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.
Low vision awareness
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

NEHEPsq75The 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.

Understanding and Treating Corneal Scratches and Abrasions

Corneal Scratches and Abrasions

Call it a scratch, an abrasion or erosion; no matter how you describe it or what the cause, damage to the cornea most always causes pain.

So what exactly is the cornea and why can even a small scratch hurt so much? The cornea is the clear dome at the very the front of the eye. Its primary job is to surface the tears and with them, focus light into the eye. It then passes through the crystalline lens and on to the retina where it is transformed into electrical impulses that are ultimately transformed by the brain into sight.

Because vision is so essential for survival and the cornea so critical to seeing, it is among the most richly innervated and exquisitely sensitive of all tissues. Even the smallest piece of dust that finds its way into the eye and touches the cornea can cause significant discomfort, irritation and copious tearing in an attempt to wash it away. A healthy cornea is transparent and consists of several layers that give the cornea its smooth dome like shape. The outermost layer, the epithelium, is designed to break away to protect the delicate deeper layers if scratched or abraded.
cornea layers - corneal scratches and abrasions

Looking For the Cause

The most common causes of corneal scratches are accidents. Tiny infant fingers and fingernails are a common cause of abrasions in young parents, tree branches are a frequent source of abrasions in hikers and lovers of the outdoors, and makeup brushes are a typical cause in women. Scratches can also be caused by foreign objects that get into the eye and then work their way on to the inside of the upper lid – causing a scratch that occurs with each blink. That’s why its important to carefully investigate the cause of every corneal scratch.

A scratch pr abrasion usually produces near instantaneous pain and tearing as the eye tries to wash away the irritant. Light sensitivity soon follows and can be so intense that the eye can involuntarily shut. This is actually nature’s way of “patching” the eye to facilitate healing.

To confirm you have a scratched cornea, a doctor or other health care professional will often apply a wetted fluorescein strip to the inside lid or white of the eye. Fluorescein is a dye that glows bright green when exposed to black light. The dye is absorbed by damaged areas, clearly showing the area if the scratch or abrasion.

Getting On the Mend

The good news is that most scratches will rapidly heal on their own, especially smaller and more superficial ones. The confocal microscope, a high tech device that provides extreme magnification views of living tissue, has been used to observe corneal healing in real time. The video captures are breathtaking as individual corneal cells can be seen literally stretching over each other to mend and seal the corneal surface.

If an abrasion is larger or deeper it may require patching to help healing. The traditional eye patch applied with tape to keep the eye shut has largely been replaced by the bandage contact lens which is far more comfortable and allows some vision and easier observation during follow up examination. It also allows medication to be applied if needed. Because there is a risk of infection whenever the outer boundaries of the body are breached, topical antibiotics are often used as a precaution in treating scratches of the cornea and ocular surface.

Most commonly the cornea heals quickly and completely, but not always. In rare cases damaged areas of the cornea may not heal fully, leaving the outer layers of the cornea susceptible to coming off again for no apparent reason. This is thought to be more common after scratches caused by organic material such as a tree branch. Called recurrent corneal erosions, they often occur during sleep waking the person with a sudden sharp pain and excessive tearing. There are a variety of treatments for recurrent corneal erosion.

Conclusion

Most people will sooner or later experience a scratched cornea. Most scratches will be minor and will resolve with minimal treatment. However, some can be serious and have significant consequences. The best way to avoid problems is to be aware that they can occur and take measures to protect the eyes in situations where the risk of eye trauma is higher. This includes: wearing safety glasses while working with power tools, or sports where eye contact is possible. This includes cycling and sport shooting.

Be aware of active infants with little fingers that seem to have a magnetic attraction of their parents eyes. If you use eye makeup, leave enough time to properly apply it without rushing and potentially scratching your cornea in the process.

Finally, if you experience a scratched cornea and the pain doesn’t rapidly abate, see an eyecare specialist. Urgent care centers are fine for most things, but when it comes to the eyes finding a knowledgeable eye care professional is wise.

2/10/15

AArthur B. Epstein, OD, FAAO
co-founder of Phoenix Eye Care
and the Dry Eye Center of Arizona
Fellow of the American Academy of Optometry
American Board of Certification in Medical Optometry
Chief Medical Editor of Optometric Physician™

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?
food pyramid - 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 MooreMichelle Moore, CHHC
Natural Style Health

Understanding Ocular Herpes

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.
ocular herpes
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 DeRemerSusan DeRemer
Vice President of Development
Discovery Eye Foundation

Adding Healthy Eating To Your Exercise Plan

1/13/15

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.
Healthy Living
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!

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

Exercise And Physical Activity For A Healthy 2015

1/6/15

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.
biking exercise and physical activity
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

Endurancegardening exercise and physical activity
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.

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

Uveitis Explained

12/18/14

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.
uveitis explained
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.

Uveitis Explained
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).

RichardRoeMD-ThumbnailRichard H. Roe, MD, MHS
Retina-Vitreous Associates Medical Group

7 Healthy Eating Tips for the Holidays

12/16/14

Every year the holidays come around to tempt us with a variety of wonderful foods. It doesn’t make any difference if its Christmas or Hanukah, food is an integral part of the celebration. And the celebrations are pretty non-stop from Thanksgiving through New Year’s. Here are seven healthy eating tips for the holidays to help you handle all the delicious temptations of the season (the average person says they gain around five pounds).
healthy eating tips for the holidays
1. Eat before you go – Have a small healthy snack before you go to the party, to help control your appetite once you get there. Some great snacks include, cut up fresh vegetables, small handful of nuts (remember to make it small as they have quite a few calories, but they are healthy and filling), low-fat string cheese, etc.

2. Select wisely – When confronted with an open bar ask for club soda, tonic water or even tomato juice. Still want that glass of wine? Add some club soda to make it a wine spritzer and cut some of the calories. Once you have your drink, walk as far away from the bar as possible. Another good reason beside calories to cut down on alcohol – you will be able to drive home safely.

3. Strive to be the last in line – This works well in two ways, first being that once the food is picked over it doesn’t have the visual impact of the buffet when everything is presented in its perfection, making your mind go into overload as you try to decide what all to pile on your plate. Second, by the time you go through not everything might be available, and what’s left might not let you take too large of a helping.

4. How to use your plate – If you have more than one size plate to choose from, select the smallest one. Also know that filling your plate does not mean you have to cover every square inch with food, nor do you have see how high you can layer food. You are better off making more than one trip. On the first trip start with vegetables and salads while you scan what else is available. Then you can go back for small portions of what you think are the three best offerings.

5. Lend a helping hand – If the pull of the buffet becomes too strong, help out your hosts by pouring drinks, taking dirty dishes to the kitchen, even helping clean dishes.

6. Leave the party empty-handed – No matter how grateful your hosts are for you attending, do not take home any of the leftovers. No matter where you hide them in the refrigerator, you will still know they are there.

7. Elastic is not your friend – As you socialize and catch up with old friends you can get distracted, making it hard to watch what you eat. You are better off wearing something fitted, or at least with a regular waistband, to remind you that you might be eating too much. Belts are great as long as you don’t adjust them after getting to the party.

Just because a food is healthy, it doesn’t mean that it is low in calories. As you fill your plate, select foods that “bright and colorful.” These will generally be healthier options with a lower calorie count, such as fresh fruits and vegetables. But remember that fruits, because of their higher sugar content, will have more calories. Also the “bright and colorful” approach won’t work at the dessert table with brightly-decorated cookies, cakes and pies.

Here is a color palate to get you started:

RED – tomatoes, red peppers, kidney beans, strawberries, cranberries

ORANGE/YELLOW – pumpkin, butternut squash, yellow peppers, citrus fruit

GREEN – kale, spinach and other green leafy produce, broccoli, asparagus, apples, green peppers

BLUE/PURPLE – purple cabbage, eggplant, blueberries, plums, blackberries

Two bonus tips:

1. Shopping is stressful – Even when you are shopping you will be surrounded by food, especially at the mall where food courts and food kiosks offer a variety of “quick” snacks and meals. Plan ahead. You know what your shopping area has for you to eat. Find a healthy option that offers you good fiber and protein and plan to go there for lunch. Taking a lunch break will keep you from snacking all day and help you power through an afternoon of shopping. If you need snacks, pack something healthy in your purse.

2. Moms and baking go together – There is something about the holidays that brings out the baker in every mom. So when you go home, or even if mom arrives at your house, you will be presented with baked goods filled with love . . . and calories. Here is where avoidance won’t work, you need to rely on strategic moderation. Choose just a few samples to keep and enjoy, then either take the rest to the office, or make goodie gift bags for the mail or UPS delivery person, your manicurist, paperboy, etc. Mom will be pleased that you want to share her baking expertise.

And if you are the mom making these baked goods – try making fewer in December and spread them throughout the year. Less stress for you, and whom wouldn’t want to eat a spritz cookie in July?

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