Macular Degeneration: Do supplements help?

richard leung_kings college hospitalAs the open enrollment period for Medicare advantage plans just came to a close, I have seen a big group of seniors start to take advantage of their new vision insurance. With the uptick in senior patients also came a sizable group of patients with Age-Related Macular Degeneration (ARMD), the leading cause of vision loss in persons older than 65 years old. ARMD is a debilitating disease which is divided into two subtypes, wet (10% of patients) and dry (90% of patients). Macular degeneration robs the patient of their central vision. Although wet macular degeneration is often more devastating, treatments have been developed to combat the primary cause – and statistically speaking, more patients will suffer from the dry variety.

Until 2001 there was no scientifically proven method to slow the progression of the dry ARMD. A study called AREDs proved that a specific vitamin formula could reduce a patient’s risk of conversion from moderate to severe dry macular degeneration by 25% over 5 years. With this study and its recently completed follow up study, AREDS 2, pharmaceutical companies began pouring money into the development of products that followed the scientifically proven formula and other products that claimed to “support eye health” but have not been proven in bias-free studies. As usual, if there is money to be made, someone will fill the void.

Many of my patients both with and without macular degeneration ask me if they should take a vitamin for their eyes. While I cannot say that vitamins will not be beneficial to a person’s vision, I do worry that my patients are spending their hard earned money on vitamins that are unproven in their ocular benefit. In fact, a recent study discovered that only 4 out of 11 top products contained the exact formulation recommended in the AREDs studies.

So what is a patient to do? First, if you have macular degeneration make sure you see your optometrist at their recommended intervals and get involved in your treatment by making sure you know the stage of your condition and the type of macular degeneration you have. If you have moderate degeneration or worse, your doctor should provide you with a specific recommendation for an AREDs or AREDs 2 formula supplement. If you do not have macular degeneration or have very mild degenerative changes you may not need vitamin supplements so long as you have a very good diet, exercise regularly, protect your eyes from ultraviolet light and refrain from smoking. I will say that patients who admit to poor diet or have a family member with macular degeneration may be at greater risk and should ask their optometrist about a multivitamin supplement. Additionally, smokers should really try quitting, as smokers have at least a 4x greater risk of macular degeneration. Smokers should also realize that some supplements have vitamin A which can be carcinogenic for them so they should be especially careful about which supplement they take. At the end of the day, being knowledgeable about your condition and seeking a doctor who is proactive will go a long way to keeping your sight.

In this holiday season I wish you all good health and a happy and peaceful 2015.

~ David C. Ardaya, O.D.
California Optometric Association
http://www.coavision.org
http://www.eyehelp.org

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Peek Retina: Technology that could change optometry

Photo courtesy of wired.co.uk/health

Photo courtesy of wired.co.uk/health

Peek stands for Portable Eye Examination Kit. It is comprised of a smartphone app and low-cost adaptor that enables eye examinations anywhere in the world, such as remotely located medical clinics. The adapter that is attached to the smartphone is portable – small enough to fit in a pocket. Peek retina includes both a retina camera function and an ophthalmoscope using the smartphone’s camera. The importance of this technology is to diagnose ocular conditions in the back of the eye such as glaucoma, diabetes and high blood pressure.

Since the adapter works with a smartphone, the images can be saved and shared with specialists located in other regions. The device was created by Dr. Andrew Bastawrous and is funded through Indiegogo. Per Dr. Bastawrous, “Around 39 million people are blind — 80% of this blindness is avoidable, but in many regions people don’t have access to eye care.”

At this time, a pledge of £60 ($95) can be used to purchase the kit or to donate an adapter to a medical worker. Shipping is estimated for October 2015. The kit currently is compatible on a Samsung S3. Also, it does not have FDA approval and cannot be shipped to the U.S.

If Peek retina actually works, this would be incredibly useful technology to provide eye examinations around the world. Of course, the resolution of the retina image must be in focus to provide the most reliable information.

There are a few disappointments, which could change in the future. First, Peek retina is only compatible with Samsung S3. There are many other smartphones out there that will not have the opportunity to use Peek retina. Second, since it does not have FDA approval, those of us in the U.S. are unable to obtain this technology to help people worldwide.

However, this technology is promising and does have the potential to prevent blindness worldwide.

~ Melissa Barnett, OD, FAAO
California Optometric Association
http://www.coavision.org
http://www.eyehelp.org

Laser toys: safe or dangerous?

Photo courtesy of UniverseToday.com

Photo courtesy of UniverseToday.com

Sometimes a child’s most favored toy is not a toy after all. For example, as a baby, my daughter preferred my bundle of keys over the plastic, bright-colored keys I had bought for her. Or nowadays, it seems a child’s favorite toy is his parent’s smartphone.

Laser pointers are especially intriguing to all, both young and old. Some of you may have used it for presentations or have played with one growing up. It’s pretty cool to see how far that laser beam can travel, or whether you can hold your hand steady to prevent the point of light from shaking. And it’s tempting to look directly into the beam of light. How bright is this? [Extremely] Can it really blind me? [Yes] Will my friend notice if I shined this beam directly into their eye? [Don’t even try.]

Last year, reports of permanent vision damage due to high-power laser beams prompted the FDA to issue a consumer alert, “Laser Toys: Not Always Child’s Play” in an effort to inform the public of laser-associated eye risks. Laser lights are a narrow beam of parallel light rays which allow for a focused point of high energy, enough to cut through tissue. The area of the eye most vulnerable to laser light is the retina, the light-sensitive thin layer lining the back of the eye. A high-intensity laser beam can cause a hole in the retina, which in some cases, may not be reparable. If this occurs, one will notice a permanent blind spot in the middle of their vision.

How do we know which lasers are safe? Usually, brief exposure to a laser light will cause temporary vision impairment, however, exposure to higher wavelengths may cause permanent retinal damage. The FDA requires manufacturers to classify laser products. Most lasers used in kids’ toys are labeled Class I which are incapable of damaging the retina, and most laser pointers in the US are labeled as Class II or IIIA, which have enough power to damage the retina.

There are a variety of toys that use lights which look like lasers, such as light sabers, spinning tops with lights, or laser-sights on guns. Most kids’ toys labeled with lasers do not use actual laser beams, rather they use LED lights made to look like laser beams. However, if the manufacturer does not indicate what type of light or what class of laser is used, then it is best to not have your child play with that toy. Unfortunately, many toys are readily available over the internet with questionable safety concerns. If you are purchasing a toy, be sure to check and see if the “laser” in the toy is a real laser beam. If it is, check to see if it is a Class I laser, which cannot damage the eye. If there is no clear indicator or label, it is best to avoid the toy.

Best tips for working with lasers:

  1. Never stare directly into a laser beam
  2. Never point a laser beam at a person
  3. Do not aim the laser at reflective surfaces
  4. Avoid laser products labeled with Class 3b or 4

For further information, check out:

http://www.fda.gov/forconsumers/consumerupdates/ucm363908.htm

http://www.aoa.org/news/inside-optometry/laser-toys-and-pointers-pose-risks-for-childrens-eyes?sso=y

 

~ Cindy P. Wang, OD, FAAO
California Optometric Association
http://www.coavision.org
http://www.eyehelp.org

The story of a color blind child

Color blind

Photo courtesy of Templatemonster.com

It’s that time of year again. Every fall, our local doctors of optometry, along with school nurses and a plethora of volunteers, corral students through our Lions Club’s Sight Savers trailer performing vision screening. And, every fall I have concerned parents rushing in their children to confirm if there is an eye problem. This year was no different.

Last week I entered my exam room to see a first grader who, it was determined, was color blind. Of course, his father did not believe the testing was correct and proceeded to confirm that his son new ALL of his colors and that there was NO WAY he could be color blind. I pulled out my trusty color vision test; administered the test to the son; and showed that indeed he was color deficient. On one page of the test with the number “35”, a color deficient person would only be able to see one digit. The boy proudly and confidently proclaimed that the number on the page was “5”. Even with prodding and cajoling from the father, his son could only see the number “5”.

A little physiology lesson:

In the retina, there are two types of nerves – cones that see color, and rods that see light. The cones are further differentiated in to three types – one that is stimulated by red light, one by green light and one by blue light. In order to have “normal” color vision, all three cones need to be present. If one of the cones is missing, or more commonly not as sensitive, then the person would have confusion of certain colors. This student has a deficient green cone. I explained this condition to the father and the student and how it would affect him.

For instance:

If we have green paint and mix it with red paint, we make brown paint. (Green + Red = Brown)

If you cannot see the green, then red and brown look the same. (Green + Red = Brown)

If we mix green with blue, we make aqua. So, blue and aqua look the same. (Green + Blue = Aqua)

This confusion of colors is what is known as “color blindness” or more correctly “color deficiency”. I explained that it is important to let the teachers know so they do not grade down for improper answers, and discussed job restriction for color deficient people. The two most common job restrictions are law enforcement and commercial aviation. If a color deficient police officer was told a suspect has a brown coat on and stops someone with a red coat on, that just doesn’t work. I do have several patients who are pilots and are color deficient. They are able to get licensed to fly, but not to fly at night due to the need to differentiate the colored lights on airstrips – no commercial or airliner work.

Facts about color deficiencies:

  • The gene for color deficiency is carried on the X chromosome
  • Somewhere between 8 to 10 percent of the male population in the US is color deficient
  • Less than one half percent of the female population in the US is color deficient
  • Men cannot pass color deficiencies on to their sons; it passes through mothers who are carriers for the gene
  • The incidence of color deficiency is highest in Caucasians; then Asians, then Hispanics, and lowest in African Americans
  • Red-Green defects account for over 95 percent of color deficiencies
  • Blue-yellow color blindnessis a dominant, not sex linked trait, which means both men and women are equally affected.
  • John Dalton wrote the first known scientific paper (1794) regarding color blindness. He was color blind himself.
  • Color deficient people hate to be asked “What color is this?”

~ Steven Sage Hider, OD
California Optometric Association
http://www.coavision.org
http://www.eyehelp.org