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

Diabetes And The Potential For Diabetic Retinopathy

11/20/14

Defining Diabetes

Diabetes mellitus is a group of metabolic disorders in which a person has high blood sugar levels. It occurs either because the pancreas does not produce enough insulin, or because the body does not respond appropriately to the insulin that is produced. Insulin is the hormone that converts sugar into energy for the body. There are several forms of diabetes.

Type 1 diabetes occurs when the pancreas does not produce adequate levels of insulin. It usually develops during childhood or adolescence; however, it can also occur in adults. Those with type 1 diabetes must take insulin injections. About 10 percent of those with diabetes have type 1.

Type 2 diabetes is the most common type of diabetes, affecting about 90 percent of those with diabetes. It is caused by the combination of the body’s resistance to insulin (not using its own insulin efficiently) and the pancreas not producing enough insulin. As a result, there is an increase in the level of sugar, or glucose, in the blood.

Gestational diabetes occurs in pregnant woman who have not previously had diabetes but whose blood sugars become elevated during pregnancy. In many patients, their blood sugars will return to normal after the pregnancy is over. Placental hormones make the mother resistant to insulin, causing a buildup of blood sugars. These women are at high risk for type 2 diabetes later on in their lives.

Diabetic Retinopathy: An Overview

diabetic retinopathy
Anyone with uncontrolled diabetes is at risk for developing diabetic retinopathy. According to the National Eye Institute, between 40 to 45 percent of Americans with diabetes have some form of diabetic retinopathy, the most common eye condition associated with diabetes.

In the United States, the Centers for Disease Control and Prevention reports between 12,000 and 24,000 new cases of blindness each year due to diabetic retinopathy, making it the leading cause of vision loss among American adults, ages twenty to seventy-four. The Center also projects that by 2050, the number of Americans age forty and older with diabetic retinopathy will grow from a current 5 million individuals to about 16 million. Although these statistics are alarming, you can prevent or delay damage to your vision by controlling your diabetes, along with obtaining regular eye evaluations and treatment.

Defining Diabetic Retinopathy
Diabetic retinopathy is a disease affecting the retina, caused by elevated blood sugar levels. It usually affects both eyes and occurs when uncontrolled blood sugar levels damage the small vessels of the retina, the light-sensitive tissue in the back of your eye. The retina is responsible for processing images that make vision possible. To produce clear, distortion-free vision, the retina must lie completely flat. If the delicate retinal tissue is damaged, images that you see may be blurred or distorted.

Diabetic retinopathy is a progressive disease, and thus worsens over time. Although some effects, such as blurriness and distortions, may be mild or subtle, the long-term consequences can cause severe vision loss.

Symptoms of Diabetic Retinopathy

Because diabetic retinopathy rarely causes pain, symptoms are not always apparent in the earliest stages. In fact, damage to your retina could be occurring long before you have noticeable signs. When symptoms do occur, they’re often caused by retinopathy affecting the macula, the area at the center of the retina. Symptoms may include the following:

• blurred vision

• seeing dark spots or “floaters” (small specs in your field of vision)

• decreased night vision

• vision loss

• problems seeing colors

It’s important that you see your eye specialist immediately if you have any such symptoms. Diabetic retinopathy cannot be cured, but with careful monitoring, it can be diagnosed and treated, before your vision is impaired. The treatment is typically less invasive and more effective when diagnosed at an earlier stage, before permanent damage has occurred.

How the Retina Works

The retina is made up of specialized nerve tissue that contain microscopic receptors (called cones and rods) and other nerve cells that line the back of the eyeball.

These cells carry signals (images that we see) along the optic nerve to a special area of the brain, where they’re interpreted into what we perceive as sight. You might compare the retina to film in a camera—the film delivers the photo image that the camera captures.

There are two main areas of the retina that can be damaged by diabetic retinopathy:

• The macula, the center of the retina. The macula allows you to read and see fine details and recognize colors. At the very center of the macula is a dimple known as the fovea. It is the most sensitive portion of the macula and makes sharp vision possible.

• The peripheral retina, which is the portion of the retina that is outside the macula. It’s responsible for your side vision and also makes night vision possible.

The retina lies on a nutrient-rich flat “carpet” of vessels that nourish it with necessary oxygen and nutrients. To reach the retina, however, nutrients must pass through two buffers—a thin membrane called Bruch’s membrane and a single layer of specialized cells called the retinal pigment epithelium. Waste products are also transported away from the retina through these two membranes. Diabetic retinopathy can interfere with this constant import of necessary nutrients and export of waste products.

Risk Factors for Diabetic Retinopathy

There are many factors that can raise your risk for diabetic retinopathy. However, you’ll note that many of these risk factors can be controlled.

Duration of Diabetes and Glucose Control

The longer you’ve had poorly controlled blood glucose levels, the higher your risk for diabetic retinopathy. Most diabetic individuals develop eye problems overtime, making duration of their diabetes one of the strongest predictors that they will develop this eye disease. Research has shown that nearly all type 1 diabetics and 60 percent of type 2 diabetics develop the condition within the first two decades of their diabetes diagnosis.

The American Diabetes Association (ADA) recommends fasting glucose levels between 70 and 120 mg/dL and less than 180 mg/dL two hours after meals. They also recommend a hemoglobin A1c of 7 percent of less. Hemoglobin A1c is a protein in red blood cells that bonds with blood sugars. Since red blood cells can live from 90 to 120 days, the hemoglobin A1c stays in the blood for that length of time. Accordingly, it is effective in measuring the average blood sugars over a period of time. This test tells doctors how well your treatment plan is working. You should always know what your hemoglobin A1c values are, as they may affect the interval between your retinal examinations.

Obesity

The more fatty tissue you have, the more resistant your cells are to insulin. Obesity increases your risk for diabetes as well as other serious conditions such as heart disease. Estimates suggest that 65 percent of Americans may be overweight. Being overweight aggravates high blood pressure and cholesterol. Achieving a healthy weight is important in controlling blood sugars and diabetes related complications.

Lifestyle Choices

A sedentary lifestyle, especially if you are overweight, contributes to many diseases, including diabetes, heart disease, high blood pressure, and high cholesterol levels. On the other hand, physical exercise improves circulation, lowers blood sugars, and improves your body’s use of insulin. This results in improved blood sugar levels. This benefit of increased sensitivity to insulin continues for hours after you stop exercising.

Exercise also promotes weight loss. A sedentary lifestyle contributes to insulin resistance, and makes it more difficult to keep weight off. Even light or moderate physical activity can help lower blood sugars.

Smoking is another major risk factor for developing diabetic retinopathy. Smoking also causes diabetic retinopathy to progress faster. The nicotine in tobacco not only contributes to higher blood pressure and higher cholesterol levels, but it also impairs insulin activity. Even though quitting can be difficult, it is critical to heart health and diabetes control.
Unlike smoking, alcohol consumption doesn’t have a direct influence on diabetic retinopathy. Yet because it can affect diabetes control, drinking in excess can affect the health of your eyes. Your doctor can tell you what constitutes drinking in moderation for you.

High Cholesterol Levels

Diabetes puts you at risk for chronically high cholesterol or blood fats that promote the buildup of plaque in your arteries. Although the tiniest vessels of the retina are too small for such build-up, uncontrolled cholesterol can contribute to macular edema and the development of hard exudates, the small yellow spots or lipid deposits that may form in the macula. Both conditions are associated with a higher risk of vision loss.

Doctors advise keeping “bad” or low density cholesterol (LDLs) less than 70 mg/dL. Good cholesterol or high density lipoproteins (HDLs) should be greater than 40 mg/dL in men and 50 mg/dL in women. Both men and women should strive for triglycerides, another type of fat, at levels less than 150.

High Blood Pressure

If you have both diabetes and high blood pressure (also called hypertension), you may be at higher risk for a number of eye-related problems, including retinopathy, glaucoma and optic nerve damage. Seriously elevated blood pressure not only stresses your heart, it also raises the risk for eye problems, particularly macular edema and bleeding. Chronic hypertension combined with long-term diabetes also increases the chance that your retinopathy will be more destructive and progress more rapidly. Research has consistently shown that keeping your blood pressure below 130/80 mmHg is important in minimizing the risk of hypertension related complications.

Race/Ethnicity

Diabetic retinopathy is more common in some ethnic and racial groups than others. African Americans, Asian Americans, Hispanic/Latino Americans, American Indians and Alaskan Natives are at higher risk for type 2 diabetes than non-Hispanic whites.

African Americans and Mexicans are almost twice as likely as whites to have eye problems, according to the American Diabetes Association. Native Americans also have an increased for diabetic retinopathy. Researchers aren’t sure why some ethnic groups have higher rates of diabetes, which increase the risk for retinopathy and other problems.

Age and Gender

As mentioned earlier, the longer you have diabetes, the greater your risk for diabetic retinopathy. Not surprisingly, this complication is rare among children but common among older diabetic adults. A recent study by Prevent Blindness America and the National Eye Institute, demonstrated that older adult Americans are facing a bigger threat of all age-related eye diseases (diabetic retinopathy, age-related macular degeneration, cataracts and open angle glaucoma) today than at any other time.

Genetics

Our genetic make up has an important effect on our predisposition for many health issues such as diabetes. Scientists believe that many genes or combinations of genes either promote diabetes in certain individuals or protect them from developing it.

Scientists have yet to identify every gene involved in type 1 and type 2 diabetes, but they have shown that genetics are a factor. Research studies of identical twins, for instance, have demonstrated that if one twin has type 1 diabetes, the other twin has a 50 percent change of developing the disease. If one twin has type 2 diabetes, the other twin has a 75 percent chance of developing it.

Pregnancy

Gestational diabetes is a type of diabetes linked to pregnancy; however, diabetic retinopathy is usually not a complication in these women. However, if you’re already a diabetic and become pregnant, you are at an increased risk of developing diabetic retinopathy. This is a result of the hormonal and metabolic changes that occur during pregnancy, making the disease and its complications progress more rapidly. It is recommended that you see a retinal specialist for evaluation and monitoring.

In Summary

• Diabetic retinopathy is a serious complication of diabetes that results from high glucose levels damaging the retinal blood vessels. This can cause loss of vision.

• Between 40 and 45 percent of diabetic Americans have some form of diabetic retinopathy.

• The earliest form of the disease is called background diabetic retinopathy. With time it progresses to mild, moderate, or severe nonproliferative diabetic retinopathy.

• Without proper diagnosis and treatment of nonproliferative diabetic retinopathy, the condition can advance to proliferative diabetic retinopathy, which is a serious sight-threatening stage of the disease.

• Macular edema is due to build up of fluid and thickening of the macula and can occur with any type of diabetic retinopathy. It is the most common cause of vision loss in those with diabetes.

• The duration of your diabetes and how well blood glucose is controlled are major risk factors for the development and progression of diabetic retinopathy.

• Other risk factors that play a significant role in the development of retinopathy, include high blood pressure, high cholesterol, and smoking.

• As an individual with diabetes, you’re also at increased risk for other eye diseases, especially glaucoma, cataracts, retinal vein occlusion and optic nerve damage.

• Good blood sugar control, regular eye examination, and timely treatment are the key factors in reducing the damage to the eye and keeping your vision.

Pouya Dayani - Diabetic RetinopathyPouya N. Dayani, MD
Retina-Vitreous Associates Medical Group

Photophobia

11.4.14

Photophobia is a severe sensitivity to bright light which can result in discomfort and even pain. It can vary from person to person with discomfort coming from lights that don’t ordinarily affect others, including natural outdoor light, overhead lighting (such as fluorescent light), reflected light or flames of a fire.

Although in most cases photophobia is harmless, it is NOT an eye disease, but may be a symptom of an underlying problem. These could include an infection or abrasion that irritates the eye, a viral illness, medications, severe headache or migraine. sky

It could also be the result of your unique physical makeup. A person’s eye color can also affect ones sensitivity to light. People with lighter colored eyes can be more sensitive to light as opposed to people with darker eyes. An examination by an eye doctor can help determine the cause of your sensitivity.

The best treatment option for relieving the discomfort of photophobia is to address the underlying cause. The answer may be as simple as changing a medication or treating a corneal abrasion. Or your photophobia could be the clue that alerts doctors to another treatable condition. If you are naturally sensitive to light, wearing sunglasses with UV protection, brimmed hats or avoiding bright light situations are the only alternatives. In most cases, if you treat the underlying cause, the sensitivity will decrease or disappear.

Susan DeRemerSusan DeRemer, CFRE
Vice President of Development

Night Blindness

10/28/14

As the number of daylight hours decrease and daylight savings time is about to end, many of us feel that the days are getting much shorter. If you suffer from night blindness, your days are shorter, because getting around or driving at night, are sometimes impossible.

Night blindness is a condition that makes it difficult for a person to see in low-light situations or at night. Some types are treatable, while others are not. You will need to consult your eye doctor to determine the underlying cause of your night blindness to determine what can or cannot be done.

night blindness
Courtesy of wikipedia
There are several things that could cause night blindness:
•Cataracts
•Genetic eye disease
•Vitamin A deficiency
•Diabetes
•Aging eye
•Sunlight exposure

Here is a brief look at each.
Cataracts – This is when the lens of the eye becomes gradually becomes clouded, reducing vision. Besides reducing vision at night you may also experience halos around lights. This is a treatable condition requiring cataract surgery and replacing your clouded lens with a clear artificial lens. Your vision should improve considerably.

Genetic Eye Disease – Both retinitis pigmentosa or Usher syndrome are progressive genetic eye diseases where the rods that regulate light, and cones that control color perception and detail die. Progressive night blindness is one of the first visual symptoms of these two diseases. Currently there is no treatment for them as there is no way to treat or replace the dying rods.

Vitamin A Deficiency – While rare in the US, it can be a result of other diseases or conditions such as Crohn’s disease, celiac disease, cystic fibrosis or problems with the pancreas. Options to help with the deficiency include vitamin supplements suggested by your doctor, or increasing your intake of orange, yellow or green leafy vegetables.

Diabetes – People with diabetes are at higher risk for night vision problems because of the damage to the blood vessels and nerves in the resulting in diabetic retinopathy. Not only can it cause poor night vision, it may also take longer to see normally after coming indoors from bright light outside. There is no cure, but controlling blood sugar levels with medicine and diet can help prevent developing retinopathy or help slow the progression.

Aging Eye – As we age several things happen to our eyes. Our iris, which regulates the amount of light going into the eye, gets weaker and less responsive. This can make adapting from light to dark more difficult and slower. Our pupils shrink slightly allowing less light into the eye. The lens of the eye becomes cloudier, as explained above in cataracts, limiting the amount of light into the eye. We also have fewer rods for light perception. Aside from cataract surgery there is no treatment for age-related night blindness. However, eating a diet rich in fruits and vegetables and low in saturated fat is the best way to slow the progression. Here is more information on how the aging eye is affected.

Sunlight Exposure – If your night vision seems temporarily worse after a trip to the beach or a day on the ski slopes, it probably is. Sustained bright sunlight can impair your vision, especially if you fail to wear sunglasses or goggles.

Night blindness due to genetic conditions or aging cannot be prevented. However if you protect your eyes from extreme sunlight, eat a healthy diet, and monitor blood sugar levels if needed, you can reduce your chances for night blindness.

As we head into the holiday season, you should know that some great sources of vitamin A include sweet potatoes, butternut squash and … pumpkins!

Susan DeRemerSusan DeRemer, CFRE
Vice President of Development

15 Things Doctors Might Like Us To Know

10/16/14

The Doctor Patient Relationship

Doctors are human. Professional decorum may not let them speak their minds and for that reason, I have gathered comments heard from eye doctors with whom I have been privileged to associate as a so-called “expert patient”. These may not speak for all, but I do think they represent the majority. Here are 15 of the most important, which we might benefit from hearing.15 - doctor patient relationship

1. Your eyes are growing older, and I can’t turn back the years in an aging retina. I can, however, help you try to maintain your current vision for as long as possible.

2. Your appreciation means a lot. Don’t hesitate to compliment me if I have earned it.

3. I have quite a few patients who need my help and don’t want to be kept waiting. So I don’t have to keep repeating myself, please take notes, or bring someone with you who can refresh your memory later.

4. It is important that you comply with my instructions and show up for appointments if you want the best results.

5. My specialty is eye care. I will, however, try to provide you with resources for other ailments you may have.

6. Please be concise with your questions and stay on topic, so I’ll have time to treat other deserving patients.

7. Don’t believe everything you see in the media unless the source is reliable. If the information isn’t based on good evidence, my response to you may be disappointingly negative.

8. My services may seem expensive, but I have so many expenses and debts resulting from my profession that my bottom line may not be much different than yours.

9. An ethical physician will not choose a particular drug or treatment by how much of a profit he can make prescribing it.

10. I might not agree with everything you say, but rest assured that I will never let it affect the level of care I will provide.

11. Don’t expect me to keep all eye research in my head. I do know where to look it up, so allow me some time to get back to you on some questions.

12. Conferences I attend are sometimes in exotic places, but most of the time is spent going from one event to another, so it is really not a vacation.

13. Even if there is no current effective treatment for your eye disease, I still need to see you regularly to monitor your condition. Regular check-ups are important to your health and preventative care and treatment options are changing all the time.

14. I may not remember you personally, especially in the beginning or if I see you only see you once or twice a year, but your records contain everything I need to know to care for your vision.

15. I may not agree with your decision to try an alternative treatment, but I respect your right to do so. All I ask is that you seriously consider my opinion, and if you decide to go ahead with the treatment on your own, please keep me in the loop so I can monitor your condition.

We should try to understand that doctors are human beings who truly care about our welfare. Doing so could turn a top-down doctor-patient relationship into one of mutual respect and understanding. We might even get a few extra minutes of precious time in the chair, just because we’re a pleasure to have around.

dan robertsDan Roberts
“Expert Patient”