vision, and a series of videos featuring patient stories about living with low vision. These and other resources are available at http://www.nei.nih.gov/lowvision.

The Best Nutrition for Older Adults

Our bodies change as we age. Our metabolism slows down and we lose lean body mass. Changes occur in the kidneys, lungs, and liver. Total body fat typically increases. The digestive system slows down and changes, producing less of the fluids it needs to process food, thereby making it harder for the body to absorb important nutrients. We lose bone density, which can cause osteoporosis, fractures, and vertebral compression. Many of us lose some sense of taste and smell and our medications interfere with many vitamins. Because of these changes, older adults have very different nutritional needs than those who are younger. What is the best nutrition for older adults?

The basic challenge when one gets older is to meet the same nutrient needs as when we were younger, but doing it while consuming fewer calories. Extra weight and health issues may be the result if we don’t. We can meet the challenge by eating a healthy diet that provides the necessary nutrients and variables for good digestion and absorption of nutrients. A nutrient-dense (meaning foods high in nutrients in relation to their calories), fiber-filled, colorful and varied diet is key.

First, let’s look at some of the important vitamins and nutrients we need to insure healthy bodies:

WATER – of all the nutrients, this the most important. Drinking enough water reduces stress on kidney function, which can decline with age. It also eases constipation. Be aware that the ability to detect thirst declines with age. Instead of waiting to feel thirsty, drink water and other healthy fluids throughout the day. The goal should be about 8 glasses of water per day.

CALCIUM – Calcium’s most important role is for building and maintaining strong bones. Unfortunately, as we age, we tend to consume less in our diets. If you don’t get enough, your body will leach it out of your bones. If your diet includes dairy, three low-fat servings per day are recommended. But also consider plant alternatives such as collard greens, kale, and broccoli. In addition, tofu, almonds, sesame and chia seeds are other great non-dairy sources for calcium.

VITAMIN D – This vitamin helps the body absorb calcium, maintain bone density and prevent osteoporosis. Recent studies suggest it may also protect against some chronic diseases and vitamin D deficiency has been linked to an increased risk of falling in seniors. Vitamin D can be found in salmon, tuna, and eggs. You can also look for vitamin D fortified foods, including cereals, milk, some yogurts, and juices. Because aging skin becomes less efficient at producing the vitamin from sunlight, some experts believe seniors may need vitamin D supplements. You may want to discuss your vitamin D needs with your health care provider.

FIBER – Getting enough fiber in the diet will promote healthy digestion by moving foods though the digestive tract. It will also not interfere with the absorption of nutrients, which occurs with laxative use. Eating foods rich in fiber have additional benefits, including protecting against heart disease. So eat more whole grains, nuts, beans, fruits and vegetables.

POTASSIUM – Potassium is an essential mineral vital for cell function. It has been shown to reduce high blood pressure and the risk of kidney stones. It may also help keep bones strong. Older people can get the recommended daily amount by including fruits and/or vegetables in their diet at every meal. Banana, prunes, plums and potatoes with their skin are particularly potassium rich.

MAGNESIUM – Magnesium is important to many different physiological processes and keeps the immune system in good order. It also keeps the heart healthy and your bones strong. Absorption of magnesium decreases with age and some age-related medications, such as diuretics, may also reduce absorption levels. Eating as many unprocessed foods as possible, including fresh fruits, vegetables, nuts, seeds, grains, and beans will provide you a great source of magnesium.

VITAMIN B12 – Vitamin B12 is important in creating red blood cells and maintaining a healthy nerve function. Getting enough is the challenge for older people because of the decrease in absorption from food. The solution is to eat more food rich in B12 which includes fish, meat, poultry, eggs, and low-fat dairy. Also check with your health care provider about whether a supplement is in order.

FOLATE/FOLIC ACID – Anemia is the result of not enough of this essential B vitamin, which is related to B12 absorption and may improve hearing. Eat plenty of fruits and vegetables and/or make sure your breakfast cereals are fortified to ensure you are getting enough.

OMEGA-3 FATS – Primarily found in fish, these unsaturated fats have a wide range of benefits, including possibly reducing symptoms in rheumatoid arthritis and slowing the progression of age-related macular degeneration. They may also reduce the risk of Alzheimer’s disease and may even keep the brain sharper as we age. Strive toward at least two servings of fish a week and choose salmon, tuna, sardines, and mackerel which are especially high in omega-3. Plant sources of omega-3 include soybeans, walnuts, flaxseed, chia, hemp and sesame seeds, and cauliflower.

IRON – Iron intake sometimes appears to be low in many older adults. To improve absorption, include vitamin C-rich fruits and vegetables with iron-rich foods such as red meats, fish, and poultry.

ZINC – Along with vitamins C and E, lutein and zeaxanthin, it may help slow the progression of age-related macular degeneration. Eat lots of fruits and vegetables, especially those that are dark green, orange or yellow in color, such as kale, spinach, broccoli, peas, oranges, and cantaloupes.

VITAMIN E – This vitamin may have a potential role in the prevention of Alzheimer’s disease. Including whole grains, peanuts, nuts and seeds in your diet may help reduce the risk of this disease.

Now, how do we get these into our diet to ensure optimal nutrition? Strive to have your diet look like this:

Colorful and varied. Have three to five different colors of food on your plate at each meal. This will translate into getting the most variety of nutrients. Eat more veggies than fruit.
More natural and unprocessed. This will give you more fiber. Choose whole fruit over juice; whole grains over processed flours; include seeds, nuts, whole grains and beans in your salads and soups. Look at labels – choose foods with five or fewer ingredients you can pronounce.
The majority of your food should be complex carbohydrate foods – vegetables, fruits, grain products, seeds, legumes and nuts. Choose more vegetables to keep the calorie count down.
High-quality protein – eat less processed and high-fat choices and go for fish, lean meats, skinless poultry, low-fat dairy and plant-based protein sources.
Less sodium, sugar, and “bad” carbs (such as white flour, refined sugars, and white rice). Too much of these things can lead to many age-related health issues and diseases.
More steaming and sautéing and less battering and/or frying.
Use of good fats such as olive oil, avocados, salmon, walnuts, flaxseed, and other monounsaturated fats to protect your body against heart disease.
Try not to skip meals (it slows down your metabolism), eat smaller portions (we don’t need the extra calories), and exchange unhealthy snacks with healthier choices (raw veggies instead of potato chips, piece of fruit instead of a candy bar, etc).
Lastly, don’t forget to drink your water!

2/10/15

Michelle Moore, CHHC
Natural Style Health

Spotlight Text – A New Way to Read

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.”

Howard J. Kaplan, MD
Retina Surgeon
Hudson Retina

1/15/15

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