Fort Collins Eye Doctors-Dr Kisling | Your Eye Health Is Our Number One Concern

Eye Doctors Report Macular Degeneration And Other Eye Disease Are Rapidly Increasing

According to the National Eye Insitute,  a study that was conducted by the Eye Disease Prevalence Research Group found the graying of America is asssociated with vision loss becoming a major public health issue in the next 10 years. The number of people over the age of 40 who suffer vision loss or blindness is expected to be as follows:

• Macular Degeneration: Currently 1.8 million people, by 2020 2.9 million              (62% Increase)
• Glaucoma: Currently: 2.2 million people, by 2020 3.3 million (66% Increase)
• Vision Loss From Diabetes: Currently 4.1 million people, by 2020 7.2 million    (56% Increase)

In Fort Collins Optometry Finds The Same Problems Seen Nationally- But At A Lower Rate Due To Our Younger Eye Demographics

Eye Doctors Reported Some Further Vision Loss Statistics:

• Nationally, people 80 or more years old comprise 8% of the total population but have such a higher incidence of serious eye disease that their age bracket contains almost 70% of the cases of blindness
• Over 10% of eyesight cases have significant vision loss from macular degeneration
• Eye researchers found the prevalence of glaucoma is about three times higher in African Americans, and is also the leading cause of blindness in Hispanics
• About 8% of people with diabetes over the age of 40 have some eye condition that puts them at substancial risk for sight loss.

Fort Collins Eye Doctors Find A Higher Risk For Vision Loss And  Macular Degeneration Due To Our Increased UV Exposure From The Mountain Altitudes In Northern Colorado

Practicing Optometry n Fort Collins I see an increase in the number of  patients with macular degeneration every year. There is less filtering of ultraviolet radiation when people with active lifestyles  spend time in the mountains of Northern Colorado. Optomerist reccomendations include quality sunwear, hats with brows, and spending more time outdoors before 11:00  AM and after 3:00 PM to avoid the intense UV of the midday.

Schedule Your Optometrist Visit Today-Annual Eye Exams Become More Important With Age

This research highlights the fact that many cases of sight loss can be prevented by early detecion and treatment. Nutritional supplements and new injectable drugs can often slow the progerssion of vision loss from macular degeneration. Glaucoma is more treatable than ever before, with stepped choices of multiple medication, laser surgery, and filtering surgery to drain fluid slowly from the eyes. A large number of cases of diabetes eye problems can be prevented by early lifestyle interventions, and well regulated blood sugar can delay the onset of eye problems. After 40, annual eye exams should become routine, and by age 65 seeing your eye doctor annually is essential to insure you have healthy eyes and good vision for a lifetime.

Fort Collins Eye Doctors-Dr Kisling | Your Eye Health Is Our Number One Concern

Northern Colorado Fort Collins Region Sees Rise In Macular Degeneration

March 10, 2005

Recent studies by four groups of investigators have uncovered a gene that seems to have a strong association with macular degeneration. Age related macular degeneration is very important in Northern Colorado due to the aging of the population and the high amount of outdoors activities we play at. Unfortunately, these activities increase our exposure to UV radiation from the sun which is a contributing  factor in macular degeneration.  Better understanding the genetic contributions to age related  macualar degeneration by optometrists in Fort Collins and similar environments may lead to preventative treatments in the future.  Investigators have identified a gene that is “strongly associated” with a person’s risk for developing age-related macular degeneration (AMD). The finding was made by four independent teams, which include researchers with the National Eye Institute (NEI) and the National Cancer Institute, components of the National Institutes of Health (NIH), and other leading research centers. Detecting an AMD-associated gene may lead to early detection and new strategies for prevention and treatment for the debilitating eye disease. Papers from three independent teams appear in the April 15 issue of the journal Science, with a fourth paper published in the May 3 issue of the Proceedings of the National Academy of Sciences (PNAS).

AMD is a disease well known by Doctors of Optometry, and it blurs or destroys sharp, central vision and is the leading cause of blindness in people over age 60. There is no known cure for AMD but routine eye exams by your eye doctor may help intervention for early treatment. Most scientists think the cause lies in a complex interplay of hereditary and environmental factors. Family history of AMD is a risk factor for the disease. In recent years, researchers have been applying several genome-derived experimental approaches to find AMD-associated genes. The new studies provide the strongest evidence yet of a role for common genetic variants in the development of AMD.

“The four studies are a significant step in AMD research. They confirm a strong genetic component of AMD, which may allow scientists to develop tests for the disease before symptoms begin to appear and when therapies might help slow its progress,” said Paul A. Sieving, M.D., Ph.D., director of the National Eye Institute.

Our Fort Collins Optometry Office Provides You WIth The Following Actions You Can Take Now To Lesson Your Risk From Macualr Degeneration:

• Consider fully protective UV sunglasses as a necessity for being outdoors-lenses should also protect into the blue visible light range which means avoid blue lenses.
• Sunglasses from the gas station may allow the eye pupils to dilate without providing UV protection-rely on optical quality sunwear
• In ou Ft Collins Eye Doctors Office we often recommend transitions lenses that lighten inside and darken outside. They have inherent UV protection. Since transition lenses don’t fully activate behind a car window shield,  adding a magnetic clip on provides great relief and safe vision for driving home or to work facing the sun.  The morning sun reflecting off snow or bodies of water in Northern Colorado can be blinding and dangerous without this added protection. On a good note, the transitions lenses don’t fully activate behind a car window shield because a significant of UV radiation is stopped by a regular automobile window, it’s the glare and eyestrain that overwhelms your capacity to see at dawn and dusk.
• Sunglasses that wrap around the side of the face can lower the UV exposure by another 30-40%
• Hats worn outside will make a marked reduction in the amount of UV and blue visible light that can reach the eyes
• Talk to your optometrist about nutritional supplements for macular degeneration. Science supports using certain supplements at certain points in the disease stage to slow down changes and loss of vision.  As someone who spends lots of time outdoors, and as an optometrist in Fort Collins, I frequently use supplements in a different manner to try and prevent or delay the onset of macular degeneration. The jury is out on the effects, but it was not too long ago that the same could be said of the accepted uses and type of supplements being prescribed by eye doctors today that have been found to be effective.
• If you are fair skinned and have blue eyes, double your precautions. Blue eyes have very little pigment and allow much more UV to pas through to potentially damage the retina.
• Stop Smoking. Probably the best preventive measure you can take.
• Eat a healthy diet and exercise well.  A healthy cardiovascular system is essential in preventing macular degeneration.

When Eye Doctors fully understand the genetics dehind macualar degeneration, interventions combined with healthy lifestlye choices may make ARMD Blindness a thing of the past!

Make Sure Your Eyes See as Well as  They Can and Stay Healthy! Contact Fort Collins Eye Doctors-Dr Kisling For A Complete Eye Health Wellness Exam!

Call Dr Kisling at:(970) 226-0959

Macular Degeneration In Northern Colorado

Age-related macular degeneration (AMD) is a disease associated with aging that gradually destroys sharp, central vision. Central vision is needed for seeing objects clearly and for common daily tasks such as reading and driving. Due to the higher altitude a high numbers of sunny days in Fort Collins, there is more UV exposure which is a risk factor for macular degeneration.

AMD affects the macula, the part of the eye that allows you to see fine detail. AMD causes no pain. In some cases, AMD advances so slowly that people notice little change in their vision. In others, the disease progresses faster and may lead to a loss of vision in both eyes. AMD is a leading cause of vision loss in Americans 60 years of age and older. AMD occurs in two forms: wet and dry.

Where is the macula?

The macula is located in the center of the retina, the light-sensitive tissue at the back of the eye. The retina instantly converts light, or an image, into electrical impulses. The retina then sends these impulses, or nerve signals to the visual cortex region of the brain.

Wet AMD occurs when abnormal blood vessels behind the retina start to grow under the macula. These new blood vessels tend to be very fragile and often leak blood and fluid. The blood and fluid raise the macula from its normal place at the back of the eye. Damage to the macula occurs rapidly.

With wet AMD, loss of central vision can occur quickly. Wet AMD is also known as advanced AMD. It does not have stages like dry AMD.

An early symptom of wet AMD is that straight lines appear wavy. If you notice this condition or other changes to your vision, contact your eye care professional at once. You need a comprehensive dilated eye exam.

Dry AMD occurs when the light-sensitive cells in the macula slowly break down, gradually blurring central vision in the affected eye. As dry AMD gets worse, you may see a blurred spot in the center of your vision. Over time, as less of the macula functions, central vision is gradually lost in the affected eye.

The most common symptom of dry AMD is slightly blurred vision. You may have difficulty recognizing faces. You may need more light for reading and other tasks. Dry AMD generally affects both eyes, but vision can be lost in one eye while the other eye seems unaffected.

One of the most common early signs of dry AMD is drusen

Drusen are yellow deposits under the retina. They often are found in people over age 60. Your eye care professional can detect drusen during a comprehensive dilated eye exam. Drusen alone do not usually cause vision loss. In fact, scientists are unclear about the connection between drusen and AMD. They do know that an increase in the size or number of drusen raises a person’s risk of developing either advanced dry AMD or wet AMD. These changes can cause serious vision loss.

Dry AMD has three stages, all of which may occur in one or both eyes:

1. Early AMD. People with early AMD have either several small drusen or a few medium-sized drusen. At this stage, there are no symptoms and no vision loss.
2. Intermediate AMD. People with intermediate AMD have either many medium-sized drusen or one or more large drusen. Some people see a blurred spot in the center of their vision. More light may be needed for reading and other tasks.
3. Advanced Dry AMD. In addition to drusen, people with advanced dry AMD have a breakdown of light-sensitive cells and supporting tissue in the central retinal area. This breakdown can cause a blurred spot in the center of your vision. Over time, the blurred spot may get bigger and darker, taking more of your central vision. You may have difficulty reading or recognizing faces until they are very close to you.

If you have vision loss from dry AMD in one eye only, you may not notice any changes in your overall vision. With the other eye seeing clearly, you still can drive, read, and see fine details. You may notice changes in your vision only if AMD affects both eyes. If blurriness occurs in your vision, see an eye care professional for a comprehensive dilated eye exam.

Ninety percent of all people with AMD have this type. Scientists are still not sure what causes dry AMD.

Frequently Asked Questions about wet and dry macular degeneration

Which is more common-the dry form or the wet form?

The dry form is much more common. More than 85 percent of all people with intermediate and advanced AMD combined have the dry form.

However, if only advanced AMD is considered, about two-thirds of patients have the wet form. Because almost all vision loss comes from advanced AMD, the wet form leads to significantly more vision loss than the dry form.

Can the dry form turn into the wet form?

Yes. All people who have the wet form had the dry form first.

The dry form can advance and cause vision loss without turning into the wet form. The dry form also can suddenly turn into the wet form, even during early stage AMD. There is no way to tell if or when the dry form will turn into the wet form.

The dry form has early and intermediate stages. Does the wet form have similar stages?

No. The wet form is considered advanced AMD.

Can advanced AMD be either the dry form or the wet form?

Yes. Both the wet form and the advanced dry form are considered advanced AMD. Vision loss occurs with either form. In most cases, only advanced AMD can cause vision loss.

People who have advanced AMD in one eye are at especially high risk of developing advanced AMD in the other eye.

Causes and Risk Factors-Who is at risk for AMD?

The greatest risk factor is age. Although AMD may occur during middle age, studies show that people over age 60 are clearly at greater risk than other age groups. For instance, a large study found that people in middle-age have about a 2 percent risk of getting AMD, but this risk increased to nearly 30 percent in those over age 75.

Other risk factors include:

• Smoking. Smoking may increase the risk of AMD.
• Obesity. Research studies suggest a link between obesity and the progression of early and intermediate stage AMD to advanced AMD.
• Race. Whites are much more likely to lose vision from AMD than African Americans.
• Family history. Those with immediate family members who have AMD are at a higher risk of developing the disease.
• Gender. Women appear to be at greater risk than men.

Can my lifestyle make a difference?

Your lifestyle can play a role in reducing your risk of developing AMD.

• Eat a healthy diet high in green leafy vegetables and fish.
• Don’t smoke.
• Maintain normal blood pressure.
• Watch your weight.
• Exercise.

Symptoms and Detection

What are the symptoms?

Both dry and wet AMD cause no pain.

For dry AMD: the most common early sign is blurred vision. As fewer cells in the macula are able to function, people will see details less clearly in front of them, such as faces or words in a book. Often this blurred vision will go away in brighter light. If the loss of these light-sensing cells becomes great, people may see a small–but growing–blind spot in the middle of their field of vision.

For wet AMD: the classic early symptom is that straight lines appear crooked. This results when fluid from the leaking blood vessels gathers and lifts the macula, distorting vision. A small blind spot may also appear in wet AMD, resulting in loss of one’s central vision.

How is AMD detected?

Your eye care professional may suspect AMD if you are over age 60 and have had recent changes in your central vision. To look for signs of the disease, he or she will use eye drops to dilate, or enlarge, your pupils. Dilating the pupils allows your eye care professional to view the back of the eye better.

AMD is detected during a comprehensive eye exam that includes:

1. Visual acuity test. This eye chart test measures how well you see at various distances.
2. Dilated eye exam. Drops are placed in your eyes to widen, or dilate, the pupils. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of AMD and other eye problems. After the exam, your close-up vision may remain blurred for several hours.
3. Tonometry. An instrument measures the pressure inside the eye. Numbing drops may be applied to your eye for this test.

Your eye care professional also may do other tests to learn more about the structure and health of your eye.

During an eye exam, you may be asked to look at an Amsler grid. The pattern of the grid resembles a checkerboard. You will cover one eye and stare at a black dot in the center of the grid. While staring at the dot, you may notice that the straight lines in the pattern appear wavy. You may notice that some of the lines are missing. These may be signs of AMD.

If your eye care professional believes you need treatment for wet AMD, he or she may suggest a fluorescein angiogram. In this test, a special dye is injected into your arm. Pictures are taken as the dye passes through the blood vessels in your retina. The test allows your eye care professional to identify any leaking blood vessels and recommend treatment.

How is wet AMD treated?

Wet AMD can be treated with laser surgery, photodynamic therapy, and injections into the eye. None of these treatments is a cure for wet AMD. The disease and loss of vision may progress despite treatment.

1. Laser surgery. This procedure uses a laser to destroy the fragile, leaky blood vessels. A high energy beam of light is aimed directly onto the new blood vessels and destroys them, preventing further loss of vision. However, laser treatment may also destroy some surrounding healthy tissue and some vision. Only a small percentage of people with wet AMD can be treated with laser surgery. Laser surgery is more effective if the leaky blood vessels have developed away from the fovea, the central part of the macula. (See illustration at the beginning of this document.) Laser surgery is performed in a doctor’s office or eye clinic.The risk of new blood vessels developing after laser treatment is high. Repeated treatments may be necessary. In some cases, vision loss may progress despite repeated treatments.
2. Photodynamic therapy. A drug called verteporfin is injected into your arm. It travels throughout the body, including the new blood vessels in your eye. The drug tends to “stick” to the surface of new blood vessels. Next, a light is shined into your eye for about 90 seconds. The light activates the drug. The activated drug destroys the new blood vessels and leads to a slower rate of vision decline. Unlike laser surgery, this drug does not destroy surrounding healthy tissue. Because the drug is activated by light, you must avoid exposing your skin or eyes to direct sunlight or bright indoor light for five days after treatment.Photodynamic therapy is relatively painless. It takes about 20 minutes and can be performed in a doctor’s office.

   Photodynamic therapy slows the rate of vision loss. It does not stop vision loss or restore vision in eyes already damaged by advanced AMD. Treatment results often are temporary. You may need to be treated again.

3. Injections. Wet AMD can now be treated with new drugs that are injected into the eye (anti-VEGF therapy). Abnormally high levels of a specific growth factor occur in eyes with wet AMD and promote the growth of abnormal new blood vessels. This drug treatment blocks the effects of the growth factor.You will need multiple injections that may be given as often as monthly. The eye is numbed before each injection. After the injection, you will remain in the doctor’s office for a while and your eye will be monitored. This drug treatment can help slow down vision loss from AMD and in some cases improve sight.

How is dry AMD treated?

Once dry AMD reaches the advanced stage, no form of treatment can prevent vision loss. However, treatment can delay and possibly prevent intermediate AMD from progressing to the advanced stage, in which vision loss occurs.

The National Eye Institute’s Age Related Eye Disease Study found that taking a specific high-dose formulation of antioxidants and zinc significantly reduces the risk of advanced AMD and its associated vision loss. Slowing AMD’s progression from the intermediate stage to the advanced stage will save the vision of many people.

Age-Related Eye Disease Study (AREDS)

What is the dosage of the AREDS formulation?
The specific daily amounts of antioxidants and zinc used by the study researchers were 500 milligrams of vitamin C, 400 International Units of vitamin E, 15 milligrams of beta-carotene (often labeled as equivalent to 25,000 International Units of vitamin A), 80 milligrams of zinc as zinc oxide, and two milligrams of copper as cupric oxide. Copper was added to the AREDS formulation containing zinc to prevent copper deficiency anemia, a condition associated with high levels of zinc intake. New studies are underway to test refinements of the supplements being used, with omeag-3 oils being one of the possible future additions.

Who should take the AREDS formulation?

People who are at high risk for developing advanced AMD should consider taking the formulation. Vitamin A may be contra-indicted in smokers and an A free supplement form may be recommended by your optometrist. You are at high risk for developing advanced AMD if you have either:

1. Intermediate AMD in one or both eyes.

OR

2. Advanced AMD (dry or wet) in one eye but not the other eye.

Your eye care professional can tell you if you have AMD, its stage, and your risk for developing the advanced form.

The AREDS formulation is not a cure for AMD. It will usually not restore vision already lost from the disease. However, it may delay the onset of advanced AMD. It may help people who are at high risk for developing advanced AMD keep their vision.

Can people with early stage AMD take the AREDS formulation to help prevent the disease from progressing to the intermediate stage?

There is no apparent need for those diagnosed with early stage AMD to take the AREDS formulation. However, you should discuss the possibilty with your optometrist. Some eye doctors are recommending supplementation if there is a strong family history present. The study did not find that the formulation provided a benefit to those with early stage AMD. If you have early stage AMD, a comprehensive dilated eye exam every year can help determine if the disease is progressing. You should discuss taking supplements at the early stage AMD and if it progresses to the intermediate stage.f antioxidants and zinc as the AREDS formulation?
No. The high levels of vitamins and minerals are difficult to achieve from diet alone. However, previous studies have suggested that people who have diets rich in green leafy vegetables have a lower risk of developing AMD.

Can a daily multivitamin alone provide the same high levels of antioxidants and zinc as the AREDS formulation?
No. The formulation’s levels of antioxidants and zinc are considerably higher than the amounts in any daily multivitamin.

If you are already taking daily multivitamins and your doctor suggests you take the high-dose AREDS formulation, be sure to review all your vitamin supplements with your doctor before you begin. Because multivitamins contain many important vitamins not found in the AREDS formulation, you may want to take a multivitamin along with the AREDS formulation. For example, people with osteoporosis need to be particularly concerned about taking vitamin D, which is not in the AREDS formulation.

How can I take care of my vision now that I have AMD?

Dry AMD. If you have dry AMD, you should have a comprehensive dilated eye exam at least once a year. Your eye care professional can monitor your condition and check for other eye diseases. Also, if you have intermediate AMD in one or both eyes, or advanced AMD in one eye only, your doctor may suggest that you take the AREDS formulation containing the high levels of antioxidants and zinc.

Because dry AMD can turn into wet AMD at any time, you should get an Amsler grid from your eye care professional. Use the grid every day to evaluate your vision for signs of wet AMD. This quick test works best for people who still have good central vision. Check each eye separately. Cover one eye and look at the grid. Then cover your other eye and look at the grid. If you detect any changes in the appearance of this grid or in your everyday vision while reading the newspaper or watching television, get a comprehensive dilated eye exam.

Wet AMD. If you have wet AMD and your doctor advises treatment, do not wait. After laser surgery or photodynamic therapy, you will need frequent eye exams to detect any recurrence of leaking blood vessels. Studies show that people who smoke have a greater risk of recurrence than those who don’t. In addition, check your vision at home with the Amsler grid. If you detect any changes, schedule an eye exam immediately.

What can I do if I have already lost some vision from AMD?

If you have lost some sight from AMD, don’t be afraid to use your eyes for reading, watching TV, and other routine activities. Normal use of your eyes will not cause further damage to your vision.

If you have lost some sight from AMD, ask your eye care professional about low vision services and devices that may help you make the most of your remaining vision. Certain eyeglass lens tints have been benficial for some patients.

The National Eye Institute is conducting and supporting a number of studies to learn more about AMD. For example, scientists are:

• Studying the possibility of transplanting healthy cells into a diseased retina.
• Evaluating families with a history of AMD to understand genetic and hereditary factors that may cause the disease.
• Looking at certain anti-inflammatory treatments for the wet form of AMD.

This research should provide better ways to detect, treat, and prevent vision loss in people with AMD.

Optometrists are receiving more

calls and questions about

Marijuana and the treatment of

eye diseases

Medical Marijuana Fails full disclosure and eye doctors must work to provide clear education about what is known at this point.

Reports circulating the last few years indicate that there may be no increases risk of lung cancer associated with smoking marijuana. What they fail to mention is a rapid increase in chronic lung disease. Other studies have been quoted showing a decrease in VEGF (vascular endothelial growth factor) and supposed value in treating macular degeneration. VEGF stimulates new blood vessel growth. Decreasing VEGF would theoretically lower the conversion rate of dry macular degeneration to the more sight threatening wet form.

Unfortunately, the chronic lung disease and damage combined with the blood pressure lowering effect of marijuana will probably prove the reverse and show it accelerates the risk for macular degeneration. Decreased oxygen to the retinal tissues is a primer driver in the transformation of dry macular degeneration to wet macular degeneration.

Isolating the VEGF may someday prove useful in the treatment of macular degeneration by your optometrist, but for today it is still best to stay with the documented nutritional interventions and current VEGF treatments available,  Avastin and Lucentis.

Don’t be timid in asking your optometrist for advice about medical marijuana and eye problems. The facts can potentially save your vision and prevent a lifetime of blindn

Glaucoma Treatment

ess.

Age Related Macular Degeneration

Several exciting new advances are going on in the treatment of macular degeneration. AREDS 2 is a refinement of the original age related eye disease study that showed a significant correlation between certain supplements and a decrease in progression of dry macular degeneration to the more sight threatening wet form.

Eye Doctors to Start New Age Related Eye Disease Study-AREDS-2

AREDS 2 will add and refine the supplements being tested. They will also be tested to see if there is a reduction in the development of cataracts. Omega 3 (fish oils) will be added to the supplements.

Omega-3 Fatty Acids Have Proven Effects on Dry Eye Treatment and are widely used by Optometrists Today. Now they may prove just as beneficial in Macular Degeneration Treatment.

Omega 3 oils contain docosahexaenoic acid (DHA) and decrease the production of inflammatory compounds like prostaglandins and Leukotrienes. They may possibly offer some form of neuroprotection to the cells of the retina and delay cellular death.

Lutein  and zeaxanthin are the major phytopigments.

Phytopigments are pigments found in vegetables like broccoli, spinach, peas and a number of other foods. They are the major components of the pigment found in the macula, the area of retinal tissue effected by macular degeneration. They help prevent damage to the retinal cells from free radicals (oxidative damage) and may also offer some neuroprotective benefits. Beta-carotene, the precursor for vitamin A, may be tested to see if it has any impact on results. While included in the original studies, there have been questions raised about the possibility of beta-carotene increasing the risk of lung cancer in smokers. Smoking is one of the major risk factors that makes people susceptible to developing macular degeneration.

With about 4000 patients to be enrolled, this is an exciting move forward in studying the effects of nutrition and supplementation on eye diseases. The results of the original trial were as good as any major drug used in treating health problems, I expect this trial will only improve those outcomes.

The Optometric Nutrition Society

A Professional Society Whose Time Has Come

Dr.David Kisling of Fort Collins,Colorado has become an active member of The Optometric Nutrition Society.  Lifestyle modification and nutrient intake are proving to play an important role in vision health and eye disease prevention. Several studies have shown a correlation with nutrition and chronic eye disease. This area of study has become a focus of primary vision care doctors.

The purpose of the Optometric Nutrition Society is to:

To promote excellence in the care of optometric patients through nutritional support of eye health and the prevention and control of ocular and systemic disease.
To sponsor professional symposia as well as a website, and to generate materials to educate professionals regarding the role of nutrition in systemic and ocular health.
To provide a collegial atmosphere where health care professionals can exchange ideas and concepts regarding nutritional influences on vision.
Provide a resource pool of clinically relevant refereed studies that support the role of safe nutritional support for the management of ocular and systemic disease.
To monitor and validate claims made by industry regarding the quality and efficacy of nutritional supplements.
To encourage the inclusion of nutrition education in the curricula of optometry schools.

The society closely monitors peer-reviewed published science on nutritional influence on eye health, as well as safety and ethical issues regarding specific micronutrients included in supplements being marketed to vision patients.

For more information contact:

Name:    Dr David Kisling, O.D.
Address 181 West Boardwalk Ste. 201
Fort Collins,CO. 80525
Phone:     (970) 226-0959
Email       info@harmonyeyes.net

Do your child a favor when they visit their optometrist for back to school eye exam this year. Discuss sunwear protection with the eye doctor. Lifetime doses of UV radiation from the sun are associated with nuclear sclerosis. This is a type of cataract where the lens yellows then turns brown similar to plastic left outdoors for a few years. UV exposure has also been implicated as a risk factor for macular degeneration, and recent studies suggest even visible blue light may be damaging.

If you live in an area like Fort Collins at high altitude and snow,  closer to the equator, or spend time around lakes or the ocean, your child’s exposure rate is much higher.

Think of sun protection for the eyes just like sun protection for the skin. No reputable childcare center allows children on outdoor excursions without sunscreen. It should be the same for your child’s eyes. UV (Ultraviolet) protection with sunwear that is tinted or transitions lenses that are clear indoors and darken outdoors are both good options. If you child spends a large amount of time in outdoor activities consider sunglasses that wrap around on the side.  If you Normal eye glasses  may allow 35% of the light in from the side. Gray is the tint that alters color perception the least but brown is popular also.

For non prescription sun wear avoid the cheap $5.00 variety. Look for something with an 100% UV protection. Expect to pay $30 to $40 at minimum for the quality your child deserves. Poor quality sunwear may actually damage your child’s eyes by dilating them and allowing more UV exposure with inadequate protection.

By starting early you are providing preventative care for two of the leading causes of blindness.

The leading causes of blindness in the U.S are diabetic related eye complications, glaucoma, and macular degeneration. Cataracts are generally listed as the number one cause but this is somewhat misleading.

Cataracts effect in excess of 20 million people but most cataracts are treatable with modern surgical techniques and artificial lens implants. The complication rate is low. While some cataracts may be inoperable due to other health problems, most can be successfully removed. Many cases of blindness attributed to cataracts are actually due to preexisting retinal problems such as macular degeneration and advanced glaucoma. If the retina is not healthy to start with, removing the cataract will not restore vision, and the low level of vision categorized as blindness is actually not due to cataracts. The cost of cataract surgery is a barrier to treatment to the uninsured and can account for some of the large numbers of blindness attributed to cataracts.

Next to cataracts, diabetic complications in the eye do result in blindness in over 4 million people. With the current increase in obesity in our culture, especially in youth, this is a serious concern for the future. Most diabetes related blindness is due to changes in the blood vessels in the retina that causes microanuysms, bleeding, proliferation of fragile new blood vessels, and detachments of the retinal tissue. There is a correlation with how many years the diabetes has been present and how well the blood sugar has been controlled. Early treatment of retinal complications is a proven method of greatly lowering the incidence of blindness.

Glaucoma also is responsible for several million cases of blindness. Glaucoma has traditionally been thought of as high pressure in the eye. Today it is gradually becoming viewed as a circulatory problems to the optic nerve and a neurodegenerative disease, where the death of the nerves are a vital part of the disease. This will greatly alter our treatment regimins at some point in the future as we transition to using drugs to protect the nerve health and increase blood circulation.

All three of these conditions are primarily a condition of aging and as the population ages the incidence is increasing. All three are also highly likely to prove amendable to lifestlye and nutritional intervetion at early stages.

Protection of the lens in the eye from UV exposure and enrichment of the diet with food and nutriional supplements containing lutein and zeaxanthin appears to show promise. Eating a diet with a low glycemic index (limiting refined sugars, eating complex carbohydrates like whole grains, and lost of vegetables) also will probably be shown to reduce cataracts. Finally, like the other leading causes of blindness, reducing obesity will reduce cataract fomration. While vitaimin E and C have been shown in recent studies not to reduce cataract formation. I do not beleive this will prove to be true with repeated studies. I do beleive antioxidants will be shown over time to be useful but it may be true in the context of whole foods and balanced diets, not in the form of supplementation.

Macualr degeneration has it’s proven formula manufactured by Bausc & Lomb under the name of Preservision which was shown in the initial Age Related Eye Disease Study (A.R.E.D.S.)  to slow the progression of the mild form of macualr degeneration to the severe form. The supplements in the original formula are:

PRESERVISION
Vitamin A (beta-carotene)
Vitamin C  (ascorbic acid )
Vitamin E (dl-Alpha Tocopheryl Acetate)
zinc oxide
copper cupric oxide

While a studies have shown an increase in lung cancer in smokers taking Vitamin A (beta-carotene) supplements, this is not a clear cut finding and may be proven wrong in the future. Currently supplements are being made both with and without Vitamin A. The exciting new news on the macular degeneration front is Age Related Eye Disease Study 2 -, which is testing the addition of lutein and zeaxanthin. Omega 3 fatty acids are also currently being looked at as a preventative supllements for macualr degeneration. Oxidative damage is presumably a major factor in macualr degeneration but it, like every other disease is usually not a simple one fix all type of propostition. Focusing on lifestlye prevention and nutrition and not late miracle  cures should be a large part of our research expenditures.

It is still incredibly important to remember that many cases of all three of these conditions are due to genetic, environmental,coexisting health conditions, social, and mental health conditions out of our hands; and to place the blame or burden on an individual for their own illness is one of the cruelest and narcissistic attitudes we can take. On the other hand, we are enterning a new era where we can offer new forms of advice and interventions at an early age.

Glaucoma is at an earlier stage where we know less. While we will address individuals supplements and conditions in laters articles, for now a few peices of the clue. Vitamin C  loweres eye pressure in some people due to osmotic pressure.  Ginko may increase blood flow to the optice nerve. Forskolin comes from a plant named Coleus forskohlii and it has been  used to lower intraocular pressure.

You can alter your lifestlye and nutrition and in conjunction with your prevetative eye exams from your family eye doctor thier is a good chance you can expect a lifetime of healthy eyesight. Fortunatly, most vision insurance plans, including Vision Service Plan and Medicare are recognizing the need for annual eye check ups for theses diseases.

As a final note, we feel so strongly about preventing blindness, if you have lost your job the last 12 months and are unisured we will work with you to manage your glaucoama for free for the remaider of the year if we feel we can help your case.

The National Eye Institute does love it’s acronyms. CATT is one of the more recent ones-the comparison of AMD Treatments Trials. Translated that means there is going to be a study on the two drugs already being widely used to treat macular degeneration, one of the top leading causes of blindness.

Lucentis was actually approved by the U.S. Food and Drug Administration  in June of 2006 for the treatment of advanced macular degeneration based on clinical studies. Avastin is a drug similar to Lucentis not approved for use in the eye but it has become the treatment of choice in many offices due to the feeling  that it is more efficacious and requires less frequent injections. This is more than a minor consideration since many people have a high level of fear for injections involving their eye and less frequent injections may translate to much higher compliance with treatment schedules. Lucentis and Avastin are both made by Genentech, Inc.

Macular degeneration is at an epidemic proportion with over 2 million Americans visually compromised. It is unfortunate that the clinical trials are coming after the drug has entered the mainstream, hopefully in the future we can have a voluntary mechanism to help translate off label use of drugs into the first layer of clinical trials when advantages become apparent early on as they have in this case.

Neither drug should be looked at as a miracle cure. Mostly there has been a slowing of progression of the wet form of macular degeneration and a small improvement in vision in about a third of the patients. Time will tell whether there is a real or perceived difference between the two drugs.

Annual preventative eye health check ups with your eye doctor are vital to early detection and treatment of conditions like macular degeneration, glaucoma, and cataracts.

Fascinating information from out for this world on new directions in eyecare from the NEI:

NEI Press Release

NATIONAL INSTITUTES OF HEALTH
National Eye Institute

For Immediate Release Thursday, January 8, 2009

From Outer Space to the Eye Clinic: New Cataract Early Detection Technique
Patients and Astronauts Benefit from NEI-NASA Collaboration

A compact fiber-optic probe developed for the space program has now proven valuable for patients in the clinic as the first non-invasive early detection device for cataracts, the leading cause of vision loss worldwide.

Researchers from the National Eye Institute (NEI), part of the National Institutes of Health, and the National Aeronautics and Space Administration (NASA) collaborated to develop a simple, safe eye test for measuring a protein related to cataract formation. If subtle protein changes can be detected before a cataract develops, people may be able to reduce their cataract risk by making simple lifestyle changes, such as decreasing sun exposure, quitting smoking, stopping certain medications and controlling diabetes.

“By the time the eye’s lens appears cloudy from a cataract, it is too late to reverse or medically treat this process,” said Manuel B. Datiles III, M.D., NEI medical officer and lead author of the clinical study. “This technology can detect the earliest damage to lens proteins, triggering an early warning for cataract formation and blindness.”

The new device is based on a laser light technique called dynamic light scattering (DLS). It was initially developed to analyze the growth of protein crystals in a zero-gravity space environment. NASA’s Rafat R. Ansari, Ph.D., senior scientist at the John H. Glenn Research Center and co-author of the study, brought the technology’s possible clinical applications to the attention of NEI vision researchers when he learned that his father’s cataracts were caused by changes in lens proteins.

Several proteins are involved in cataract formation, but one known as alpha-crystallin serves as the eye’s own anti-cataract molecule. Alpha-crystallin binds to other proteins when they become damaged, thus preventing them from bunching together to form a cataract. However, humans are born with a fixed amount of alpha-crystallin, so if the supply becomes depleted due to radiation exposure, smoking, diabetes or other causes, a cataract can result.

“We have shown that this non-invasive technology that was developed for the space program can now be used to look at the early signs of protein damage due to oxidative stress, a key process involved in many medical conditions, including age-related cataract and diabetes, as well as neurodegenerative diseases such as Alzheimer’s and Parkinson’s,” said NASA’s Dr. Ansari. “By understanding the role of protein changes in cataract formation, we can use the lens not just to look at eye disease, but also as a window into the whole body.”

The recent NEI-NASA clinical trial, reported in the December 2008 Archives of Ophthalmology, looked at 380 eyes of people aged 7 to 86 who had lenses ranging from clear to severe cloudiness from cataract. Researchers used the DLS device to shine a low-power laser light through the lenses. They had previously determined alpha-crystallin’s light-scattering ability, which was then used to detect and measure the amount of alpha-crystallin in the lenses.

They found that as cloudiness increased, alpha-crystallin in the lenses decreased. Alpha-crystallin amounts also decreased as the participants’ ages increased, even when the lenses were still transparent. These age-related, pre-cataract changes would remain undetected by currently available imaging tools.

“This research is a prime example of two government agencies sharing scientific information for the benefit of the American people,” said NEI director Paul A. Sieving, M.D., Ph.D. “At an individual level, this device could be used to study the effectiveness of anti-cataract therapies or the tendency of certain medications to cause cataract formation.”

The DLS technique will now assist vision scientists in looking at long-term lens changes due to aging, smoking, diabetes, LASIK surgery, eye drops for treating glaucoma, and surgical removal of the vitreous gel within the eye, a procedure known to cause cataracts within six months to one year. It may also help in the early diagnosis of Alzheimer’s disease, in which an abnormal protein may be found in the lens. In addition, NASA researchers will continue to use the device to look at the impact of long-term space travel on the visual system.

“During a three year mission to Mars, astronauts will experience increased exposure to space radiation that can cause cataracts and other problems,” Dr. Ansari explained. “In the absence of proper countermeasures, this may pose a risk for NASA. This technology could help us understand the mechanism for cataract formation so we can work to develop effective countermeasures to mitigate the risk and prevent it in astronauts.”