Diabetes Awareness Month

cohen_headshotBy Stephen Cohen, O.D. – 

Although life expectancy is at an all-time high, the current diabetes epidemic is getting much worse, increasing by 27 percent in just the past 10 years. Seventeen million people are diabetic, and about one-third (almost six million) do not know it.  Diabetics are at risk for heart disease, kidney disease, loss of a limb and blindness.  National programs are in place to increase public awareness about preventable diseases like diabetes, and November has been labeled Diabetes Awareness Month.

Every year, as many as 24,000 people go blind as a result of eye damage (diabetic retinopathy) brought on by diabetes.  It is estimated that 95 percent of vision loss can be prevented through early detection and treatment.  Diabetic retinopathy typically shows no early warning signs.  Without timely treatment, there can be fluctuations of vision and changes in your eye prescription, as well as increased chances of developing glaucoma, macular degeneration, and/or cataracts.  Almost 30% of diabetics haven’t had an eye exam within the past year, but prevention starts with early detection through a comprehensive eye exam.  Only your eye doctor can fully evaluate your eyes and detect the early signs of retinopathy, glaucoma, and cataracts.

There are several things you can do to decrease the chance of developing diabetic eye disease.  Keeping blood sugar levels within the target range and without significant fluctuations throughout the day can reduce the damage to blood vessels in the eye, thereby reducing damage to sensitive ocular structures.  Studies have actually shown that a widely fluctuating A1C level (but lower overall average) can be more damaging to your eyes than a more stable but higher overall A1C level. Controlling blood pressure (which can further damage vessels) is also important.  A healthy diet and exercise program are obvious, but underutilized defenses, such as an annual eye exam, needs to be near the top of the list.  Remember that “an ounce of prevention is worth a pound of cure.”  In this case, “an ounce of prevention is worth a lifetime of vision.”

Eat 220 Pounds Of Fish Skin…Or Do This

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By Stephen Cohen, O.D. – 

Age-related eye conditions will triple in the next 15 years. Macular degeneration alone will account for 50 percent of visual impairment and 20 percent of blindness. It is also estimated that 30 million people will develop cataracts by the year 2020 (due to increased life expectancy, poor nutrition, ultraviolet (UV) exposure, diabetes, smoking, and certain medications). However, it is now shown that taking specific supplements can reduce macular degeneration by almost 25 percent and cataracts by 15 percent. This could save our healthcare system almost $7.5 billion. Additionally, four separate clinical studies performed in four different countries around the world showed that dietary supplementation can provide better visual acuity after just one year.

The three main components of this supplement are retinal carotenoids that help with the metabolism in the back of the eye. You may have seen commercials for vitamins that include “Lutein for macular health.” Lutein is the main component, which, interestingly, is also found in our brain. As a matter of fact, there has been a relationship established between macular degeneration and cognitive loss, and a belief that a deficiency in lutein may contribute to both problems. Lutein is found in green, leafy vegetables. The second component is zeazanthin, which is found in orange vegetables, like orange peppers. The third carotenoid, meso-zeazanthin, has only been recently discovered, and in our body is only found in the macula of our eyes. Unfortunately, it is very hard to obtain meso-zeazanthin in our diets. As a matter of fact, it has been calculated that you would need to eat 220 pounds of fish skin to receive 2 milligrams of meso-zeazanthin! No thanks!

There are supplements available that contain one or two of these components, and one product, called “MacuHealth” that contains all there. Studies show that products like these can protect the eyes from “oxidative stress” which is what happens when things rust. As such, these products have been affectionately called “ocular rust preventers,” or “internal sunglasses.” Vision can be sharper, and it has been proven that people with driving challenges (night driving, glare, peripheral awareness [such as at intersections] can see improve in as little as one year after beginning this regimen.

For additional information, please feel free to contact our office (480.513.3937) or email me at stephen.cohen@doctormyeyes.net. Or…you can start piling up the fish skin!

It’s All Greek To Me

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By Stephen Cohen, O.D. – 

Myopia. Hyperopia. Astigmatism. Presbyopia. I have no idea what you’re talking about-opia. If you are like millions of other Americans, one of these terms describes you. Presbyopia alone affects over 100 million people, but don’t worry, it’s not contagious. These are the terms that describe how your eyes work, or, in some cases, do not work. They are terms that are often thrown around, but at the same time, are often not really understood.

The first two terms, “myopia” and “hyperopia,” are more commonly known as nearsightedness and farsightedness, respectively. However, even these more common terms are often misunderstood. When you are nearsighted, you are “sighted for near,” and may have difficulty seeing far away. When you are farsighted, you are “sighted for far.” In this case, you may have difficulty seeing things up close, or your eyes may have to work harder to see things up close. Nearsightedness and farsightedness involve the shape of the front of our eyes, and/or the length of our eyes from the front to the back. Up to the age of about five or six, farsightedness is not only fairly common, it is expected. Conversely, nearsightedness tends to develop during the school age, most commonly between about third grade through the late teens to early twenties.

Presbyopia, on the other hand, is the loss of our ability to focus on things up close. This is also known as the time when “our arms get too short,” and involves changes in the capability of the lens inside our eyes to change shape to be able to focus with reading. That is different than farsightedness. Presbyopia typically becomes noticeable at around 40 years of age. As a matter of fact, may people think it comes on very suddenly, as if someone came in during the night of their 40th birthday and stole their reading vision. In reality, these changes are very gradual, yet progressive, typically leveling off in our mid 50’s. When presbyopia affects us, we find that we have to hold things further away from our face to read. Small print will be difficult to see, and we need better lighting and contrast. Reading glasses or bifocals are the most common remedies, but there are also several contact lens options, including bifocal contacts.

Astigmatism, sometimes called “that ‘stiga’ thing,” also typically involves the shape of the front of our eyes. Unlike nearsightedness, most astigmatism develops at a very young age. With astigmatism, instead of our eyes being shaped round, like a baseball, they will be shaped more like a football, with one curve being different than another. Light will then focus on different places in the back of our eyes, causing blur. It would be like sitting in a movie theater, and having the projector lens distorted a bit so that light focuses at several places, none of which are on the screen itself. Like presbyopia, glasses are the most common treatment, but, again, there are many contact lens options available to address astigmatism.

There are now also both surgical (e.g., LASIK) and non-surgical (e.g., Corneal Refractive Therapy” using contact lenses that reshape your eyes while you sleep) options available for many of these conditions.

However, you “look” at it, we have more options than ever to treat whatever “opia” ails you.

Sports Vision

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By Stephen Cohen, O.D. – 

“Float like a butterfly. Sting like a bee. Your hands can’t hit what your eyes don’t see.”

Muhammad Ali’s words apply for all sports. Nothing happens until the eyes tell the brain to tell the muscles what to do. Most of us equate great vision with being able to see 20/20. Although this level of eyesight is the benchmark for visual performance, it is only one of several important factors and skills. Other significant skills include depth perception, visual reaction time, eye tracking and teaming and peripheral awareness. Each plays a vital role in not only seeing, but in judging position, movement, speed, action and response.

With athletic endeavors come injuries. It is estimated that about 100,000 sports-related eye injuries occur each year, with about one-third of these to children under the age of 16! In children’s hockey and baseball leagues that require protective eyewear, eye injuries drop by 90 percent! It is also imperative that, as parents, we make sure our children have UV protection while engaging in daytime outdoor sports. UV damage (e.g., cataracts) is cumulative, and may take decades to show up.

Vision correction options are numerous. Unlike glasses, contact lenses do not alter the perception of image size, can provide better peripheral vision and some contacts also have UV protection built in. There are new tinted contacts (often bright red or green) that enhance contrast and are being used by professional baseball players and golfers. For glasses wearers, there are lens materials that are 20 times stronger than regular lenses, and can withstand a ball traveling at 90 mph. Additionally, a polarized lens or a non-reflective coating can dramatically cut glare. Lastly, the glasses (e.g., bifocals) someone uses for “normal” activities may not be optimal for sports. Athletes spend a lot of time and money on specific equipment for sports, and then use a “one-size-fits-all” approach to their eyewear. “Sports glasses” could make as significant difference in performance as other equipment.

Whether you’re a competitive athlete or a weekend warrior, thinking about your eyes and vision can help to take your game to the next level.

The Magnificent Seven

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By Stephen Cohen, O.D. – 

Most people cherish their vision more than any other sense. However, like many things in life, we often become most motivated to preserve our vision only when we find ourselves at risk to lose our vision. With deference to the proverbial “an ounce of prevention,” here are seven things you can easily do to help protect your eyes.

UV OR NOT UV: Ultraviolet radiation can cause both short and long-term damage to our eyes. A simple triad of a hat with a brim, sunglasses and for those who wear contact lenses, a UV-blocking lens (e.g., Acuvue), can help protect the highly sensitive external and internal ocular structures.

HAVE A HEART: Increasing your heart rate (e.g., three workouts per week) has been shown to reduce eye pressure and can reduce the risk of developing glaucoma, also known as the “silent thief of sight.”

EAT YOUR GREENS: Dark, leafy vegetables (e.g., spinach, kale, collard greens) contain carotenoids that may help reduce the risk of cataracts and macular degeneration.

DON’T RUST: Oxidation causes rust on metal surfaces, and in our bodies it causes cellular damage that can lead to cataracts and macular degeneration. Berries, oranges and foods high in anti-oxidants can help reduce the damage that can come from environmental factors like UV and pollutants.

HAVE YOU SEEN A RABBIT WEARING GLASSES?: Carrots, along with butternut squash, contain beta-carotene, which can help keep eyes healthy.

TIME FOR A ‘FLINTSTONE’ VITAMIN: A National Eye Institute (NEI) study verified that supplements with antioxidants, beta-carotene, copper and zinc, slowed the progression of macular degeneration. Other studies show that B6, B12 and folic acid can slow the onset of cataracts.

GONE FISHIN’: Omega-3 Fatty Acids (e.g., cold water fish such as halibut, salmon and tuna) can help treat dry eyes, prevent cataracts, and protect the retina. For a “fish oil” supplement, look for one that is in the triglyceride form, which provides higher “bioavailability (absorption).” [NOTE: Most fish oil is in an ethyl ester form. Feel free to contact me for recommendations if you have trouble finding one in a triglyceride form.]

We have two eyes that are designed to last a lifetime. Take some simple steps now. Your eyes will thank you later!

To Protect And Preserve

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By Stephen Cohen, O.D. – 

While the rest of the country hunkers down for winter, we can relish in the weather that reminds us why we put up with Arizona summers. What we don’t often consider is the full affect the sun has on our eyes, even during the winter months when the daylight hours are shorter and the sun feels less intense. Surveys show that whereas almost nine out of 10 people understand that Ultraviolet Radiation (UVR) can be damaging to our skin, almost nine out of 10 do not realize the potential damage that repeated UVR exposure can have on our eyes. This is particularly relevant for our children, since up to 80 percent of lifetime UVR exposure occurs by age 18. Unfortunately, like skin damage, the effect of UVR to our eyes is cumulative, and may not show up for decades. For example, up to one-third of all cataracts are as a result of long-term UV exposure. There are also unsightly benign growths on the white part of our eyes that result directly from UVR exposure, as well as cancerous growths, and potential retinal damage (e.g., macular degeneration).

UV coatings in glasses and contact lenses are virtually clear. The degree of tinting (lens darkness) merely determines how much the visible light might be reduced. Although even cheaper sunglass lenses can have adequate UV protection, they may distort vision as a result of inferior optics of the lenses. Sunglasses should have three qualities: ample coverage (size of the glasses) to protect the eyelids (one of the major locations for melanoma) as well as the sides of the eyes, good optics and adequate levels of UV-blocking. On another note, most contact lenses offer about 10 percent UVR protection, however, there are now contact lenses that provide protection equivalent to sunglasses. Lastly, recent studies show that the “blue end” of the visible spectrum can cause damage to the eyes. Newer lens coatings are now available to block these rays as well.

Optimal UVR protection involves a hat with a brim, sunglasses and where appropriate, contact lenses with UVR protection. As the New Year begins, make a resolution to protect your eyes early and often. In the long run, your eyes will thank you for it.

False Positives And False Negatives

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By Stephen Cohen, O.D. – 

For most people, vision is their most precious sense. For children, this is even more significant, as about 80 percent of what a child learns is through the visual system. Most parents take their children to the dentist for regular preventative care, but rely only upon obvious signs of a vision problem, or upon a school or pediatrician screening, before seeking professional eye care for their children.

A vision screening does not diagnose a problem, but rather identifies children in need of further assessments.  A vision screening is often performed by parent volunteers, with just a few minutes of training, or by pediatrician offices.  However, according to the American Academy of Pediatrics, vision screenings were not even attempted on almost two out of three of three-year olds, and a screening “attempt” was defined as “10 seconds or more” of testing.

Even with completed screenings, there can be false positives (a suspicion of a problems where there is none), and false negatives (passing a screening in spite of a problem).  Also, most vision screenings test for visual acuity only (eye chart), and according to the American Foundation for Vision Awareness, this only identifies about five percent of vision problems in children.  Although a child may see clearly from 20 feet away, it doesn’t mean that the child’s eyes work together efficiently, can track properly, can see and read comfortably at 12 inches away, or can make easy visual transitions from distance to near and near to distance.  (Testing in those areas, which are rarely part of a screening, are routinely part of a comprehensive pediatric eye exam.)  Even for children who “fail” a vision screening, studies show that less than half ever receive professional eye care, and the average time between the screening and the eye exam is 18 months.

As the school year begins, make sure you are setting your children up for success by making sure their vision, the predominant sense in learning, receives a grade of 100 percent.

Computer Users: Don’t Forget Your Eyes!

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By Stephen Cohen, O.D. – 

In the past 200 years, we have gone from hunters and farmers, to industrialists, to “computerists.” Clearly, the physical demands of each of these tasks are different. We now spend much of our waking day in front of a computer, viewing tiny details from no more than two to three feet away. In considering the “price tag” of computer use, we often overlook a potentially significant cost: our eyes. Vision complaints top the list of concerns from computer users. Computer Vision Syndrome (CVS) is estimated to cost industry billions of dollars in decreased productivity, absenteeism and treatment. Symptoms related to CVS include headaches, eyestrain, burning, tearing, redness, fatigue, fluctuations of vision and eyeglass prescription changes. As a matter of fact, there was just a report published that verified that computer use causes changes in our tear film that mimics (or causes) dry eyes.

There are a number of things that can be done to decrease CVS. Assessment of the workstation ergonomics is one area to consider. For example, the monitor should sit 10-20 degrees below eye level. Attention also needs to be paid to lighting conditions (e.g., glare from overhead lights, and/or from windows). A comprehensive eye exam is the next critical step. Most computer monitors are positioned further away than the distance that we typically hold our reading material. As a result, the glasses prescription for the computer distance can be notably different from our reading prescription. Just as we do not have one pair of shoes to meet all of our needs, computer users often find that they need more than one pair of glasses to address the various visual demands.

There is a new mantra when it comes to computer vision “health.” To help remember it, think of “20/20” vision. The mantra is called “20-20-20,” which stands for taking a 20 second break from computer work every 20 minutes and look at something at least 20 feet away (such as out a window, or, if none is available, close your eyes and envision looking off to the horizon. 20 seconds doesn’t sound like much, but you know how fast 20 minutes can go by. Think of it this way. Lifting weights 30 times in a row is harder than doing three sets of 10 with a brief break in between each set.

When we work on a computer, our blink rate, which coats the eyes with new tears, can decrease by as much as half, which can lead to dry eyes. Testing can be done to determine if dry eyes is contributing to your computer complaints. Lastly, a special lens coating can decrease glare from the computer monitor, which can be quite debilitating.

Between assessing and adjusting our computer environment, comprehensive vision testing and proper glasses prescriptions, we can greatly reduce the effects of Computer Vision Syndrome. In doing so, our eyes and visual comfort can be subtracted from the “price tag” of computer use.

That’s Nothing To Sneeze At

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By Stephen Cohen, O.D. – 

Although allergies can occur year round, we are now entering the prime season…beautiful weather that reminds us why we live here, but a huge challenge trying to fend off the plethora of allergens floating around. Up to 30 percent of Americans have some form of allergy, and itchy, watery eyes ranks number one as the most annoying symptom (ahead of runny nose, sneezing and scratchy throat). Most people are left to feel that they “just have to learn to live with it.” Fortunately, that is not the case.

The hallmark ocular allergy symptom is itchiness. Other ocular symptoms can include redness, tearing, increased mucous production, foreign body sensation, grittiness and scratchiness. During the height of allergy symptoms, people may also complain about blurry vision, and many contact lens wearers cannot tolerate having their lenses in their eyes.

Most people will “self-medicate” with OTC allergy products, which may not be effective and can even cause toxic reactions. Unlike pink eye (bacterial conjunctivitis), an antibiotic is ineffective in treating allergies. Newer prescription allergy medications provide both antihistaminic relief of symptoms, and also control the underlying cause of allergy symptoms, often providing some relief within even one or two doses. For severe symptoms, a steroid drop may be added for short term use. Cool compresses and certain lubricating drops can also provide some relief of symptoms. Lastly, there are oral non-sedating prescription antihistamines, which have been effective in decreasing ocular allergy symptoms, along with the typical nose, sinus and throat symptoms. It is important to note, however, that with the use of antihistamines, we experience an increase in dry eye symptoms. This can be a particular challenge to contact lens wearers.

If you are an allergy sufferer, you know how debilitating it can be. For those who do, it’s a shame to have to look forward to the “dog days of summer,” when allergens decrease, in order to find relief. Allergies cannot be cured, but they can be controlled. Your eye doctor can help you come up with a plan that will control and often prevent ocular allergy symptoms.

What do you have to lose, except your itchy, watery, mucousy, blurry, scratchy, gritty eye symptoms? And that’s “nothing to sneeze at.”

Insomnia And Vision Loss

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By Stephen Cohen, O.D. – 

I recently saw a patient who told me that her prior eye doctor told her that if she didn’t deal with her insomnia, she would develop cataracts (a clouding of the lens inside our eye) and eventually go blind. Perhaps the message wasn’t delivered so harshly, but that’s what she heard. Here’s an explanation about how sleep affects our eyes, and how insomnia can impact our vision.

Sleep is a restorative time for our eyes, after the day’s impact from environmental and other factors can irritate the surface of our eyes. That is one of the reasons why, when we don’t get a good night’s sleep, our eyes are red and uncomfortable the next day. Recent studies have also shown a relationship between sleep apnea and glaucoma, which is often called the “silent thief of sight.”

However, the comment about insomnia and vision loss from cataracts has a slightly different relationship. There is a hormone in our body called melatonin that helps us know when it is time to go to sleep. After age 40, it can deplete enough to impact sleep patterns. Melatonin is also a strong antioxidant, which helps to prevent free radical damage from UV and other sources. Therefore, if we lose enough melatonin to induce insomnia, we are also losing the antioxidant protection that also comes from this hormone. One of the causes of cataracts is long-term UV exposure, so when antioxidants (such as Vitamins A, C and E, and hormones like Melatonin) are depleted, we are more susceptible to developing cataracts. Cataracts rarely cause blindness in the developed countries of the world since there is easy access to care and treatment.

Statistically, by our mid 50’s, about 40 percent of us will have some cataract development, and by our mid 70’s, over 90 percent will exhibit cataract develop. While cataract surgery is quick, relatively painless and highly effective in restoring vision, not everyone ultimately needs surgery.

In summary, for people with insomnia, a melatonin supplement could be worth trying. While there can be a relationship between insomnia caused by decreased melatonin levels and eventual cataract development, we cannot make the leap to say that not sleeping well will lead to blindness, a fear that would certainly cause someone to lose even more sleep!

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