Selecting Your Best Vision Correction Options

Today technology has evolved to a point where patients either with normal refractive errors such as nearsightedness, farsightedness, astigmatism and presbyopia or those with ocular diseases that require specialized vision correction options such as those with keratoconus all have spectacular alternatives to maximize their visual performance. With the multitude of choices available, how does an individual make the decision which to take advantage of? Well let’s begin by saying that the input from your eye care professional is critically important. You need to be properly educated not only about the various options that are applicable to your individual situation but about the advantages and disadvantages of these options.

Normal Refractive Error Options

Let’s begin by discussing vision correction options available to those with normal refractive errors. Basically stated, these individuals have the ability to utilize spectacles, contact lenses or if they are appropriate candidates, consider the refractive surgical alternatives.

Glasses
Today spectacle lens technology has evolved to the point where exceptional vision quality can be achieved with lens designs that allow for the selection of almost any frame size or shape. Thin lens technologies have enabled those with high prescription powers to not only see amazingly well, but to wear glasses that remain quite thin and attractive even with some of the most extreme prescription powers. Your eye care professional can discuss the various lens material options that best work for your situation. New high index materials are not only thin but are very light weight. A concern for some however can be the significantly higher costs associated with these lens materials. For those who need multifocals, new digital and free form progressive addition lenses (PALs) have dramatically increased the success rates associated with adaptation to PALs.

Contact Lenses
Contact lens alternatives for those with normal refractive errors have also dramatically developed technologically over the past years. Today virtually every patient with normal refractive error is a candidate to wear contact lenses. Developments such as astigmatic contacts, multifocal contacts, and hybrid (rigid center / soft periphery) contact lens designs along with the introduction and the tremendous growth in the use of single use daily disposable contacts has made one form or another of contact lenses something to consider for almost everyone. Today’s CLs are healthier, more comfortable and provide better vision than ever before. CLs have the advantage of superior peripheral vision, more natural vision “sensation” and obvious advantages for demanding physical activities. With contemporary contact lens materials and designs we have successfully addressed issues that limited many people in the past such as concerns of poor comfort due to dryness, contact lens vision instability and contact lens induced complications associated with over-wear and over-use of lenses. Your eye doctor should always present contact lens options to you regardless if you ask or not. So often patients think that they can’t wear contacts, so it does become the responsibility of your doctor to inform and educate you about CL alternatives.

Combination of Glasses and Contact Lenses
So how do you decide if you should be a contact lens wearer or a glasses wearer? Who said you have to? The two vision correction options are not mutually exclusive; in fact they are quite synergistic. All contact lens wearers should have an excellent pair of glasses to use. Contacts may be more cosmetically acceptable to many, they may be much better for various physical activities such as sports, however there are many times when glasses may be preferred such as at the end of a long day of contact lens wear, first thing in the morning before inserting your CLs, or on those days you just don’t want to bother with your CLs or simply prefer the look of your glasses for some situations. Today even the person who predominantly wears glasses can consider part time contact lens wear. Single use daily disposable (DD) CLs are the perfect option for such an individual. DD CLs are now even available in astigmatism and multifocal designs!

Refractive Surgery
Refractive surgery is also developing and is more effective and safer today than ever before. An experienced and skilled eye doctor is in the best position to consult with you in order to determine if you are an excellent candidate for the various refractive surgical options available. Again, having refractive surgery does not always eliminate your need for glasses or contact lenses. Although that would be the optimal outcome, many patients still use glasses and contact lenses after having refractive surgery. Typically the glasses and contact lenses are far less strong and are used significantly less often than prior to surgery. Some patients need them due to complications of surgery while others need them when outcomes did not perfectly correct vision and of course refractive surgery does not stop eyes from changing over the years, so many patients who had successful refractive surgery may experience vision changes years after surgery that require the use of glasses, contacts or both.

Irregular Refractive Error Options

Specialty Contact Lenses
Next let’s talk about choices in vision correction for those with irregular corneas and other conditions that are termed “medically necessary” vision correction cases. Individuals with irregular corneas such as those with keratoconus or post LASIK or other refractive surgery induced ectasias often require contact lenses that in essence “mask” the irregularity of the cornea. In the past this equated with the fitting of rigid corneal contact lenses, however today many other alternatives can be considered such as the fitting of scleral large diameter gas permeable contacts, hybrid CLs designed for irregular corneas and even combination systems of soft lenses with corneal gas permeable lenses (called “tandem” or “piggyback” CL systems). These CL alternatives provide advantages such as improved comfort, improved eye health response by limiting contact lens to cornea bearing, and improved contact lens positioning and stability which positively impacts visual performance.

Combination of Contact Lenses With Glasses
It should be clearly stated that spectacle lens alternatives still can have a significant role in the treatment of individuals with irregular corneas. Often glasses can be prescribed that provide adequate vision if even for part time and limited applications. While less severe cases may perform quite well with glasses as their primary modality of vision correction. Your doctor may need to modify the power of your glasses prescription in order for you to adapt to wearing glasses, however even a modified prescription power can frequently allow for some degree of visual function and allow for the ability to reduce the number of contact lens wearing hours during the day.

Surgical Procedures
Application of certain surgical and medical procedures such as intra-corneal ring segments (Intacs TM) or corneal collagen cross linking (CXL) for corneal irregularity can often help these patients in various ways and may allow for perhaps a less complex contact lens application or easier adaptation and improved function with glasses. Management of these diseases and conditions is quite complex and requires the expertise of doctors with extensive experience. Your doctor, if appropriately skilled and experienced can provide you with all of the required information and education so that you both can jointly decide on the best vision correction options for you.

In conclusion, patients today have numerous options for their vision correction. These options each have advantages and disadvantages but in most cases can be utilized synergistically. The role that your eye care professional plays in consultation and education of the vision correction alternatives applicable to you cannot be over stated. Vision is a precious gift and you should experience the highest quality of visual performance possible.

2/26/15

S. Barry Eiden, OD, FAAO
Medical Director, North Suburban Vision Consultants, Ltd.
NSCV Blog: www.nsvc.com/blog
President and Founder, International Keratoconus Academy of Eye Care Professionals

Watery, Red, Itchy Eyes

Do you have watery, red, itchy eyes?

As brutal winter weather continues to grip many parts of the US, we just want to remind you to protect your eyes – see our post on Winter Weather and Your Eyes. But there are other conditions that can cause excessive tearing and itchy eyes.

While tears are an important element in clear vision and healthy eyes, helping to keep eyes moist, wash away foreign objects and spread nutrients across the eye; this is not the case if there are too many tears and they are accompanied by redness, discharge, puffiness and an itchy, burning sensation.

Here are three common causes you should be aware of:

1. Allergies – In the US, eye allergies affect one in five people. There are two types of eye allergies, seasonal that generally happen early spring to late fall, and perennial that occurs throughout the year. Triggers for seasonal allergies include airborne pollens from grasses, trees and weeds. Perennial triggers include dust mites, feathers, animal dander, cosmetics, perfumes and smoke.

The first thing you should do is limit your exposure to the allergens. This could include:

Stay indoors when pollen count is highest, usually mid-morning or early evening.
Close all windows and use air conditioning in both your home and car.
Consider an air purifier for your home.
Wear wraparound sunglasses to help shield your eyes from pollen.
Limit exposure to dust mites by enclosing pillows, comforters, mattresses and seat cushions in allergen-impermeable covers.
Have your pet spend as much time outside as possible, and keep it out of your bedroom – don’t let it share your bed.
Clean floors with a damp mop – sweeping just stirs up the allergens.
Don’t rub your eyes as it will likely make the symptoms worse. Try a cold compress instead.
Remove your contact lenses and wear glasses during allergy season because the surface of the lens can attract and accumulate airborne allergens. If you must wear contacts, consider daily disposable contacts to avoid the build-up of allergens on your lens.
Sterile saline rinses and eye lubricants.
Oral antihistamines such as Claritin or Zyrtec.
Eye drops can also provide relief. In most cases you can use over the counter (OTC) eye drops, but be aware that overuse of decongestant eye drops can cause a “rebound effect” where the situation could get worse. You are better off asking your doctor to recommend an OTC eye drop. However, if the problem persists or gets worse, you need to contact your eye doctor for prescriptions eye drops tailored to your needs. Here you can learn more about types of eye drops and how to successfully get them in your eyes.

2. Dry Eyes – It seems counterintuitive, but if your eyes feel dry and gritty your tear glands go into overproduction as a protective response. This can become even more of a problem as you age and your tear ducts tend to shrink. For more information on dry eye and treatment options see Dr. Arthur Epstein’s article on Dry Eye and Tear Dysfunction.

3. Blepharitis – Chronic blepharitis is generally caused by seborrheic dermatitis, an oil build-up because of excessive oil secretion. While this results in dandruff on your scalp, near the eyes it leads to eye irritation, redness, burning, itchy and dry eyes. The best treatment is to keep the eyelid area clean and free of discharge. This is done with the application of a warm compress to the outer eyelid and cleansing the eyelids with eyelid cleaner. If a bacterial infection occurs you will need your eye doctor to prescribe an antibiotic ointment.

Blepharitis doesn’t usually damage your eye or affect your vision, but if a bacterial infection is left untreated you can develop ulcerative blepharitis which can result in the loss of eyelashes, eyelid scarring and inflammation of the cornea. Eyelid hygiene is the key with treating blephartis.

These are just three causes of watery, red, itchy eyes. While most are not a serious threat to your vision, you can relieve the discomfort yourself through lifestyle choices, good hygiene and OTC options. However, if you have tried to manage on your own and the condition does not seem to improve within a week, or gets worse, you should contact your eye care professional immediately.

2/24/15

Susan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

GMO and the Nutritional Content of Food

Genetically Modified Organisms (GMO)

How do advances in biotechnology affect the nutritional quality of our food? Historically, humans have realized that the tastiest and most abundant fruit could be selected and replanted the next season. Food crop’s genes change continuously by natural mutation and recombination. Today, advances in our understanding of genetics and molecular biology are permitting scientists to find specific genes that can be moved from one species to another. Genetic material can be transferred from viruses, bacteria, plants, and animals to produce significant changes in the original species. Unlike traditional breeding, gene transfer allows the transfer of genes between organisms of different species. It also permits the transfer of only specifically selected genes to produce the desired outcome in a controlled laboratory setting. Terms frequently used to describe the gene transfer and modification of plants and animals include: Genetically Modified Organisms (GMO), Genetically Engineered (GE) and Biotechnology-Derived (BD).

Nutritional Content of Food

Ways the nutrient profile and density of a food can be altered include: gene modification, agricultural growing and feeding practices, conventional plant breeding and selection, and vitamin biofortification. A gene selected for modification can increase or decrease the vitamin, mineral or fatty acid content found in the modified food. For example, golden rice is genetically altered to increase its beta carotene content. Sometimes when one nutrient is increased another will decrease as an unintended consequence. For example, canola oil genetically engineered to contain vitamin A has reduced vitamin E levels. Growing and feeding practices such as grass-fed versus corn-based animal husbandry, and wild versus farm-raised fish, alters the animal’s fatty acid profile. The amount of omega-3 fatty acids found in eggs varies depending upon the chicken’s diet. Conventional plant breeding and selection can also change the nutritional profile, and has been practiced for a very long time. Finally, grains and cereals are frequently fortified with iron and vitamins before being marketed without the need for genetic modification.

There are intended and unintended consequences of gene modification. Some of the intended goals driving the genetic modification of food include an altered nutritional profile, longer shelf life, and better texture and flavor. Other goals include improved agronomic characteristics such as insect and disease resistance, and herbicide and climate tolerance. For example, plant geneticists can isolate a gene responsible for drought tolerance and insert that gene into a different plant. The new genetically modified plant will then be drought tolerant as well. As the world population grows, perhaps genetic modification can increase crop yields.

The unintended consequences of genetic modification include an increased potential for new allergens in the food supply, antibiotic resistance, toxicity and environmental challenges. Genetic modification ultimately results in the introduction of new proteins into the food supply. True antibody mediated food allergies are an important health issue occurring in approximately 2% of adults and nearly 5% of children. Protecting people with food allergies from unwanted exposure to these new proteins represents a major public health challenge for genetically modified sources of food. Additionally, consumption of foods genetically modified by using “antibiotic resistance markers” may reduce the effectiveness of antibiotics to fight bacterial diseases. Antibiotic-resistant genes produce enzymes that degrade antibiotics and might be transferred to human or animal pathogens, also making them resistant to antibiotics. Finally, a gene selected for modification may have two functions, one with the desired effect and one that has an undesired effect like enhancing natural plant toxins. This occurs in legumes (protease inhibitors), lima beans (cyanogens) and canola species (goitrogens).

Environmental Risks

The unintended environmental risks of genetically modified crops include herbicide and insecticide resistance, gene transfer to wild and conventionally grown plants through cross pollination, crops that are too genetically uniform and thus susceptible to being wiped out by disease, farmer’s limited access to seeds due to patenting of genetically modified food plants, and hard to eradicate “super weeds.”As just one example of the unintended environmental consequences of genetically modified food, Bt corn has been genetically modified to create a toxin in the pollen which kills the European Corn Borer. However, when the pollen is disbursed by the wind, it can land on milkweed, the food plant of the Monarch butterfly, killing the caterpillars that feed on the milkweed. This is one of the reasons the Monarch butterfly population has decreased in recent years.

Lableing of GMO Foods

National and state organic certification rules do not allow genetically engineered foods to be labeled “organic.” Organic products cannot be grown from GMO seeds; an organic animal product like beef, chicken or eggs must not have fed on genetically modified food. Common sources of genetically modified food include sugar made from beets; corn, corn syrup and corn tortillas; papayas; tomatoes; rice; potatoes; soy, including tofu, soymilk, soy nuts, soy sauce; milk produced with rBGH ; zucchini and summer squash; and oils such as vegetable, canola, soybean, cottonseed and corn.

Read the labels and know your ingredients. It is a challenge to avoid genetically altered food. The PLU code on the sticker reveals if the fruit or vegetable was genetically modified, conventionally or organically grown. Bananas labeled with the four digit PLU code 4011 were conventionally grown with the use of pesticides. Bananas labeled with a five digit code beginning with ‘9’ are organically produced without genetic modification (eg. 94011). Genetically engineered produce has a five digit PLU code beginning with the number ‘8.’ For bananas, that code would be 84011.

While genetic modification can alter the nutritional profile of the foods we eat… are we ready to open Pandora’s Refrigerator?

2/19/15

Sandra Young, OD
Author: Visionary Kitchen: A Cookbook for Eye Health
www.visionarykitchen.com

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.

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.

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

Arthur 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?

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

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.

The National Eye Institute (NEI) says an estimated 400,000 Americans have experienced some form of ocular herpes, with close to 50,000 new and recurring cases occurring each year, ranging from a simple infection to a condition that can possibly cause blindness. There are several forms of eye herpes:

Herpes keratitis is the most common form of eye herpes and is a viral corneal infection. Ocular herpes in this form generally affects only the top layer which is called the epithelium, of the cornea, and usually heals without scarring.
Stromal keratitis occurs when the infection goes deeper into the layers of the cornea. This can lead to scarring, loss of vision and, occasionally, blindness. Although the condition is rare, the NEI reports that stromal keratitis is the leading cause of corneal scarring that subsequently causes blindness in the United States.
Iridocyclitis is a serious form of eye herpes where the iris and surrounding tissues inside the eye become inflamed, causing severe sensitivity to light, blurred vision, pain and redness.

Treatment for eye herpes depends on where the infection is located in the eye – in the corneal epithelium, corneal stroma, or iris, etc.

Some ocular herpes treatments could aggravate the outbreak and therefore should be considered on a case-by-case basis.

If the corneal infection is only superficial, it can normally be alleviated by using antiviral eye drops or ointments, or oral antiviral pills over a two to three week period. In some patients, both drops/ointments and pills are used. Steroid drops can help decrease inflammation and prevent corneal scarring when the infection appears deeper in the corneal layers. Steroid drops are almost always used in conjunction with and simultaneously with antiviral drops. For those relatively few eyes where, despite the best of treatment, the virus has caused vision-impairing scars, corneal transplantation surgery is often a highly successful solution.

Although eye herpes has no cure, treatment can help control outbreaks. Studies are underway to determine better methods for managing the disease.

1/27/15

Susan DeRemer
Vice President of Development
Discovery Eye Foundation

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.

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 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.

Physical Activity and Exercise

What us the difference between exercise and physical activity? Exercise is generally a planned physical activity that is structured and repetitive such as yoga, Pilates, weight training, tai chi or Zumba classes. Physical activity are things you do throughout the day that involve movement such as gardening, walking the dog, grocery shopping, vacuuming or taking the stairs instead of the elevator. Both provide benefits, and a combination of the two can help improve health and help you lose weight.

Regular exercise and physical activity are important for your physical and mental health, and over long periods of time, can provide you with long-term health benefits. They can also help you reduce the risk of developing some disease and disabilities that can happen as you grow older as well as being an effective treatment for arthritis, heart disease, diabetes and even eye disease.

Exercise and physical activity can benefit you in many ways:

Help improve your physical strength and fitness
Help improve your balance
Help manage and prevent diseases like diabetes, heart disease, osteoporosis, etc.
Help reduce depression
Help improve cognitive function

Types of Exercise and Physical Activity

Endurance
This includes activities that increase your breathing and heart rate:

Brisk walking, hiking or jogging
Dancing
Swimming
Biking or spinning
Sports such as tennis, squash or basketball
Yard work such as mowing the grass or raking
Climbing stairs

Strength
This includes activities that help you in everyday life such as climbing stairs, carrying groceries, etc.:

Lifting weights
Resistance training such as using a resistance band or Pilates

Balance
These activities help prevent falls:

Standing on one foot
Heel-to-toe walking
Tai Chi

Flexibility
These activities help you stay flexible and limber, which means more freedom of movement and better posture:

Shoulder, upper arm and calf stretches
Yoga
Pilates

Making Your Goals For Success

Now that you understand the importance of keeping fit, it is time to make a written plan to help you achieve your goals. These goals need to be specific, realistic and important to you to increase your chances for success. They also need to be fun and interesting to keep you engaged. Think about both short-term and long-term (where you want to be in 6 months or a year) goals. Things to consider when making your plans include:

What kind of activity you want to do
Why you want to do it
When you are planning to do it
Where you will do it
Any financial considerations such as equipment, shoes and clothing, gym membership, etc.

Writing down your exercise and physical activity goals is important as it will help you follow through with your and help you track your progress. Put them where you can see them, and review them regularly. Some people also find involving another person, such as an exercise buddy or trainer, can help keep them motivated.

It is also wise to consult your doctor about any change in exercise and physical activity. This particularly true if you have had any previous injury, surgery, health issue or are older. While doctors will not tell you to be sedentary, they may have safety tips or suggestions that will help keep you healthy and increase your enjoyment and success with your plan. Things you might want to ask your doctor include:

Are there any exercises or activities you should avoid
Let them know about any unexplained symptoms you might have such as chest pain or pressure, joint pain or stiffness, dizziness or shortness of breath
If you have any ongoing health concerns, how can these affect your exercise of physical activity
Let them know what your activity plan is and the goals to assure they are reasonable

Finding A Personal Trainer

If you are not used to exercising, are trying a new type of exercise, or need the motivational help, you may want to work with a persona fitness trainer. One of the best ways is to get a referral from someone you know who likes and has had success with their trainer. But it is also important you learn more about the trainer as they will relate to you and your goals. Here are some questions you might want to ask them:

Do they have a certification from an accredited organization
How much training experience do they have, including training people your age or medical condition
Will they be able to develop an exercise program based you your goals and what should you expect from their sessions
Will the trainer give you a list of references you can check

When making your final assessment consider how well the trainer listened to you and answered your questions. Also, if they have a sense of humor and are a good match to your personality.

These suggestions should get you started for a healthy 2015. Next Tuesday we will explore more ways to help you succeed.

Susan 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.

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).

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

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