Can Vitamins Help Prevent Cataracts?

Can Vitamins Help Prevent Cataracts?

One of the most common questions I am asked during an eye exam is “Doc, what can I do to protect my eyes against cataracts?”  My advice has always remained the same, UV protection!  New research from the National Eye Institute may change my tried and true answer.

Data from the Physicians’ Health Study (PHS) II was analyzed by William G. Christen, ScD of Harvard Medical School.  Participants of the study were all middle-aged to older male physicians.  Of these, 11,497 of them were randomly assigned to take a multivitamin, while 14,233 were assigned a daily placebo pill.  None of the study participants had existing cataracts at the start of the study.

The physicians in the study were followed between 1997-2011 and provided information on pill-taking adherence, adverse side-effects, and pre-existing cataract risk factors.  The study participants also reported the occurrence of new cataracts.

After following each male for an average of 11.2 years, there were 1817 cases of cataract formation.  The researchers determined that the participants taking the multivitamin had a 9% lower risk for developing cataracts than the placebo group.

While 9% is a pretty low amount, that 9% may have a large impact.  Cataract surgery is the most commonly performed surgery in North America.  Reducing the amount of cataract extractions by even 9% would greatly reduce the impact it has on our healthcare system.  It could reduce the dollars spent on cataract removal surgeries as well as decrease the wait time for the surgery.

The new data suggests that taking a multivitamin is something we should encourage in more patients.  You're probably doing yourself some good by taking a multivitamin - not likely going to cause any harm - and maybe it will stave off your cataract progression.

If you live long enough, you will get cataracts, they are a product of time.  But there are a few things you can do to slow this process down.  As I mentioned earlier, protect yourself from UV rays with a UV coating or sunglasses.  Don’t smoke.  Eat healthy, and especially eat foods high in antioxidants such as dark green leafy vegetables and berries.  And finally, a multivitamin may be beneficial as well.

Charles Bonnet Syndrome

Charles Bonnet Syndrome

Charles Bonnet was a philosopher of the 18th century.  Circa 1760, Bonnet noted that his grandfather, who was of sound mind and good physical health, had started to experience hallucinations.  The only thing wrong with his grandfather was that his vision had gradually declined over the years due to cataracts.  Bonnet reported that despite not being able to see much, his grandfather could see bird cages, men, women, tapestries, etc with excellent clarity.  In the 1930’s a syndrome was named after Mr. Bonnet to describe a condition in which psychologically sound people with visual loss experience hallucinations.

Charles Bonnet syndrome usually affects elderly people who have had a decline in vision, especially when that decline is due to macular degeneration.  Not all people with a decrease in vision are affected, and it is unclear what determines who will be affected.  People with Charles Bonnet Syndrome know that the images aren’t real, and it can be quite distressing - they will often not tell anyone about what they are experiencing.  Because of this, the prevalence of Charles Bonnet Syndrome is not well known. It is thought to be between 15-50% of people with moderate to severe visual loss.  It’s theorized that a lack of visual stimulation causes the brain to produce it’s own images.  It has been compared to phantom limb symptoms after amputation, a condition in which people report that can still feel their limb even though it’s not there.

People with Charles Bonnet syndrome have reported seeing all sorts of phenomena, including, people, bricks, animals, dream-like colorful animations, and lattice work patterns.  These hallucinations can last only a few seconds or continue for most of the day, and people can experience just one or a few hallucinations repeatedly.  The hallucinations rarely have any personal meaning associated with them and can persist for up to several years.  Usually the brain adapts to the visual loss after about 18 months and the hallucinations will begin to reside.  In the mean time, there are a few ways to cope with the hallucinations as reported by Charles Bonnet peer support groups.  Some of those methods include blinking repeatedly, moving the eyes around in all different directions, turning on a light, looking directly at or looking away from the hallucination, and even yelling or swatting at the hallucination.  It’s been documented that hallucinations can also be stopped completely if the vision is improved. 

Although there is no proven drug you can take to stop CBS hallucinations, some medications for other problems have been successful in helping people, including anti-depressants, drugs for epilepsy, Parkinson's disease, dementia or mental health problems. However these drugs can also have unwanted side effects.  When you experience CBS, often the most effective form of treatment can come from knowing that the condition is due to sight loss and is not a mental health problem or a symptom of another disease.  Being informed about the condition and sharing your experiences with friends or family can also help.

The best way to avoid getting Charles Bonnet Syndrome is to keep your vision crisp with healthy eyes.  A healthy diet, exercise, and lifestyle can help in this regards.  Unfortunately, some eye diseases cannot be influenced by a healthy lifestyle, so early detection via annual comprehensive eye exams is the best way to reduce your risk of vision loss.

Do you ever wake up with crusty, scaly eyelids? Read on...

Blepharitis: The low down on scaly itchy eyelids

Do you ever wake up in the morning with crusty, scaly eyelids? Combined with your bed-head and morning breath, it’s not a pretty picture – but good news, your optometrist may be able to help you treat that “sleep” in your eyes.  You may have a really common condition called blepharitis.  

Other symptoms include flakes and a general redness, puffiness, or scaliness along the base line of your lashes.  You may feel like there is sand in your eyes, or have a general burning or itchy sensation throughout the day.  Blepharitis is also associated with an oily or sticky sensation on your eyes, caused by discharge from the eyelid glands – left untreated these glands can become plugged and infected, which can cause recurrent styes, or dry eye syndrome – not to mention crusted scales and debris on your eyelids. Over the long term, the chronic inflammation can lead to scarring of the eyelids and eyelash problems (loss of eyelashes or eyelashes that grow in the wrong direction).

I know what you’re thinking:  Gross, right?  But not to worry – although blephartis is a chronic condition with no known cure, we have solutions – including a brand new in-office treatment called BlephEx.

Just as your dentist recommends you floss and see the hygienist to prevent gum disease, your optometrist will want you to perform regular maintenance on your eyelids.  He or she will want you to use hot compresses and special lid washes or wipes at home.  If your condition is particularly severe, they may ask you to come in for a more extensive blepharitis treament.  BlephEx is an instrument that spins a medical grade micro-sponge along the edge of your eyelids and lashes, removing debris and exfoliating your eyelids.  It takes less than 15 minutes for the procedure, and it doesn’t hurt a bit, in fact most patients simply report a tickling sensation.  The effects are long lasting, but not permanent, and you’ll probably come in every six months or so for a repeat treatment in conjunction with the regular lid wash maintenance you’ll be doing at home.  

There are different kinds of blepharitis and different causes for the condition. It’s usually bacterial, but can also be caused by seborrhea (dandruff), rosacea, allergies, toxins or viral infections. Another common cause of blepharitis and the symptoms related to this condition comes from parasitic mites called Demodex. Often these little critters need to be treated with tea tree oil washes.  Early diagnosis and proper treatment are the trick for getting the condition under control.

If you’re suffering from crusty, dry, scratchy, red or irritated eyes – do yourself a favour and make an appointment with your optometrist right away, so that you can start a treatment plan that’s right for you.

Fish is the new CARROT!

Fish is the new carrot

Carrots?  Forget carrots!  Fish is the new food to eat for healthy eyes!  Fish, especially cold water fish like salmon and tuna, are packed with eye loving omega-3 fatty acids.  Omega-3 fatty acids are an essential part of our diet.  Why?  Our bodies can’t produce omega-3’s, but we need them for things like regulating blood pressure and heart rate.  In fact, the American Heart Association currently recommends 2 servings of cold water fish weekly, and many eye doctors are starting to do the same.

Dry eye is probably the most common eye condition that omega-3’s are prescribed for.  Omega-3’s have been shown to dramatically reduce dry eye symptoms and signs.  Tears are kept from falling off our eyes with a special oily secretion produced in our eyelids.  This oily secretion can sometimes become less like olive oil and more like butter.  When that happens, the oils can get jammed up inside of our eyelids and our tears end up on their own with nothing keeping them on our eyes.  The tears will either evaporate or fall out of our eyes, causing dry eyes.  It’s thought that omega-3’s help stabilize those oily secretions and keep them the consistency of olive oil, therefore preventing tear evaporation and dry eye.

Some studies have shown that omega-3’s may even help prevent the occurrence or progression of macular degeneration.  Macular degeneration can be a visually devastating disease, and with no cure in sight, preventative methods are all we have.

Omega-3’s aren’t just for adults either.  A Harvard study compared the visual acuity of infants fed with formula with and without omega-3’s.  The group of infants that were given the omega-3 formula had better visual acuity at 2-4 months than the infants who were not receiving the omega-3 formula.  Studies have also shown that when mothers have a diet higher in omega-3’s, their child tends to have better visual acuity at 2-4 months due to more intake of omega-3’s through their mother’s milk.

There are many foods that are packed with healthy omega-3’s.  As mentioned earlier, cold water fish, including salmon, mackerel, tuna, and sardines are a great source for the essential fatty acid.  Fresh caught fish are a better source for omega-3’s than farm caught fish.  If you aren’t a fan of fish there are plenty of other options for you.  Dark green leafy vegetables, walnuts, olive oil, and flaxseed have lots of omega-3’s.  There’s also the option of supplements, such as fish oil pills, krill oil pills, and many more.  While the supplements are a great option, studies do tend to favor the benefits of omega-3’s from food sources over supplement sources.  So switch out that canola oil for olive oil, enjoy that tuna sandwich, and make it a sushi night for a doctor approved feast!  - Dr. Nicole Hewitt, OD

Protecting Your Eyes From The Sun

Protecting Your Eyes From the Sun

Protecting your eyes from ultraviolet radiation is just as important as putting on sunscreen to protect your skin. Many age-related eye diseases, such as cataracts and macular degeneration, may be partially caused by UV exposure throughout your life, so protecting your eyes today may save your vision later in life.

How Does UV Harm the Eyes?

We can’t see ultraviolet light, but it is absorbed by the tissue of the eye and can cause serious eye damage. Conditions such as cataracts, macular degeneration, photokeratitis (sunburn of the cornea), pingueculae (small yellowish bumps on the white of the eye) and pterygium (opaque growth over the surface of the cornea), are directly related to UV exposure. The more UV exposure you have during your life, the more likely you are to develop one of these damaging conditions.

Options for UV Protection

There are many options to protect your eyes from UV light.  If you want protection from UV rays as well as comfort from glare and brightness, tinted glasses work well and tinted polarized lenses are best.  Options include permanently tinted sunglasses (prescription or non-prescription) or photochromic lenses, which get darker with increased UV intensity but offer UV protection even when clear.  You can also use clip-on sunglass lenses over your regular glasses, or large sunglasses that fit over your own glasses and block UV light, even from the sides.  Tinted lenses do not necessarily block UV light, so it is important to ensure your lenses block 100 per cent UVA and UVB.  Lenses do not have to be dark to block UV rays, so if you want protection, but not the darkening effect of sunglasses, you can choose clear UV blocking lenses.  You can even get contact lenses with UV protection.

If you dislike wearing sunglasses, it may be because your lenses are too dark or are not good optical quality. Poor quality lenses may cause distortions and give a general feeling of discomfort. Grey tints are “colour neutral” and will not affect your colour perception, but some people prefer the “warm” feeling of brown tints.

Factors in UV Exposure

Light skin, eye pigmentation and certain medications, such as oral contraceptives and some antibiotics, can affect how susceptible you are to UV light.  Infants and young children are especially vulnerable to the damage from UV radiation, and should wear sunglasses and a hat.  UV exposure is greater during the mid-day and is also greater near the equator and at high altitudes. UV is reflected from water and snow, increasing your exposure, so you should wear protective lenses around them, such as when skiing or doing water sports.

Your BC Doctor of Optometry can make specific recommendations to ensure your eyes are well-protected from the harmful effects of UV radiation.

BC Doctors of Optometry provide a full range of vision and eye health care and are your first stop for comprehensive, doctor-delivered care.  For more information about your vision and eye health, speak to your BC Doctor of Optometry or check their website at www.bcdoctorsofoptometry.com

Third World Eyecare trip to Nicaragua

Bringing Clear Vision to Nicaragua – by Dr. Trevor Miranda

The world health organization has identified uncorrected refractive error as the leading cause of blindness worldwide.  For those folks, a simple pair of glasses will restore their vision but due to lack of access to eye care and poverty those sight giving glasses are unattainable.  I was fortunate to be part of a team, Third World Eyecare, that recently went to Nicaragua to provide eye exams and glasses to those in need.  The Third World Eyecare Society ‘TWECS’ is made up of a group of optometrists and opticians.  We travelled to the Chinendega area of Nicaragua on November 17 and returned on November 29. 

A patient would arrive at the clinic in the middle of the night.  They would stand in line for about 8 hours in eager anticipation of their first ever visit to an Optometrist.  At around 8:00am the majority of our team would head out in the crowd and start the registration process.  Every person would receive a form that would be used for entrance to the clinic.  On the form we would record the patients name, age, basic medical issues, any issues with vision and their occupation.  With this form they would then proceed to the Visual Acuities or V.A. station.  Here the patient’s ability to see near and far would be quantified.  This is the test you will recall from your Optometrists office; the chart with the large letters on top diminishing to the smallest letters on the bottom.  There was a slight difference to this test in Nicaragua.  Due to the high illiteracy rate with many older people, letters could not be used, so the test consisted of symbols that pointed up, down, left and right.  It was amazing to be able to quantify vision with a simple test and only a few words.  Next, the patient would enter the Red Cross Headquarters for further testing.  A quick test with an auto-refractor (AR) was used to determine the next step.  The AR is an instrument that can determine an individuals prescription.  This is a very rough measurement, but it quickly determines the focus of further visual testing.  After AR, patients would go to one of three stations for further examination to check the health of the eyes, to refine the prescription, and to be counselled on any visual issues they may have.  After the patient had the prescription in hand they would proceed to the dispensing area.  This is where the TWECS (Third World Eyecare Society) magic can really be seen.  The dispensing team would take the Doctors prescription and find the appropriate glasses out of the 10,000 pairs that were packed from Canada.  Once these glasses were placed on the faces of many visiting the clinic, a whole new world was revealed.  Most had never had glasses before.  Many had never seen further than their hand so needless to say the reactions from many were priceless.  They ranged from a smile, to patients breaking down in tears.  One little boy was actually frightened to see the real world.  From dispensing, the patients would fill out an exit survey with the help of interpreters and be on their way home to enjoy their new life with vision.

This was a monumental trip for all those involved and I for one will be travelling with this group again. 

I am also putting out a plea for help.  If you have an old pair of glasses, please donate them.  If you are looking for Christmas gift ideas, make a donation to the amazing work that TWECS does in someone’s name.  Visit www.twecs.ca for more information.  Special thanks to the Rotary Club of South Cowichan for their support in purchasing equipment for the TWECS trip. 

How to encourage your child to wear their specs

Fashion and Function:

How to encourage your child to love their glasses

Refractive correction of myopia (nearsightedness),  hyperopia (farsightedness), and astigmatism, problems of eye alignment, accommodative or convergence difficulties or wearing glasses for sun protection are all among the many reasons your child may be wearing spectacles.

Glasses need not be perceived negatively; spectacles can be both fashionable as well as functional.  In fact, many children love the idea of wearing glasses.  Recommendations for harnessing that enthusiasm and helping your child love their spectacles include the following:

• Let your child be involved in the selection process. Helping to choose the frame style and colour will go a long way to encouraging the wear of their new spectacles.  If this is their first pair of spectacles, be sensitive to their concerns and answer any questions they may have about when and why they must wear them.

• Ask your optometrist or optician for assistance in selecting the right frame for your child. They can help quickly narrow the options to frames most suitable to the size and shape of your child’s face, and ensure that the chosen frames are kid durable.   They will also ensure the correct fit of the spectacles.  Spectacles should not be too tight or pinch at the temples or behind the ears or slip down your child’s nose; they should be comfortable for your child to wear. Because children’s noses and bridges are not fully developed, spectacles with nose pads may provide a better fit for a young child and stay in place better than plastic frames, which may tend to slide down their nose.   Your optometrist will also advise you on the best options for lenses and protective coatings along with the warranty available on children’s spectacles. 

• Teach your child respect for their spectacles.  Encourage proper storage of the glasses when not in use, and proper cleaning of the lenses to help prevent scratched lenses interfering with comfortable vision.   If you wear spectacles, modeling the acceptable behaviour is key.

• Children play hard and frames can become misaligned; your child will need to have their spectacles adjusted regularly to ensure the frames are sitting comfortably.

 If your child is resisting wearing their spectacles, ask them why.   It may be that the frames are uncomfortable and need adjusting, or they may be unclear as to the need to wear spectacles, or their vision may have changed and they need an eye examination.

Optometrists recommend that children have their eyes examined by six months of age, and annually thereafter to ensure eye disorders do not go undetected and that their eyes remain healthy.