NEWS: Potassium and Blood Pressure

High blood pressure is a disease that causes vascular damage, which, left untreated can destroy the gift of sight. Hypertensive Retinopathy destroys vision by causing poor perfusion, fluid leakage, and macular swelling. It can also cause strokes inside the eye. We urge our patients with high blood pressure to keep it well controlled for their eyes' sake, and have regular visits with the doctor to ensure treatable problems don't go unnoticed.

Here is an interesting piece of "news you can use." This report of a recent study on Potassium finds that it may help lower blood pressure. Click here for the report.

http://www.upi.com/Health_News/2009/01/28/Potassium_may_help_lower_blood_pressure/UPI-12251233197984/

NEWS: Got Eyelashes?

Lattise. We have long wondered, when are they going to start selling this stuff for the cosmetic side effect of eye-lash growth? Lumigan, Travatan, and Xalatan are three similar drugs that we use to control eye pressure in patients with Glaucoma. All three drugs have an interesting side effect--they stimulate eyelash growth. So much in fact, some of our patients on these drugs look like they are wearing big, fake eyelashes. I even have a few who come in regulary for a trim--the lashes get too long.

Often our patients will ask, "My friends wonder if they can come here and get this medicine for their eyelashes?" Well...the thought certainly makes me a little uneasy.

CLICK HERE FOR ARTICLE

Today's New York Times article raises many interesting questions. First, the Mascara market is 5 billion dollars a year. The drug company knows opportunity when it sees it. Second, who is going to prescribe this stuff? Will our glaucoma patients be tempted to bypass us and assume that their treatment is going OK without monitoring progress after their dermatologist Rx's the cosmetic version? (The cosmetic version is the same strength as the glaucoma med).

It will be interesting to see where this goes...

Diabetes and the Ketogenic diet

News you can use, Click here.

Researchers report (at MedpageToday) the finding that a Ketogenic diet, (one high in fat, and low in Carbohydrates) is more effective in controlling blood glucose than the earlier low-glycemic diet espoused by the Atkins Diabetes Revolution.

The study had some flaws, but the findings are worth a look and raise interesting questions that contribute to our overall understanding.

As eye physicians, we are keenly interested in blood sugar control for diabetic patients. Strict blood sugar control delays or prevents the devastating retinopathy that goes with diabetes. As always, we recommend you take this information and apply it carefully, consulting your internist with all diet and excersize decisions you make that can affect your blood sugar.

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.

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.

Diabetes and the EYE

November is Diabetic Awareness Month

Diabetic Retinopathy is the leading cause of blindness in the United States. People who are diabetic should be having an annual dilated eye examination.

Symptoms of diabetic retinopathy include:

• Seeing spots or floaters in your field of vision
• Blurred vision
• Having a dark or empty spot in the center of your vision
• Difficulty seeing well at night

If you are diabetic and have not had an annual dilated eye examination. Call us today and make your appointment now. 435-673-5577

Related Websites:

http://www.diabetes.org/home.jsp
http://www.aoa.org/diabetic-retinopathy.xml
http://diabetes.webmd.com/
http://www.nei.nih.gov/health/diabetic/retinopathy.asp