The Great American Epidemic

By 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. 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, dry eyes and/or cataracts. Almost 30 percent of diabetics haven’t had an eye exam within the past year, but prevention starts with early detection through a comprehensive eye exam. New technology can potentially pick up changes five to 10 years sooner than they become obvious. 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. A stable A1C level and blood pressure control can reduce the damage to blood vessels in the eye, thereby reducing damage to sensitive ocular structures. As a matter of fact, a stable but mildly higher average A1C level is potentially less damaging that a lower average A1C that fluctuates significantly when it comes to damage to the eyes. Besides the fact that some of the most frightening aspects of diabetes is the potential loss of vision that can be associated, it is also through the eyes that diabetes can be monitored and sometimes identified to begin with. 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.”

Photo by Nithi clicks on Trend Hype / CC BY

Reducing the Risk of Macular Degeneration

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 are developing cataracts, due to factors such as: increased life expectancy, poor nutrition, ultraviolet (UV) exposure, diabetes, smoking and certain medications. Recently, “blue light” (most commonly emitted by the sun along with all other wavelengths of light, but now found in higher levels indoors due to overhead lighting, computer screens, tables and smart phones) has been labeled as a future cause of macular degeneration.

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 carotenoid” 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 zeaxanthin, which is found in orange vegetables, like orange peppers. The third carotenoid, Meso-Zeaxanthin, 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-zeaxanthin 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 two milligrams of meso-zeaxanthin! No thanks!

There are numerous supplements available that contain one or two of these components, and at least one product, called “MacuHealth” that contains all three. 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 shown 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.

Photo by Nithi clicks on Trend Hype / CC BY

The Myopia Epidemic

By Stephen Cohen, O.D. —

Nearsightedness (difficulty seeing things far away), aka myopia, is growing at an alarming pace and is estimated to impact one in two Americans by the middle of this century. In parts of Asia, it affects 80–90 percent. Although genetics plays a role (two nearsighted parents are more likely to have a nearsighted child), other factors are becoming more prevalent.

We have not gone through an evolutionary phase, but over the past few hundred years we have gone from hunters and farmers to industrialists, to now, “computerists.” More and more time is spent engaged in activities that are no more that 1–3 feet from our faces. We have two eyes to help us with depth perception (3-D vision) and with peripheral vision to be aware of things to our side. With the exception of driving and sports, we pay less and less attention to our peripheral vision.

The typical manner in which this has been addressed is for children to be fit with glasses. At their next annual exam, if their prescription increased, glasses were updated. Statistically, things start to level off at about age 17–18, but with the amount of time being spent on devices, we are seeing myopia progress even at later ages. Recent studies, however, have shown that this is not just a matter of how thick the glasses wind up, it can also be a predictor for more serious vision and eye health issues. It has been found that for people with stronger prescriptions, cataracts can develop earlier, and the risk of glaucoma and degeneration of the back of the eye increases substantially.

For parents (and interested others, such as grandparents, pediatricians, school nurses, teachers, etc.), there are things that can be done to prevent or slow down this progression. Two-and-a-half hours has been found to be a critical time period. For young children, the chances of becoming nearsighted can be decreased by having a child spent at least 2.5 hours per day outdoors. Additionally, it was found that for a child who spends 2.5 hours or more on a digital device, the degree of nearsightedness can increase dramatically. Having young children engage in outdoor activities will help to stop nearsightedness from developing and reducing the amount of time on digital devices can help to slow down or stop the progression of nearsightedness, where the prescription continues to increase over time.

Studies have also shown that there are other ways to slow down this progression. Bifocal glasses or contact lenses (even for children), certain types of contact lenses that reshape the eyes, as well as certain eye drops used at bedtime, can slow down the progression by 30–60 percent. The key here is that slowing down the progression means it is less likely for the child to reach that level of nearsightedness that increases the risk of cataracts, glaucoma and retinal changes.

For many years, eye care practitioners sought ways to slow down the insidious increase in nearsightedness. There are now techniques available to not only improve a child’s vision now, but to help protect his or her eyes for the future!

Photo by emden09 on / CC BY-NC-SA

It’s All Greek to Me

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.

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