Lutein and Macular Degeneration

Age Related Macular degeneration represents one of the most significant causes of vision loss in patients over 65. According to the CDC and NEI,  nearly 7 million people are at risk of developing this condition. Understanding what causes and what may prevent macular degeneration will allow you to take steps NOW that will decrease your chances of developing ARMD in the future.

What Is Macular Degeneration?

The Macula can be thought of as your “center vision area”  it is a portion of the retina (the delicate tissue that lines the back part of our eyes) that allows you to recognize people’s faces and read this blog post.  Dry macular degeneration is a chronic eye disease where the macula slowly disintegrates.  Wet macular degeneration, is much less common but far more sinister.  It occurs when blood vessels behind the retina leak blood and fluid, causing changes in central vision.

Curbing Macular Degeneration

Certain characteristics put individuals at a higher risk of developing macular degeneration. Being Caucasian, persons over 65, and a family history of macular degeneration are strong risk factors outside of your control. Other risk factors, such as obesity, smoking, poor diet, cardiovascular disease, lack of exercise and high cholesterol can be modified through lifestyle change.

Incorporating healthy fruits and vegetables into your diet, reducing caloric intake to manage your weight, quitting smoking, increasing physical activity (walking), and reducing your consumption of saturated and trans fats will lower your cholesterol.

Currently, dry macular degeneration is irreversible. However, it often progresses slowly and certain treatments may reduce the rate of progression. Annual visits to an optometrist for comprehensive eye exams are essential when monitoring the condition. High levels of vitamins A, C, and E as well as zinc and copper may reduce the progression of macular degeneration. Increasing your intake of omega-3 fatty acids, lutein, and other carotenoids may also help as was proven in a large multi center study (AREDS2).

Treatment for wet macular degeneration may include injection of prescription medications, photodynamic therapy, or laser treatment to destroy abnormal blood vessels and prevent new vessel growth. In very advanced cases of macular degeneration, an optometrist may recommend surgery to implant a telescopic lens in one eye.

Sources:

American Health Assistance Foundation (2012). Macular degeneration research: About macular degeneration.
Mayo Clinic (2012): Macular degeneration.

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The Bright Eyes Smoothie

The next few blog posts will revolve around nutrition and eyesight.  Vitamin B, Vitamin A, Omega 3 Fatty Acids, Lutein and Zeaxanthin have been shown over and over to be vital to eye health.  Patients with nutritional deficits and malnutrition have been shown to lose vision and improve with B12 shots.  Patients lacking Vitamin A can vision complications. Omega 3 fatty acids appear to be important when combatting Dry eye.  Some evidence suggests Lutein and Zeaxanthin are linked to macular health.

A smoothie is an excellent and efficient way to incorporate these nutrients into your diet.  Parents can involve their children, showing them the importance of eating right for lifelong health.  My assistants were able to help me come up with a recipe that has Omega 3 fatty acids, Lutein and lots of other nutrients.

We found using the Nutribullet prime blender tends to work best for this recipe.  In the Nutribullet container add 1 cup of frozen fruit, 2 cups of almond milk and 1 banana:

 

 

 

Blend!

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After the items are blended, add chia seeds (Omega 3) and Spinach (to get a good dose of Lutein we used mix of Kale, Spinach and other greens).

 

 

 

Soaking the chia seeds in water helps to soften them. Now add the softened chia seeds, some water for consistency and some ice:

 

 

 

Blend it up again!

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Finally, Enjoy!

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Here’s the recipe:

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Thanks for reading.  That’s all for now!  Look for our next post in mid June!

 

The Blue Light Battle

2018-04-18 19.44.46 HDR

 

If you look through my previous posts, you’ll see last year I posted information on the solar eclipse and eye damage from the sun and laser pointers….”Don’t stare at the sun” is universal knowledge.

But one thing we may not know, or know entirely is what does the light being emitted from digital devices do to our eyes? HEV (high energy visible) light is near ultraviolet wavelength light that is present in sunlight. You can see this same light in our smartphones, tablets, compact fluorescent lights, LEDs to name a few. Traditionally when the sun went down our exposure to HEV was near zero. Presently we are exposed to blue light every waking hour – an all time high for our species.

Definitive research shows a relationship between blue light exposure and eye damage, disrupted sleep patterns, eyestrain and headaches, blindness from cataracts and macular degeneration are all possible. This damage comes from 3 main sources; UV-A, UV-B and HEV.  Research also shows limiting this damage has a protective effect.*(see footnotes below from Gregory Good O.D., Ph.D.)

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How to protect ourselves and at what age to begin?

Research proves that the very young will benefit from HEV protection as will adults. Also cumulative exposure over a lifetime contributes to eye damage later in life so start now!  Outdoors this can be done with wide brim hats. In the snow and on white sandy beaches sunglasses known to protect the eyes from 100% UV-A & UV-B rays will be best. When driving it is important to be sure the lenses meet ANSI Z80.3 standard so drivers can still discriminate Green, Yellow and Red (traffic lights). Grey tint tends to do this the best.

Transition lenses have come a long way in color changing properties and can be a solution both indoors and outdoors.

Transitions lenses Healthy Vision

Indoors, certain lens materials naturally protect from UV-A & UV-B light Polycarbonate blocks UV-A & UV-B plus it has intrinsic “shatter proof” qualities. A material called “Trivex” also does this and is impact resistant as well. Couple these materials with blue light coating, Antireflective coating and scratch resistance coating and patients will have quality lenses that are protective and as durable as possible.

For children, tinted sunglasses made from Polycarbonate or Trivex would be an excellent option.

Certain contact lenses have UV protection incorporated into them. Contacts have an advantage as they can protect our eye from incident light coming from any direction (Sunglasses allow light to peek in around the lenses) but remember that contact lenses provide NO protection from HEV or blue light. As before, quality sunglasses over contact lenses will help protect us from the HEV or “blue light” as well.  

Eyezen Infographic

For more information click here ->Sunglasses and UV light

*Footnote

  • Salisbury Eye Evaluation (West et al. J Am Med Assoc. 1998; 280:714)
  • Blue Mountains Eye Study (Mitchell et al. Ophthalmology 1997)
  • Ham et al. (Nature 1976; 260:153)
  • Tomany et al. Arch Ophthalmol 2004;122:246)
  • Taylor et al. (Arch Ophthalmol1992; 110:99)
  • Roberts. J Photochem (Photobiol B. 2001; 64:136)

Additionally, studies have shown using a hat or sunglasss decreased the risk of early ARM changes by nearly 50%

 

Have a great May!

-Dr. Meers

“The eyes are the window to your soul”

Quotation-William-Shakespeare-The-Eyes-are-the-window-to-your-soul-46-1-0141

 

While Shakespeare may not have said this first,  he appears to be the person most attributed to the quote.  We can find a similar saying in the bible:

Matthew 6:22-24 “The eye is the lamp of the body”

When it comes to our eye health, men have advantages women lack, such as lower risk for eye diseases in general, but they also have some disadvantages women don’t have to worry as much about. These are the main ones.

“We don’t see things the same way”

It turns out that men and women don’t actually process visual information the same. Men are better than women at spotting fine details and rapid movement, but fall behind when it comes to distinguishing colors.

Men aren’t just at a slight disadvantage when it comes seeing the differences between colors.  So when couples argue over what color looks best, they are literally not seeing the same.

Men are 16X more likely to be colorblind.

A very small number of women might even be tetrachromates, meaning they’re able to see colors the rest of us can’t imagine!

“It’s the hormones!”

Beginning in puberty, hormones cause many significant changes, and that even includes the way our eyes grow! Some teenage boys become nearsighted (sometimes this nearsightedness is permanent other times it is temporary). 

Often times during the first & second trimester or pregnancy women can notice some blurry vision (it makes sense the eyes are not immune as so many other changes are taking place).  It’s a good idea with blurry vision and pregnancy to get an eye exam so we can rule out whether or not this is from needing glasses or other causes. Pregnancy, birth control, and menopause are also risk factors because they create significant hormone changes. Dry eye is common under any of these circumstances, and birth control pills have been shown to increase the likelihood of developing glaucoma.

Men & Safety Glasses

In general terms, men play more strange & dangerous sports and are reported to be employed in more hazardous work than women (for instance, the Port of Tacoma has more male Longshoremen than female), this seems to place men at greater risk of eye injury. What makes this even worse is that men are also more likely to forego protective eyewear than women, and the end result is that men suffer 3x as many eye injuries as women. So remember your protective eyewear!

Men are more prone to eye injuries but women are more susceptible to eye diseases that pop up in your 30’s and 40’s. So what problems should women be on the watch for?

Common vision disorders in women

The least serious vision problem that impacts women is simply needing corrective lenses. Women are also more susceptible to dry eye, age-related macular degeneration (AMD), and glaucoma. Macular Degeneration (AMD) and Glaucoma (a disease that permanently damages the optic nerve) run in families and are serious sight-threatening conditions, and the reason they affect women more than men is that women tend to live longer!

Chronic dry eye can result in blurry vision, irritation, redness, and pain. It’s important to contact our office so we can determine the underlying cause. The easiest way to fight back is with early detection from regular eye exams.

Taking care of the Care taker

It is nobody’s fault but is my opinion that often women’s eyes can suffer from neglect. Women are typically the primary caregivers for their families, their health often gets pushed to the back burner while they tend to everyone else’s needs. With so much to do, it becomes easier to forget to schedule eye exams, problems might go unnoticed until more serous stages when little can be done.

For more information on this topic and our eye and body health, click here. 

Have a great Spring & take care of your eyes 🙂 

-Dr. Meers

Tacoma Eye VS logo

Allergy Season

Allergy-Dandelion-email

In Tacoma, the pollen count seems higher than previous years.  You can actually check the pollen count in your zip code by visiting pollen.com.  This website will even help you determine WHICH pollens you may be allergic to.

Patients experiencing itchy, gritty, red, watery eyes that get worse in the spring are probably suffering from some form of ocular allergies to pollen.

As a general rule this is what I recommend to my patients (presuming you are not allergic to these medications!) :

*Try OTC (over-the-counter)  Loratadine or Cetirizine.  Some patients may want to use these in conjunction with Pseudoephedrine Hydrochloride.  Often this step alone is enough to clear up many seasonal allergies.  A cold compress on your eyes at night will decrease the itching and discomfort.

*If your eyes are still watery I would advise against using Visine, Naphcon-A or similar products.  If you call your PCP they often will prescribe cromolyn sodium.  In my opinion and in the opinion of researchers, OTC ketotiphen is more effective than cromolyn sodium.

*If after a few days of above treatment and your eyes STILL are bothering you, please contact my office for an appointment.  At this point an eye evaluation is in your best interest.  After my evaluation I will be able to prescribe medications stronger than ketotiphen suited to your needs.  These meds are only available with an optometrist’s prescription.

Spring_Allergies_Vision_Source

Remember to decrease pollen circulating near your eyes.  Use an air filtration system in your home and car. Keep windows closed. Try not to wear contact lenses since they are known to collect dust, pollen and debris (This is also why upgrading to daily use contact lenses is a good idea).  Try and wear eyeglasses and wraparound sunglasses when outside.

 

Happy Spring !

 

Dr. Meers

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T-town Dawgs

 

Tacoma eye doggy

It was a great summer here in T-town.  This summer showed me that Tacoma has so much to offer; quality museums, good schools, the Tacoma Rainiers and a great metro park system with many parks for recreation. In an effort to maintain these high quality parks, they also have a pet scoop law.

Why is a scoop law important? One reason is the Toxocara canis nematode.  The center for disease control (CDC) mentions that nearly 14% of the US population has developed antibodies to this parasite meaning about 14% of American citizens have been exposed to this parasite.

toxocariasis_infographic

Dogs and to a lesser extent -cats can carry “Toxo” parasites and the eggs (this should not be confused with another parasite- Toxoplasmosis). If a child/adult were to accidentally swallow dirt that has been contaminated with dog feces these eggs can be ingested. Another method of contamination is eating undercooked meats that have the Toxocara Canis larvae. Toxocariiasis was first discovered in 1950 but we know it existed much earlier. These larvae have spread worldwide and often will pose little threat to humans but in some cases the larvae will damage the liver, the lungs, the central nervous system or even the eyes. In fact 70 people in the USA are blinded by toxocara canis each year. A small number but this number can be dramatically reduced by following a few simple rules.

Rule #1 Pick up after your dog! It’s a no-brainer and as I mentioned, the city of Tacoma makes it easy for us.

Other preventative steps:

  • Get regular pet care with a veterinarian. They can test and deworm pets who are afflicted
  • Wash your hands and your kid’s hands after playing with pets, outdoor activites, handling food.
  • Don’t let your kids play with soil in dog parks, dog runs, dog pens.

Here in Tacoma, with the Asarco smelter it is fairly common practice to avoid disrupting the soil and the keep our hands clean.  Here is an uncommon but important reason as well.

DUNBAR retinal granuloma

A retinal granuloma in a patient infected with the Toxocara nematode.

 

Thanks for reading 🙂

 

Dr. Meers

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The Photic Maculopathies

In the August 2017 blog post I spoke about a safe way to view the solar eclipse that took place. The biggest reason for viewing the eclipse in this way was to avoid any risk of permanent vision loss. I’m happy to say that the response I received from my patients was very positive – A lot of people appreciated my post because several did not know the eclipse was even taking place until 24-48 hours ahead of time so purchasing glasses on amazon was not an option and paying $10 or more for eclipse glasses just did not make sense.

That the afternoon after the eclipse into this month I received several calls to evaluate adults and children to check for damage following the eclipse.  After careful examination, exactly zero patients suffered from this condition! Unfortunately in this same time frame I did examine one young patient who was suffering from poor vision in one eye. After two exams, some testing and some discussion we determined that the vision loss was the result of this youngster using a laser pointer and a mirror to shine the laser into their own eye. To this end, I’d like to devote this blog post discussing the damage that can occur from viewing an eclipse without proper eyewear, prolonged sungazing and inappropriate use of laser pointers since all of these conditions are the result of similar processes and all can be easily avoided.

The retina is a delicate tissue, it is closely related to what makes up nerve and brain tissue. This tissue does not regenerate – meaning once it is damaged it cannot repair itself effectively. Usually once the retina suffers damage the damage cannot be undone. In the Photic Maculopathies (resulting from eclipse gazing, sungazing, misuse of laser pointers, etc) this damage results when visible light (usually on the blue end of the spectrum) kicks off a chemical cascade resulting in permanent retinal damage and injury. Laser pointers usually are a red diode close to a wavelenght of 650 nanometers.  The damage is permanent.

The following photos are courtesy of Mark Dunbar OD, FAAO. A colleague of mine who I worked with at the University of Miami Medical School. The Bascom Palmer Eye Institute is part of the University of Miami, it is world renowned and has been consistently rated as one of the top eye hospitals in the nation. While at Bascom Palmer I was in charge of the Optometry Student Training Program. This program hosted between 12-14 Doctors in Training. At the time I held clinical faculty appointments at 5-6 Doctorate level Optometry Schools around the country including the University of California at Berkeley, the University of Indiana and my alma mater The New England College of Optometry.

 

 

The reddish/orange photos represent photos of the retina- the delicate tissue in the back of the eye.  When you look at a person’s face, written words or need to see things in fine detail you are using a portion of the retina called the macula.  In the color photos, the macula is in the center of each picture.  It’s a brownish spot in the center of each photo…in the middle of THAT area, if you look closely you can see a reddish spot with some yellow dots- that is a sign of solar maculopathy that spot is where the damaged, dead retina is – this patient developed decreased vision after prolonged staring at the sun.  As time goes on, the lesion can take on a brick red coloration.

The black and white photos represent an “OCT” an optical coherence tomograph. This is a “sorta retinal CT Scan” giving us a non-invasive way to look at the retina and it’s layers in cross section.  In these photos an optometrist is able to see the retinal damage that has occurred and at what layer this occured, allowing us to make the diagnosis.

As I mentioned earlier the unfortunate part is that this damage and associated vision loss is permanent.  This damage can occur from mis-use of laser pointers, prolonged sun-gazing and unprotected eclipse viewing.  The macula is the same area impacted when one develops age related macular degeration (AMD or ARMD) possibly some readers have parents suffering from this condition?  For now, Macular degeneration cannot be cured but the damage can be mitigated.

Future blog posts intend to talk about AMD, the latest treatments and possible nutrients that can help slow the progression of this disease. Stay tuned.

Thank you for reading, if you need to make an appointment regarding macular degeneration, other vision problems or any reason- I can be contacted here.

Dr. Meers

 

You can see (but not look at) the 2017 American eclipse.

By now everyone knows there is going to be an eclipse on August 21, 2017.  While the Tacoma area is not on the path of totality-we are still going to get a good view. The last time a solar eclipse crossed the entire continental US was June 8th 1918.

*What is a solar eclipse? Why should I care?

A solar eclipse occurs when the moon (that travels around the Earth) comes between the Earth (us) and the Sun (the big star that the Earth travels around). For a short while, in certain parts of the earth a HUGE shadow is cast on the Earth’s surface (moment of totality).  During this time the corona of the sun will be visible – this and other phenomena are reported to be an extraordinary sight – to the point that “eclipse chasers” travel around the world to view solar eclipses.

*But don’t look at the eclipse!

So I just told you how rare and cool a solar eclipse is but then I also told you not to look at it – why?  The sun is a star and stars are essentially the largest, most continuous, most violent thermonuclear explosions known in the universe.  So they are kind of a big deal.  On a normal day if you look at the sun it’s so bright that you naturally try to squint or evert your eyes. During an eclipse it is darker than normal so you do not have this natural tendency to shield your eyes from the sun…BUT the harmful UV rays are still present. These UV rays travel into your eyes and land on the Retina, the delicate neural tissue that lines the inside of our eyes. Common sense would lead us to believe that the damage occurs from “burning” the retina but the damage is actually created by a chemical cascade triggered by the solar rays  and you are left with permanent, irreversible vision loss.  The area of the retina that is destroyed (the Macula) is the region of the Retina devoted to your sharpest vision (like recognizing faces or seeing fine detail).  This is why older patients we see at Cascade Pacific Eyecare who have Macular Degeneration (ARMD) are so debilitated –  in ARMD the macula essentially disintegrates if treatment is not initiated.  Once this vision is gone, nothing can be done (as of 2017) to bring it back.

*So how do I see the Eclipse?

It’s 2017 – not 1918 so the answer to many questions is “Google it”, “Watch it on youtube” or “order it on Amazon” but there have been some reports of misinformation on the internet and phony eclipse glasses being sold on Amazon.  Plus there are people that are reading this post either Sunday night August 20th or early Monday morning August 21st. Remember even the bestest, priciest, most polarizedest sunglasses are NOT enough protection.

I think the answer is to make a pinhole camera like they did in 1918. Just this time with updated, readily available 2017 equipment.  My assistant and I  used 2 paper plates.  One plate is the “projector” the other plate serves as the “screen”. The greater the distance you have between the projector and the screen the larger an image of the eclipse you will have.

STEP 1) You need 2 PaperPlates, Tin Foil, A pin, Tape and Scissors.

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STEP 2)  Cut a hole in 1 plate

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STEP 3) Tape a piece of tin foil over that hole.

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STEP 4)  Use the pin to make a pinhole in the tinfoil.

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STEP 5) Go outside, put the other plate (the screen) on the ground.

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STEP 6) Point the “projector plate” in your hand towards the sun, an image of the sun will be transmitted through the pinhole onto the “screen plate” on the ground.

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Just look at the image on the screen and not the sun and you will protect your eyes and vision.  Since you are outside you will experience all the cool natural phenomena associated with an eclipse – not to mention you just did a simple craft with your kids and shared a rare experience that will last a lifetime.

Unfortunately – with every solar eclipse there is an uptick in Solar Maculopathy.  My next post will discuss this condition…If after the eclipse you or a family member feel you may have diminished vision due to the eclipse please schedule an appointment for an evaluation with us at Tacoma Eye.  (Unfortunately there is no treatment for Solar Maculopathy but we can schedule you on a next available basis for an evaluation).

Thanks for reading and thanks to my assistant.

 

Dr. Meers

1st blog post

Welcome!

This blog is intended to provide you with evidence based information so you can make informed decisions about your eye health.  I also hope this website will help readers understand the relationship between ocular health and overall health.

If you would like more information about my practice in Tacoma, WA please click this link:

Thanks,

Dr. Meers

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