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.
retinal disease
Incredible images of a normal retina on the left and a damaged retina (tissue lining the back of the eye) courtesy of Robert N. Fariss, Ph.D., chief of the NEI Biological Imaging Core, and Ann H. Milam, Ph.D., former professor in the Department of Ophthalmology at the University of Washington.
Retinitis Pigmentosis is an eye disease that is primarily genetic and causes a slow, progressive loss of vision starting in the periphery and moving in, resulting in tunnel vision. Often eyesight will remain 20/20 until very late in the disease but with the extreme loss of side vision it can be very debilitating. Vitamin A has been used to slow the progression but doses of Vitamin A as low as twice the suggested normal dosage may increase the risk of hip fracture.
Ushers Syndrome, a combination of retinitis pigmentosa and hearing loss is common in Louisiana in the Acadian and Cajun population, French settlers that fled Canada and settled along the bayous of Louisiana. It is very uncommon to see this eye disease in Fort Collins since only a small percentage of cases result from spontaneous mutations.
If you are aware of any loss of peripheral or side vision it is important to schedule an appointment with your optometrist since other eye conditions like pituitary tumors and glaucoma can also create slowly progressive loss of side vision.
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
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.
Eye nutrition is a growing area of knowledge. We know have substantial evidence that omega 3 fatty acids impact dry eyes by normalizing lipid production for the trat film and act as anti inflammatory agents to increase the watery component of the tear fluid. Supplements formulations have been showen to slow the progression of macular degeneration and are currently undergoing studies to refine the formulations. It is only a matter of time before we will have recommendations for glaucoma and cataracts. Reseach on androgens and dry eyes at menopause will likely yield even more knowledge of natural interventions.
NASA and the National Eye Institute have been working together to develop a non-invasive method to measure very early development of cataracts and monitor any progression. This is important to astronauts receiving higher daily dose of radiation, especially on a long mission such as the future Mars flight, but there are great potential applications for preventing and treating cataracts in the future. The crystalline lens in the eye is composed largely of water but there is a class of proteins present known as alpha-crystallins.
The amount of Alpha-crystallin Proteins in the eye are largely fixed at birth, we don’t produce more. They function to a help the lens maintain it’s refractive index, which allows it to focus light on the retina so we can clearly see images. They also act as so called chaperone’s, dating the bad proteins that breakdown in the lens from oxidative stress. By joining up with theses proteins they prevent cross linking between large numbers of damaged proteins and other damaged cellular substances that can develop into large clumps and form opacities in the lens. These capacities can develop large enough in size that they start to interfere with your eyesight and become clinically referred to as cataracts.
The new instrument measures how much Alpha-crystallin Proteins scatter light and can detect their levels and changes over time. Now the potential exists to measure changes in response to environmental factors.
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."
Oxidative Stress is caused by an imbalance between the production of Reactive oxygen species and your bodies capaictiy to neutrlaize them, the reactive intermediates, and repair any resultant cellular damage. Oxidative stress results from UV, radiation, drugs, chemicals,smoking, dietary components and other environmental factors that create oxygen is states where free electrons readily bind to cellular substances, Free radicals are atoms, molecules, or ions with unpaired electrons that also readily bind to proteins, lipids, and the DNA of our cells. When the threshold of repair is passed, and the Alpha-crystallin Proteins become lowered with age to the point where they can’t adequately act as chaperone’s to prevent these damgaed proteins from aggreagting into the clumps, you will likley develop cataracts.
Hopefully we can start to clarify some of the lingering questions and move forward into the arean of cataract prevention and reversal. Antioxidants have held out great hope for cataract prevention and anti-aging in general, but questions have been raised in some recent studies about the capacity of antioxidants to help.There is even a small school of thought that believes low doses of oxidative stress is essential in prolonging life. At this point, the only certainly is Vitamin A is contraindicated in smokers.
I still strongly believe in the value of antioxidants in a preventative role. Some studies have shown lutein and zeathin have reduced the incidence of cataract formation. Extensive studies are underway to test their role in treating macular degeneration. Vitamin C is still on my list as anti-catarogenic. One factor to keep in mind is natural is not always good. St John’s Wort does have some properties that my causes cataracts and sunglasses need to be worn and sunlight limited if you are taking St Johns Wort (commonly used for depression). This does not appear to be a strong causative factor but one to consider and compensate for when working in the sun.
Other lifestyle factors such as smoking, obesity, and eating a high glycemic index (highly refined high sugar,highly refined foods) are controllable risk factors. While I have not see the reasons published, presumably oxidative stress is the common factor. Smoking is know ot decrease antioxidants systemically in your body, the cellular damage from free radicals is obvious in the loss of skin elasticity. Even visible blue light causes oxidative damage in the retina and probably in the lens, Lutien and xeanthin may act as antioxidants in the lens to help prevent cataract development.
We can look forward to a great future in early detection (prior to visible damages) from cataracts and determining what lifestyle, dietary,and potential drugs ans supplements may prevent cataracts at some point in the future.
For now diet,exercise, a healthy body weight, a daily supplement (without the Vitamin A for smokers, added Lutien, Zeanthin, and vitamin C is probably your best bet. And everything you can get from food (such as Lutein from spinach or other foods with high levels is presumably better than a pill.—Add protect your eyes from the UV sunlight with quality sunglasses or UV blocking contact lenses.
The next time you see your Eye Doctor they may just be measuring your alpha-crystallins levels, especially if you signed up for that 3 year cruise to Mars.
Our office is a Proud Participent in Vision Service Plan, and we work with you to maximize your understanding of your vision insurance plans benefits. It is one more way of thankng you for entrusting your eye axam and vision care with us.
Welcome to Dr Kisling-Fort Collins Eye Doctors Choice Website. Our vision is to be the premier resource for answers about your eye symptoms and eye problems. You can use the search box to find answers to questions about your eyes. You will find articles on contact lenses, dry eyes, glaucoma, eye nutrition pinkeye ad other eye diseases.
There is also information about eye examinations, eyeglasses, prescription eye glasses for different conditions;nearsightedness,farsightedness, astigmatism, and presbyopia.
We carry a unique selection of eyeglasses for women, men and children with the latest lens technologies including glare free anti-reflection coatings, no line progressive 5th generation eye glass lens designs, transition sunglasses tints, thin and light hi-index prescription lenses.
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If there is a topic you would like more information on please feel free to leave a request in the comment box. Thank you for visiting our website and we hope we can become your partner in preventative eyecare for a lifetime of healthy eyesight!
Melanocytes are specialized cells that contain the pigment found in our hair skin, eyes, and other area of the body. The eye has melanocytes in the iris, retina, and the choroidal layer under the retina that supplies it with blood. Underneath the retina is a layer of cells referred to as the retinal pigmented epithelium. These cells interact with the photoreceptor cells, the rods and cones that register light you see and turn it into electrical impulses. Melanin is the pigment and it comes in two different forms. In the retina, melanin acts as an antioxidant to help protect the tissue from free radicals that can damage the cellular DNA.
Various detrimental influences can reduce this protective function and may even cause it to accelerate damage from free radicals. Ultraviolet exposure, blue visible light, and high levels of oxidative stress can cause cell damage and increase the rate of cell death. An article by Meyskens FL, Farmer P, Fruehauf JP suggested that this may be a contributory factor in macular degeneration and choroidal melanomas.
Melanocytes also populate our skin where they protect the underlying levels from ultraviolet damage. UV-B exposure is an essential step in producing the active form of vitamin D. Darker skinned intervals have more UV screening and subsequently are more at risk for low levels of vitamin D. When you wear highly protective sunscreen the same effect occurs, lower levels of UV are absorbed by the skin and the proactive form of Vitamin D does not get its needed UV-B exposure to form. It is a very narrow band of UV-B that is needed, not the entire spectrum.
Vitamin D degeneration is related to multiple forms of cancer and other health problems. Macular degeneration may have an association with lowered vitamin D. One possibility is the overall reduction in UVB on the skin from sunscreen, living indoors, and poor dietary habits results in systemic changes in vitamin D levels that precipitates cellular changes in the retina unrelated to the melanin in the eye. Another possibility is lowered systemic levels of vitamin D resulting in decreased melanin production in the retina. This could lead to an overload to the pigmented epithelial cells from oxidative stress and UV exposure inside the eye, degrading the functional capacity of the melanin to protect the retina.
The irony is UV exposure is a risk factor for cataracts and macular degeneration and we are always encouraging eye protection against UV (and rightfully so given today’s evidence). With the known association of skin cancer and UV exposure it is not prudent to drop recommendation for sunscreen and limiting sun exposure.
At some point there will be better answers. For now, some mild daily exposure to UV with eyewear that includes UV protection is something you should discuss with your eye doctor and dermatologist or family physician. Vitamin D supplementation during winter months and in geographic locations that get limited sunlight should also be considered with your healthcare providers. Perhaps sunscreen lotions will be developed that allow the narrow band of UV-B needed to pass through in the future. Many people have vision insurance coverage like Vision Service Plan that provides coverage for eyeglasses. Even if your prescription is minor, having protection against UV and visible blue light is good preventative medicine if you spend time outdoors. And if you spend six months on a submarine or live underground you should examine your options-and maybe see a psychologist!
Reference:
Meyskens FL, Farmer P, Fruehauf JP (June 2001). “Redox regulation in human melanocytes and melanoma”. Pigment cell research / sponsored by the European Society for Pigment Cell Research and the International Pigment Cell Society 14 (3): 148-54. doi:10.1034/j.1600-0749.2001.140303.x. PMID 11434561.
Twitchy eye? Many people become concerned when they start having an eyelid that twitches intermittently or even constantly. This may occur for weeks, months, or even years. Typically it does not occur constantly and has been coming and going for a month or so when the patient finally show up at the eye doctors office concerned they have acquired a serious vision problem. Most of the time after a lengthy eye exam and detailed analysis an accurate diagnosis is made-benign eye twitch. Essentially that means the doctor has no idea what is causing your eye problem but has ruled out serious diseases
Sometimes a cause for eye twitching is found. Anything that causes ongoing low grade irritation of the eye can elicit twitches. An eyelash growing in towards the eye, dry eyes, a foreign body such as small particles of vegetation, insects, metal, etc. can all be provoke twitching eye lids. Some prescription medications and serious medical problems can precipitate eye twitches.
A well kept secret today is there are effective treatments for benign eyelid twitches. Specific types of topical antihistamine prescription eye drops frequently can alleviate the twitch, even though an eye allergy is usually not the cause. Reducing stress may help in many cases. Stress reductions techniques that help can include improving your sleep cycle by eliminating caffeine, relaxation techniques, and looking for areas to reduce the areas of high stress in your life. Cool packs on you eyes for 5-10 minutes several times per day can be tried as a palliative measure. Cold compresses probably reduce the nerve transmissions responsible for the eye twitching. If cool packs don’t work, warm packs sometimes will. Artificial non preserved tears can be used several times per day; they are not harmful and if a dry eye is part of the problem they could provide needed relief. Often a placebo effect can occur with artificial tears and is beneficial even when you are aware that it is a placebo. Medications that can evoke eye twitches include stimulant drugs for attention deficient disorder, medications for Parkinson’s disease, some cold medications, and even asthma inhalers. If the problem is severe you should discuss your medications with your physician.
Some limited studies have shown complimentary alternative medicine may be useful is certain patients. Acupuncture has reportedly helped some people. Most simple eye twitches are probably similar to the twitches you have from time to time in you legs and arms. These are often due to muscle fatigue and electrolyte imbalances. Make sure you are well hydrated and have adequate magnesium, potassium, calcium, and vitamin D in your diet. Some healthy food to add are bananas, raisins, apricots, cantaloupes and leafy green vegetables like spinach. Avocado lovers can benefit also. Gentle stretching of leg muscle spasms has become the accepted standard replacing gentle massaging. You might try the eye equivalent of gentle stretching by slowly closing your eye, pause briefly, then open it slightly larger than normal and pause for a second. Try doing ten repetitions ten time per day.
When eye twitches become severe and spasm the eye closed it can be caused by an over stimulation of the brain center responsible for blinking. This has a genetic predisposition so if you have other family members with similar problems that is significant information you should tell your optometrist. Usually it begins with more frequent blinking and progresses to eye closure spasms. When eyelid twitches become constant and severe, they may keep the eye closed and interfere with vision. Injections of Botox, the face lifting drug, are a tremendous asset in these rare cases. Although many people are frightened by the though of injecting something into their eyelid that is so toxic it is considered a potential terrorist weapon, the doses used resemble homeopathy and are exceedingly safe. It would probably take at least 30 to 40 thousand doses at once to be lethal. Drugs in the same class as valium have had some success in treatment. As a last resort eyelid surgery can be attempted.
Uncontrollable, progressive eye spasms that effect you eye sight need further evaluation for serious underlying neurological diseases. The majority of cases are benign and the initial visit to an eye doctor can help you on the road to recovery.
As we age so do our eyes so it is important to take precautions to avoid certain eye problems. A common eye problem that accompanies aging is macular degeneration. This eye problem is caused by deterioration of the retinal tissues lining the back of the eye. This is a chronic eye disease with a multitude of evolving forms of treatment. It can give a person blurry vision and blind spots, and involves the central area of vision only. Unfortunately, this small area called the macula is vital for all detailed vision functions including reading. Since most of the retina remains healthy magnification aids can often be used to extend reading images onto the remaining healthy tissue. There are two different kinds of macular degeneration, the dry form and the wet form. The dry form of macular degeneration is less sight threatening and precedes development of wet macular degeneration.
Once macular degeneration transforms into the wet variety it can progress rapidly and cause serious vision complications. This can give you visual distortions such as seeing straight lines being crooked or wavy in appearance. You may notice objects looking very small or being farther away then they really are. You may notice loss of your central vision with blurry spots.
Evidence for nutritional intervention in preventing and treating macular degeneration continues to grow. Low dietary intake of the carotenids lutein and zeaxanthin are associated with an increased risk of age-related macular degeneration and may retard the development and progression of macular degeneration. Lutein and zeaxanthin have high levels in Broccoli, corn, squash,peas, and green leafy vegetables like spinach and kale. Foods with a high glycemic index (sugar rich simple carbohydrate foods that raise blood sugar rapidly) also increase the risk of macular degeneration -eating oatmeal may be good for more than just your heart. Vitamin deficiencies of E,D,and C seem to increase the risk of macular degeneration but vitamin A, especially in smokers may increase your risk for macular degeneration. Omega-3 fatty acids found in cold water fish contain docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), and may act in a preventative manner for macular degeneration.Coenzyme Q10 and acetyl-L-carnitine supplementation is a potential early intervention. UV and blue light increase risk for macular degeneration so sunwear should start early for children.
If you have dry macular degeneration you may notice blurriness in the words that you read, less color in certain objects and have a harder time recognizing peoples faces. Your vision may start to seem hazy and you will have the need for brighter light. With both kinds of macular degeneration, it may only effect one of the eyes. Sometimes people don’t realize that they have it with the eye that does not have it making up for the eye that is effected.
Another problem with your eyes as you age is cataracts. Cataracts cloud the eye and are a common type of eye problem. There are three basic types of cataracts that you should be aware of which are nuclear sclerosis, cortical and sub-capsular. The nuclear sclerosis cataract forms throughout the lens as a gradual darkening and discoloration. A sub-capsular cataract is at the back of the lens close to the line of sight and may cause vision loss much faster than other types of cataracts. Cortical cataracts start in the cortex of the lens. If you have a cataract you should not be overly concerned, they can be successfully removed by having outpatient surgery and are one of the most successful surgical procedures done today. Artificial lenses are implanted, often with no stitches involved in an outpatient procedure.
Another eye problem you may encounter as you grow older is called dry eye syndrome. As we age, we do not produce as many tears as before. It is known to cause discomfort and pain and can result in serious vision loss in more extreme cases. Treatment is available with a multitude of options. You do not have to suffer from the chronic burning and stinging that accompanies dry eyes. If should have your eyes dilated every one to two years by your optometrist to check for these eye problems and other diseases that can compromise your vision irreversibly. Prevention is the best gift you can give your family and yourself.
David H. Kisling, O.D., A.B.D.A.
Fort Collins Eye Doctors
Fort Collins Contact Lens
Vision Service Plan Provider
