Myopia (So, I am near sighted)

Myopia, or nearsightedness, is the easiest of the eye's focus problems to understand. As a myope, your near world is in focus and your distance vision is blurry. This happens when the light rays that enter your eye focus in front of the retina instead of on the retina.

Incidence:

• In the United States and Europe 25-40%
• In some developed Asian countries 70-90%
• In some indigenous populations from undeveloped countries 1-8%

Causes:

The arguments regarding the cause of myopia are very heated and sway between Nature/Nurture. Twin Studies show a genetic predisposition to myopia, and literacy studies show extended near-focus to be the major contributing factor. No one really knows how genetics and environmental factors interplay, but surely, both sides of the equation contribute, and it probably varies on an individual basis.

The Internet is full of information about the causes of Myopia. In my opinion, this Wikipedia article about myopia is about the fairest comprehensive treatment for the lay person that I could find: http://en.wikipedia.org/wiki/Myopia

Some promoters of the Nurture school-of-thought go so far as to blame eye doctors and the optical industry for Myopia as part of a grand conspiracy. The Myopia Mafia causes an increase of myopia by prescribing glasses to correct the vision of children with myopia, is the crux of one argument. Another claims the problem is nutritional in nature and has a vitamin to fix it. These extreme and entertaining examples usually have their own product to sell (so BUYER BEWARE) and while espousing some truths, they fundamentally over-simplify the problem.

Correction:

With today's technology, Myopia is a mere annoyance for most of us. In developed countries, it is easy to correct with glasses, contact lenses, or surgery using MINUS dioptric power--all of which use impressive new technologies. Stay tuned for upcoming articles on advances in lens and surgery technologies.

Prevention:

Because of the evidence that near stress induces myopia, there may be some things you can do. Children who spend more time outdoors and less time in front of TV, computers, or books tend to have less incidence of myopia. The problem is, we learn most of what we need to survive in today's world by reading and using the computer, so avoiding these activities to prevent myopia might cause other life-problems. And if not putting glasses on a nearsighted kid could prevent further myopic progression, would it make sense to keep your child in a constant state of blur? Like everything else, there is wisdom in balance.

Several alternative "cures" are out there, like "The See Clearly Method" and "Rebuildyourvision.com." You will often find them long on testimonials and short on credibility. We get patients who try these things occasionally thinking they will surprise us. So far, I haven't seen anyone with verifiable improvements to their refractive state via these programs.

I personally like to prescribe bifocals or progressives to myopic children who show signs of excessive accomodative convergence (misaligned eyes with close focus) or other signs of near stress. Some studies have shown a 40% reduction in myopic progression with bifocal use, and I seem to see that played out clinically in these cases of over-convergence.

Presbyopia, (where did my near focus go?)

The human eye is a remarkable organ. Besides transmitting electromagnetic waves from the visible light spectrum to the brain where they get processed as the complex sensation of vision, the healthy young eye has the uncanny ability to focus light from the distance to the near and back, without you perceiving the physical change in your eye that allows this to happen. Behind your pupil, there is a lens, attached to a radial muscle, that changes shape in response to a change in the focus distance of what you are viewing.

Then, somewhere in the middle of life (for most it happens in their 40's) you begin to lose that ability to change from distance focus to near focus. This inevitable change comes when the crystalline lens behind your pupil begins to harden. The harder it gets, the more help you need to change to near vision from your distance focused vision (IE your distance lenses or your naturally good distance vision). Gradually, after about 10 years, the loss of your near focus stops when the lens becomes too hard to shift anymore.

The way you observe this change depends on your natural vision. If you are naturally near sighted, sometimes taking off your glasses helps you see up close. If you are farsighted, you generally need reading glasses earlier, then glasses for distance too when you can no longer use your close focus power to see in the distance.

Nobody escapes Presbyopia if they live through that stage of life. Some people with naturally good distance vision in one eye, and naturally near-sighted vision in the other go into their later years thinking they beat Presbyopia, but measurements will always confirm that they have lost the close-focus ability of younger eyes. Science still puzzles over some way to stop or reverse this process. If someone does find it, they will have found the key to wealth. For today's baby boomers, Presbyopia represents one of the greatest aging frustrations they endure.

HealthDay (12/29, 2008 Robert Preidt) reported that, according to a study published in the Dec. issue of the Archives of Ophthalmology, "more than one billion people worldwide had age-related farsightedness -- called presbyopia -- in 2005," with about "410 million of" them being "unable to perform tasks that required near vision."

Many options exist to correct your vision if you are Presbyopic. From glasses, to contact lenses, to surgery, or some combination of the three, you can have clear vision for whatever tasks you are doing. You may be surprised by the number of ways we can customize a solution for you if you have specific needs beyond what the standard options correct. Stay tuned for discussion on today's lens technologies that make it easier than ever, particularly the new digitally-surfaced progressive lenses.

NEWS: Cancer of the Eye--Uveal Melanoma

Interesting news you can use:

Canada's Globe and Mail (12/12) reports that researcher Catherine van Raamsdonk, B.Sc., M.A., Ph.D., of the University of British Columbia, "has identified a gene mutation that can cause almost half the incidents of" an eye cancer "called uveal melanoma." According to Prof. van Raamsdonk, "the next step" is "to develop a treatment that targets the effects of the mutated gene." As reported by AOA's First Look

Macular Degeneration

" Macular degeneration: the loss of central vision through the age-related deterioration of the macula."

Today, with a simple google search, one can find volumes of information about macular degeneration. Some excellent links are provided at the end of this post. This is a disease we have come to understand fairly well, and a disease we have found dramatic new medical treatments for that now preserve vision much better than in the past.

Here are the things that you really need to know that will help you limit your risk of vision loss to macular degeneration.

There are two types of age related macular degeneration (ARMD):

Roughly 90% of all ARMD is dry. Dry ARMD is the progressive, slow depositing of metabolic waste in the macula which disrupts and damages the finely ordered photo receptors that give you detail-oriented vision. Current treatment is preventative in nature--there are no medical treatments at this time. But prevention works, and the earlier you start, the better.

About 10% of dry ARMD turns into wet ARMD, which is the active leakage of fluids and growth of new blood vessels in the macula. Wet ARMD can cause the rapid loss of central vision. A wide range of new medical treatments exist that can mitigate your vision loss if the wet ARMD is detected at the right time.

Prevention:

To understand prevention, you need to understand that the causes of ARMD are both genetic, and environmental. A family history of ARMD certainly increases your risk, and you can't control who your parents are, but the environmental factors that increase your risk can be controlled. All known environmental risk factors generate Free radical based oxydative damage in the macula.

Here are the main environmental risk factors:

1. Age-- environmental factor? Maybe more than we realize...
2. Smoking
3. Exposure to UV light
4. Poor nutrition
5. Neglecting your eye doctor

Here are the steps to prevent ARMD, slow its progress, or reduce your risk for vision loss:

1. Physical activity goes a long way to slowing the aging process in your body. Research now suggests it may also be an important factor in slowing ARMD.
2. Stop Smoking.
3. Wear a hat with a brim and Quality Sunglasses. You are never too young to start this habit.
4. Eat 12-15 servings of fresh fruits and vegetables a day with a variety of raw nuts and grains. Cornell University has a wealth of research on the overall benefit of getting your nutrition this way. It is difficult, but possible which is a subject for a future post. You may also follow the vitamin supplement path suggested in the AREDs study and others. With some of the recent unrelated findings on possible harm from vitamins, you need to exercise caution using Vitamin E, and beta carotene--especially if you are a smoker.
5. Only your eye doctor can help you monitor your maculae and get you timely help if your ARMD turns wet. See your doctor a minimum of once a year to start with, and follow his/her recommended schedule for return visits.

Medical intervention:

A new generation of drugs that inhibit the growth of new blood vessels have improved outcomes in patients compared to earlier laser treatments that indiscriminately damaged retinal tissue adjacent to the treatment area. Lucentis, Avastin, and Macugen are all drugs that are injected into the eye, sometimes repeated in series over weeks or months. Sometimes steroids can be injected into the eye to reduce edema in the macula as well. When your doctor sees evidence of wet macular degeneration, he/she may send you to a Retinal Specialist who will make the proper decisions about which treatment or combination of treatments will best reduce your vision loss from wet ARMD.

Patients who lose vision to ARMD voice significant frustration. It's like being blind without being blind. The peripheral vision that remains after you lose your central vision is not capable of seeing fine detail. Taking the necessary steps to prevent ARMD and having your eye checked yearly are a small price to pay for sight. http://www.allaboutvision.com/conditions/amd.htm

http://www.mayoclinic.com/health/macular-degeneration/DS00284

http://www.mayoclinic.org/macular-degeneration/prevention.html

http://vivo.library.cornell.edu/lifesci/individual/vivo/individual365 (access nutritional research by following the work of individual scientists)

Glaucoma--sneak thief of Sight

According to the World Health Organization, in a 2002 report, Glaucoma is the 2nd leading cause of blindness after Cataracts worldwide. In the United States, Glaucoma is the 2nd leading cause of blindness after Macular Degeneration, closely followed by Diabetic Retinopathy.


What does the average person need to know about Glaucoma? Lets talk about what we do and do not know about this sneaky disease that robs a person's vision by slowly and silently killing the OPTIC NERVE which sends vision signals from the eye to the brain.


First, what we know:

Science and clinical experience have provided us with an excellent ability to treat glaucoma and significantly reduce your risk of blindness from the disease if detected in time. We treat glaucoma with eye drops that lower the internal pressure of the eye. The better we control eye pressure, the more we protect the dying nerve and preserve a person's vision. We also have learned that the earlier we intervene with glaucoma, the easier it is to control or stop ongoing damage to the nerve. Glaucoma seems to have inertia. Advanced cases are reportedly more difficult to control--similar to putting the breaks on a freight train. That perception may be due to a reduced margin for error when glaucoma is at its end stage when there is very little nerve left to save. We do have patients we treat who came to us with very minimal nerve left and were dangerously near blindness, who have managed to keep their remaining vision with consistent treatment.

We know that there are several types of glaucoma. The primary types are those described in this post and are the most difficult to understand. There are several secondary types that happen when the pressure spikes due to anatomical problems, genetic defects, or injury.



What we don't know:

In the past, our view of glaucoma was rather simplistic. Too much pressure in the eye pinched the nerve and slowly strangled it to death. The pressure became elevated due to poor drainage or excessive production of the fluid that is constantly being exchanged in the front of the eye. While this certainly explains some glaucoma cases, there are many that don't fit this tidy scenario. For those of us that battle this disease daily, glaucoma is the Sneak-thief of sight. Sometimes it can look like you have glaucoma when you don't. Conversely, it can look like you don't when you do, and is often missed at Eye Exams. You can have high pressure and no glaucoma, or you can have normal pressure and have glaucoma. And if you have low pressure glaucoma, we treat by lowering the pressure (which is proven to help), but we don't know why it does. When you add to that the fact that you have to lose a significant percentage of your nerve (50-75%) before we can measure damage to your vision via Visual Field testing (one of the traditional keystones to diagnosis), you can begin to appreciate why diagnosing it can get so complicated. Theories abound, but why glaucoma actually happens is still a mystery.

So, the moment glaucoma starts in a patient, the majority of doctors will miss it. The moment you go blind from glaucoma, the majority of doctors will admit that you have it. And there is this large chasm between the two. In medicine, we love to be certain of our selves and our diagnoses which I think lends bias toward later diagnosis since glaucoma doesn't get obvious until its later stages.

Risk factors:

Over the past few years, scientific study has helped us define some of the risk factors associated with the Primary glaucomas. In general, they are listed in order of importance:

• High pressure


• large Nerve cupping


• thin corneas


• Age


• Family History


• African, Asian, or Latin race (but all races affected)


• Severe Myopia (near sighted)


• systemic disease--high blood pressure, diabetes


• Sleep Apnea


• History of Migraines

Early diagnosis:

Because glaucoma is an asymptomatic process, and because it doesn't become obvious until its end stages, there is a movement toward early diagnosis. We know that the earlier we diagnose this disease, the more uncertainty we have to live with, and the more we have to rely on the preponderance of risk factors. In medicine, we commonly treat based on risk factors (we lower cholesterol to reduce your chances of Heart Disease and Stroke, for example.) Thinking of glaucoma this way is a paradigm change from the days when we wanted to declare with absolute certainty that "you did or did not have glaucoma" when we finished up your eye exam.

The tools:

Today, one of the most significant tools we have in our toolkit is the LASER. In our office, we use Ocular Coherence Tomography (OCT) by Humphries Ziess to measure the thickness of your Retinal nerves and track that thickness over time. Thinning nerve suggests glaucoma. We also use high resolution retinal photography over time, we measure your corneal thickness, and the gold-standard Visual field testing over time (which really doesn't tell us too much in the early stages of the disease). We combine the data we collect from these tests with what we know about your risk factors and make our decisions about treatment or followup.

The treatment:

With all the uncertainty about the origins of glaucoma and its early detection, we are very certain about treating the disease. Our goal is to lower the pressure in your eyes, and then monitor the health of your nerve as we keep your pressure down over time. Today's meds are effective and easier than ever. In most cases, one drop of medicine in your eyes each night does the trick. If today's first-line meds don't work, we may have to use additional drops, which may mean instilling drops 2 or 3 times a day. If drops don't work, then we use LASERs and surgery to reduce eye pressure. Effective eye-pressure control protects the health of your nerve and preserves your vision.

END OF YEAR FLEX-SPENDING ACCOUNTS...

The end of the year is fast approaching and if you have flex-spending accounts or cafeteria plans the time to use up those benefits is now! Did you know that you can use those funds towards eye exams, prescription eyewear, sunglasses and contact lens purchases? Give us a call and set up your appointment today! Please call, e-mail, or stop by our office for any questions! Happy Holidays!

Schnuchel's

Come in and see our brand new hand made German eyewear! These frames are custom made to fit all your wants and needs. Come see what the fuss is all about.

New Arrival- Ed Hardy Readers!

Come check out our newest frame collection. Ed Hardy readers have just arrived! These are original designs from the tattoo artist Don Ed Hardy who is known as "The godfather of tatoo. These unique "Vintage Tattoo Wear" designs are like nothing else! Stop down and try on a pair and be the first in town to have them! Happy Holidays from Southwest Vision!

Cinnamon, Cloves, and Diabetes

One of the key factors to maintaining your vision as a diabetic is blood sugar control. Tight Control reduces the end-organ vascular damage that can destroy vision. Methods for controlling sugar improve with time, but it is important to remember that Adult Onset Diabetes is often related to our diets and activity levels. We effectively encourage our patients to "go back to nature" by asking them to increase their activity levels and control their diets. So how about some other natural methods?

Several studies have been conducted in recent years to determine whether or not the ancient spices Cinnamon and Cloves have any beneficial effect in the management of diabetes. These studies show promise, but deliver conflicting results--some showing no effect, leaving the consumer to determine the quality of the studies and validity of the results.

Cinnamon seems to have powerful anti-inflammitory and anti-oxidant properties which may help explain some earlier findings by Dr. Richard A. Anderson, of the Beltsville Human Nutrition Research Center, United States Department of Agriculture. He had shown that the equivalent of a quarter to half a teaspoon of cinnamon given to humans twice a day decreased risk factors for diabetes and cardiovascular disease, including glucose, cholesterol and triglycerides, by 10 to 30 percent.

Cloves have also been shown in lab studies and human studies to to improve the function of insulin and to lower glucose, total cholesterol, LDL and triglycerides in people with type 2 diabetes.

Three of these studies were presented at Experimental Biology 2006 in San Francisco and are part of the scientific program of the American Society for Nutrition, Inc:

* Dr. Heping Cao of the Beltsville Human Nutrition Research Center and colleagues, including Dr. Anderson, investigated the biochemical basis for the insulin-like effects of cinnamon. Results showed that cinnamon, like insulin, increases the amount of three critically important proteins involved in the body's insulin signaling, glucose transport, and inflammatory response. Dr. Cao says the study provides new biochemical evidence for the beneficial effects of cinnamon in potentiating insulin action and suggests anti-inflammatory properties for the antioxidants in cinnamon. Other researchers involved in the study are Dr. Marilyn M. Polansky of the USDA-ARS Beltsville (Maryland) Human Nutrition Research Center, and Dr. Perry J. Blackshear of the National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina.

* Dr. Stephanie Mae Lampke, University of California, Santa Barbara (UCSB), and colleagues, used fractionation and electrospray mass spectrometry to identify the chemical structure of active ingredients in cinnamon. She worked with UCSB's James Pavolich and Donald Graves. This study provides information on how cinnamon works. Working with Dr. Lampe, Dr. Anderson, and Dr. Polansky (also involved in the paper above) were members of the USDA BHNRC. Research was supported in part by a grant from Cottage Hospital, Santa Barbara, to Dr. Graves.

* Dr. Alam Khan, Agricultural University, Peshawar, Pakistan, a former postdoctoral student and Fulbright Fellow in the Anderson laboratory, reports the first study of the effect of cloves on insulin function in humans. Thirty-six people with type 2 diabetes were divided into four groups, which then took capsules with either 0, 1, 2, or 3 grams of cloves for 30 days. There were no significance differences in responses among the three levels of cloves used - but there were markedly significant differences between those who took cloves and those who did not. At the end of the 30 days, individuals with diabetes who had been taking some level of clove supplementation showed a decrease in serum glucose from an average 225 to 150 mg/dL, triglycerides from an average 235 to 203 mg/dL, a decrease in serum total cholesterol from 273 to 239 mg/dL, and a decrease in LDL from 175 to 145 mg/dL. The individuals with diabetes who had not been taking clove capsules showed no differences. Serum HDL was not affected by consumption of cloves.

The method, quality, and quantity of dosing play an important role. Sprinkling these spices on your cereal may not have much affect. Also, be aware that Cinnamon contains natural Coumarin, albeit very small amounts. The beneficial compounds in Cinnamon are water soluable, while the harmful ones are not, according to Dr. Richard A. Anderson. So making a tea from the bark, or grinding it into your coffee grounds before brewing may improve its effect. Dr. Anderson also reports that "saliva has a chemical harmful to Cinnamon."

We recommend that you involve the doctor who Rx's your diabetic meds if you decide to try these methods. And remember, diabetic retinopathy must be followed regularly by your eye doctor. Diabetics need a minimum of one exam per year--and more frequently if your retinopathy is in danger of progressing as determined by your eye doctor.