Obesity and the Eye

In honor of American Diabetes Month, I wanted to talk about obesity and how it relates to the eye. Obesity is the fastest growing epidemic in the United States, according to the US Assistant Surgeon General. The prevalence has increase 74% since 1991. Can you believe that?! You know that obesity affects systemic health, but have you ever thought about how obesity can affect eye health?

Before we get into eyes, let’s review a little. Obesity is defined as excess body fat relative to lean body mass. We most commonly measure this by calculating one’s BMI (body mass index). This can be done by dividing weight (kg) by height. For adults aged 20 years and older, a BMI of less than 18.5 is considered underweight, 18.5-24.9 is considered normal, 25-29.9 is considered overweight and a BMI. Obesity is a major contributor to chronic disease and disability. Diabetes is the most common co-morbidity associated with obesity. It has been reported that 97% of all cases of type 2 diabetes are due to excessive weight.

Now you must see where I am going with this, where there is diabetes, there can be diabetic eye disease! Obesity itself is a risk factor for the development of diabetic retinopathy (changes to the retinal health due to uncontrolled diabetes). High BMI and a high waist-to-hip ratio are significant risk factors for the development of diabetic retinopathy.

Not only does obesity increase the risk for diabetic eye disease but obesity also increases the risk of Age-Related Macular Degeneration due to changes that occur in the body. Some of the changes include increased oxidative stress, changes in the lipoprotein profile (cholesterol levels) and increased inflammation.

Obesity is also a risk factor for cataract development. In one study, patients whose BMI was 30kg had a 36% higher risk of any type of cataracts compared to those whose BMI was less than 23kg.

Obesity is a scary epidemic. We really should be doing anything and everything to increase the awareness of the complications that obesity can lead to. I hope today I have helped shed some light on how obesity can affect the eye!

Keeping and Eye on You,

Betsy W. Fraser, O.D.

information taken from: optometricnutrionsociety.org

The Visionary Diet

By now you know that I have a passion for educating my patients on the importance of eye health. I'd like to take that a step further. My goal is to educate you, my patient, on the impact total health and wellness can have on eye health. I like to call area of focus "Wellness Optometry." By keeping your body healthy through proper diet, exercise, and other lifestyle choices, you can protect your eyes against several kinds of sight-threatening diseases. I want to help you on that journey.

I want to share with you something called "The Visionary Diet." I found this while doing research on eye health and nutrition. The diet was written by Elizabeth Somer, a Registered Dietician and author of Age Proof your Body.

This diet is not meant to be inclusive of what it will take to get you to the "healthiest you" possible, but it will certainly help your eyes and body get on the right track!

The Visionary Diet:

1. Consume eight servings of colorful fresh fruits and vegetables per day.Include two servings of lutein-rich dark, green leafy vegetables and two servings of vitamin C-rich citrus fruits.

2. Take a moderate-dose multiple vitamin and mineral supplement on the days when you don’t eat perfectly. (At Family Vision Care, we recommend daily use of multivitamins if not contraindicated)

3. Limit or avoid saturated fat. Reduce the intake of meat and fatty dairy products; emphasize the eye-healthy fats in fish.

4. Wear protective sunglasses year-round. They filter out 99 to 100 percent of damaging UV rays.

5. Don’t forget regular visits to your doctor of optometry.The American Optometric Association recommends adults age 60 and under should have a comprehensive eye examination every two years, or as recommended by an eye doctor. Adults over age 60 should have an eye exam annually.

6. Smoking Cessation. Smoking can increase the risk of cataract formation, Age-Related Macular Degeneration, as well as elevates risk for several different systemic diseases that can affect eyesight. Did you know that Age-Related Macular Degeneration is the leading cause of blindness in people 55 and over in the Western world and that the incidence (new cases) is expected to triple by 2025? (I added this one in)

To me, all six points discussed above seem pretty reasonable especially if the reward is a chance to preserve our most precious gift...the gift of sight. What do you think?

Keeping an Eye on You,

Betsy W. Fraser, O.D.

Read more about today's topic: http://www.aoa.org/x12852.xml
Link to MyPyramid.gov: http://www.mypyramid.gov/

What is the buzz about Vitamin D?

I'm back! I know that it has been awhile since my last blog post--my apologies! This Summer has been crazy! I hope everyone has been doing well. I chose to talk about Vitamin D today not only because of its popularity in health research lately but also because I personally believe in the health benefits it provides. So here goes...

I recently read a newsletter entitled "Vitamin D and Mental Health." I want to share some of the highlights with you here:

Did you know that there are a number of recent studies that show that vitamin D may play an important role in the prevention and treatment of mental illnesses from depression to schizophrenia? In fact, in high doses, vitamin D had a positive effect on reducing the symptoms in patients with depression. In a paper presented on April 14th, 2010 at the American Academy of Neurology Meeting, it was reported that vitamin D deficiency appears to increase the risk of cognitive impairment, based on a large population based study of older women. Vitamin D acts as a neurosteroid hormone and research has shown that vitamin D has a unique function on the central nervous system, including the regulation of (bare with me here), neurotransmission, neuroimmunomodulation and neuroprotection (Whew)!

Vitamin D wears many hats; not only does it act on the central nervous system, but it also regulates the levels of calcium and phosphorous which are necessary for the strength and growth of bones. In addition, it does have an effect on different genes in our body that influence health and many diseases. Research continues to emerge linking vitamin D deficiency to different kinds of cancer (including breast and colon), cardiovascular disease, multiple sclerosis, diabetes and other inflammatory disorders. As far as the eye goes, vitamin D deficiency appears to be associated with both an increased risk of diabetic retinopathy and age-related macular degeneration, two of the leading causes of permanent vision loss in the US.

It is clear that vitamin D is important and the research emerging continues to support that notion. So now that you have heard some of the science you are probably thinking, "What do I really need to know about Vitamin D and how can I tell if I am deficient?"

Here ya go...

* Our bodies synthesize (or make) vitamin D when our skin is exposed to the sunlight--specifically UVB radiation. In fact about 90% of our blood concentrations of active vitamin D are derived from sun exposure. If you work inside and do not spend time in the sun, have darker pigmented skin, or perhaps live in an environment with less sun exposure, chances are your body is not producing enough vitamin D.

* Foods rich in vitamin D include cold water fish, soy beans, eggs and fortified milk

* Vitamin D3 is the most potent and active form of vitamin D. These supplements are readily available over the counter and are not very expensive.

* Many scientists now recommend a minimum of 1000-2000 IU of vitamin D3 per day for adults, with even higher dosages for people of color, those living in the Northern US, people who spend most daylight hours indoors, the elderly, and those proven deficiency by laboratory testing.

The suggested daily amount of vitamin D is still under debate. It is pretty safe to say that you are probably NOT getting enough vitamin D and you should talk to your doctor about having a simple test to check your vitamin D levels. This test is called the 25-hydroxyvitamin D test, also called a 25(OH)D. I encourage you to talk to your primary care physician about vitamin D and find out your levels!

There is a lot more that can be said about the daily value of vitamin D, but I didn't want to overwhelm you! If you have any questions please don't hesitate to ask!

Keeping and Eye on You,

Betsy W. Fraser, O.D.

Sources: Ocular Nutrition Society. Chous, Paul: "Vitamin D and Mental Health." August 2010 Newsletter

Can Working on the Computer Really Affect My Eyes?

Yes it can! Let's explore the how and why...

People who sit in front of a computer for long periods of time may experience a variety of uncomfortable symptoms. Headaches, neck strain, backaches and wrist pain are common, but, sadly, the most prevalent symptoms of prolonged computer use-eye strain, blurred vision and dry-eye are often overlooked.

So there you are at work, sitting in front of your trusty computer, looking straight ahead for hours right? Most often you will find yourself in a dry work or home and environment and research tells us that you will actually blink LESS while working on the computer. These factors can lead to vision problems. In addition, computer use actually requires specific vision skills, which add further demands to the visual system and contribute to eye and vision discomfort. Here are the skills we are talking about:

*Ocular motility--the ability of the eyes to move in various positions

*Accommodation--the ability of the eyes to focus clearly at various distances

*Vergence--The ability to move the eyes in (convergence) or out (divergence)

While you may not be able to decrease the time you spend on the computer (because it's work, right?), DON'T FRET, there are things you can do to make you visual system more comfortable and your eyes less dry! Thanks to the American Optometric Association, below are some variable factors that can play a part in computer vision syndrome, that you may be able to adjust:

• Screen resolution — Better resolution offers greater clarity and usually leads to improved comfort. Adjust the resolution to the highest resolution your monitor will support. If the increased screen resolution makes items too small, try increasing the font size (DPI) to compensate.
• Screen contrast — Adjust the contrast between the characters on the monitor and the background so the letters are easily read. Adjust the brightness of the monitor to an intensity that is comfortable to your eyes--not too bright and not too dim. Adjust both brightness and contrast for the best clarity.
• Screen glare and reflections — Minimize reflected glare on your monitor by using window treatments, dimmer switches on lights and glare reduction filters. Look for glare reduction filters that have received the American Optometric Association Seal of Acceptance. Proper adjustment should eliminate any reflected images from the monitor screen. To reduce glare, eliminate bright light sources from your peripheral vision and position your monitor perpendicular to windows or other bright light sources.
• Image refresh rates and flicker — A higher refresh rate for your monitor is best. The image on the screen should not flicker at all. (This is not a concern with LCDs.)
• Working distances and angles — It is important to work at a distance that is comfortable for you and where the image on the screen is clear. Having to move your head to an awkward angle to see the screen clearly suggests that your prescription may need adjustment.
• General eyeglass prescription may not be adequate — Computers are usually further and higher than a typical reading task. Glasses for most people wearing bifocals are not adjusted for this new distance or angle and therefore often are not adequate for using the computer.
• Repetitive and stressful tasks — Difficult tasks are challenging. Don't forget to take occasional breaks and let the eyes look far away while resting

Here are some more tips from the American Optometric Association on setting up your workstation for comfortable computer use:

Is Your Work Station Properly Arranged?

• Feet should be flat on the floor (or on a slightly angled foot rest) with knees bent close to or greater than 90 degrees.
• Chair seat should support the legs without excessive pressure on the back of the thighs.
• The back should be snug against the seat to fit your spinal contour. Thigh-to-trunk angle should be 90 degrees or greater.
• Wrists and hands should extend nearly straight from the elbow to the home row of the keyboard.
• A commonly preferred work surface height for keyboard use is about 26" as opposed to the conventional 29" of most tables or desks.
• Place the monitor 20"-26" from your eyes, depending on the size of the monitor and individual vision conditions.
• The monitor and keyboard should be straight ahead.
• The top of the monitor should be slightly below horizontal eye level. Tilt the top of the monitor away from you at a 10 degree to 20 degree angle. The center of the monitor should be 10 degrees to 20 degrees below your eyes. This is 4?-9? below your eyes at a distance of 24"
• Keep the monitor free of fingerprints and dust. Both can reduce clarity.
• Place document holders close to the screen within the same viewing distance. Keep the keyboard and monitor in line.
• Adjust the keyboard tilt angle so that wrists are straight.

Hopefully the above has been helpful! The best place to start if you feel like you are suffering from computer vision syndrome is to see your optometrist for a comprehensive eye exam. He/She will determine if you will benefit from computer glasses and will come up with a plan to make your eyes more comfortable!

I want to leave you with a few tips that you can start doing NOW to help your eyes feel better as you work away on the computer:

- take breaks--every 10-20 minutes look up from your computer

- stay hydrated--keep water at your desk

- keep your eyes lubricated--use artificial tears every few hours to keep those eyes feeling refreshed

Questions? Don't hesitate to ask. Thanks for reading!

Keeping an Eye on You,

Betsy W. Fraser, O.D.

Nearly Half Of Americans Have High Blood Pressure, High Cholesterol, Or Diabetes.

Can you believe that?! I just read that statistic in an article this morning. The truth can sometimes be scary and this is definitely one of those times! The Los Angeles Times reports that "1 in 8 Americans has at least two of the conditions and 1 in 33 has all three."

The article on WebMD summarized a new study published by the CDC. Here are some highlights from the study: "It is well know that high blood pressure, high cholesterol, and diabetes all increase the risk for cardiovascular disease, a condition that affects more than 81 million Americans and accounts for one out of every three deaths in the US. What is less known is the co-existence of these three conditions based on race/ethnicity, as well as the prevalence of diagnosed vs. undiagnosed high blood pressure, cholesterol, and diabetes among these groups. The study shows that about 8% of adults have undiagnosed high blood pressure, 8% have undiagnosed high cholesterol, and 3% have undiagnosed diabetes."

So now you may ask ok, so Dr. Fraser is an optometrist; why so much information on systemic diseases? Well all three of the diseases mentioned above if uncontrolled or untreated can show up in the eye and can in the most severe cases lead to blindness. Yes...blindness!

Some of you may know that my undergraduate degree is in Health Science (public health degree from the greatest university in the country...CLEMSON of course)! Because of this background, my passion is educating friends, family members and patients on the importance of healthy living and how that impacts eye health.

Let's start with Diabetes. According to an article I read on WebMD an estimated 18 million Americans have diagnosed Diabetes and another 5.7 million Americans are walking around with undiagnosed diabetes. Pretty astounding numbers isn't it? I thought so; although I can't say that I am surprised with the way Americans live today! Diabetes is a disease that interferes with the body's ability to use and store sugar, which can cause many health problems. Too much sugar in the blood can cause damage throughout the body, including eyes. Over time, diabetes affects the circulatory system of the retina. The tiny blood vessels that line the back of the eye can become leaky and new blood vessels can grow where they should not be growing. Trust me, you don't want this happening to your eyes!

Let's move on to high cholesterol. The same article reported more than 102 million US adults have elevated cholesterol levels--meaning a total blood cholesterol measurement of 200mg/dL or higher--and 35.7 million among this group have cholesterol levels 240 mg/dL or high and considered high risk. Tiny plaques can be observed in the blood vessels that line the back of the eyes in patients with hypercholesterolemia (high cholesterol).

Finally let's address hypertension (high blood pressure). High blood pressure accounted for more than 56,000 deaths in the US in 2006; and about 74.5 million people age 20 and older have high blood pressure. So again, we see here that a large number of Americans are living with this disease as well. Hypertension is dangerous because it makes the heart work harder to pump blood to the body and it contributes to hardening of the arteries (atherosclerosis) and the development of heart failure. As an optometrist, I have the ability to detect uncontrolled or undiagnosed hypertension if it is affecting the eyes. Most often we will see changes to the blood vessels that line the back of the eyes.

So as you can see keeping your body healthy is good for so many reasons, one being eye health! I hope this entry has been helpful Please don't hesitate to ask questions. I would love to hear from you. Thanks for reading!

Keeping an Eye on You,

Betsy W. Fraser, O.D.

Do you like to see how long you can make your contact lenses last?

If you answered yes, the picture shown here is why your eye care professional may scold you. I know, I know, I should have warned you about the photo. This is a mean corneal ulcer that can be caused by guess what? Over wearing your contact lenses!

In today's economy, we are all trying to save money somewhere right? I get that, but trust me trying to stretch out your contact lens supply is NOT the way to do it!

With so many different kinds of contact lenses out there and with several modality options, it is important for you to know what type you are wearing. The most common modalities are two week disposable lenses, monthly disposable lenses and daily disposable lenses. The two week lenses (ex. ALL Acuvue products are two weeks) and the monthly lenses (example Air Optix or Focus) can be broken down a little further. Some of those lenses can be worn on an extended basis (over night) and some cannot. This is another important distinction to make: are your lenses approved to be worn on an extended wear basis? When I say approved, I mean approved by the FDA, yes that is right, the FDA. If you don't know the answer to this question, I can help you! Just ask.

Now let's talk a little bit about what can happen to your eyes if you are wearing your contacts too long. One of the main issues is the fact that anytime you have a medical device (a contact lens is considered to be a medical device) on your eye, you are decreasing the amount of oxygen that is getting to the cornea.Your cornea, which is the clear part of the eye (where the contact lens sits) is a very unique tissue. It is unique in the sense that there is no blood supply. When the brain senses that there is not enough oxygen getting to the cornea, it will stimulate the production of new blood vessels to deliver oxygen to the cornea. This is called corneal neovascularization. A big word that really just means new blood vessel growth. This is bad because corneal neovascularization can cause scarring and lead to permanent vision loss (in severe cases).

The longer you keep those contact lenses on, the higher your chance for developing neovascularization. It doesn't stop there either! Think about it, sleeping in your lenses night after night, wearing them continuously day after day without removing them is creating a breeding ground for bacteria. Nice thought right? As you can see from the picture, it's not a pretty site either! Bacteria can get trapped underneath the contact lens and will essentially start eating their way through the cornea leaving a very painful ulcer. This can cause vision loss in some patients. It really depends on the severity and the location of the ulcer.

Have I made you think a little? My goal here is not to scare you away from contact lenses; they are great when worn as recommended by your eye care professional. In fact, I have mine on right now. We really aren't trying to be the bad guys. We just want to prevent your eyes from looking like the one in the picture shown here!

Thanks for reading!

Keeping an Eye You,

Betsy W. Fraser, O.D.

Kale...what is it?

It may seem like it is a new buzz word. Kale is becoming increasingly more popular! Ok, so let's get to it. One of my favorite sites happens to be Wikipedia. According to Wikipedia, Kale or borecole is a form of cabbage (Brassica oleracea Acephala Group), green or purple, in which the central leaves do not form a head.

Kale is considered to be highly nutritious with powerful antioxidant properties. It is also considered to be an anti-inflammatory. In the eye world, we have always educated our patients on the importance of green, leafy vegetables, including, spinach, kale and collard greens. Boy am I glad that the word is getting out! I know this because now my favorite salad bar (Whole Foods) has kale as an option. It is always mixed with a "garlicky" dressing that just tastes delicious! You can buy kale at most grocery stores near the lettuce section. At Publix, where I tend to shop the most, I buy it bagged and it can be found next to bagged collard greens.

Kale is very high in beta-carotene, vitamin K, vitamin C, lutein and zeaxanthin as well as rich in Calcium. Even if you don't know much about nutrition, you can see that this green leafy veggie is packed full of essential nutrients needed in our diet everyday! Let's go a little deeper:

-Beta carotene: It can be converted into vitamin A which serves a vital role in eye health. Beta carotene can be found in, yep you guessed it...carrots! But it can also be found in mangoes, papayas, sweet potatoes, kale (of course), spinach and collard greens.

-Vitamin K: Because of kale's high vitamin K content, patients taking anticoagulants such as warfarin are encouraged to avoid this food since it increases vitamin K's concentration in the blood, which is what the drugs are often trying to lower. Please consult your physician if you are taking any of these medications before adding kale to your diet.

-Vitamin C: We all know that vitamin C is essential to our daily diet. Ascorbic Acid (which is another name for Vitamin C) is necessary for collagen to form in bones, cartilage, muscle and blood vessels. Sources include fruits and vegetables, particularly citrus fruits such as oranges.

-Lutein and Zeaxanthin: They are both important for eye health. Studies have suggested that supplementing with both may lower one's risk for developing macular degeneration as well as cataracts. Sources include those green leafy vegetables I keep talking about; kale, spinach and collard greens.

-Calcium: We all know that calcium is important for bone health and strength. Now you can add kale to you diet knowing that it is providing you with extra calcium!

I found it to be interesting that kale freezes very well and actually has a sweeter flavor after being frozen. I love to add fresh kale to other mixed greens in all of my salads as well as use kale in all of my soup recipes.

Hopefully now you have a better understanding of what kale is and how it can be used. Happy cooking!

Keeping an eye on you,

Betsy W. Fraser, O.D.

Sources included: www.mayoclinic.com and wikipedia.org

Zinc: What you need to know about it!

Good Afternoon All,

This is my first blog post! I know, I know, it may not be a big deal to you, but to me--a technologically challenged individual, this is a big deal!

I am an associate optometrist at Family Vision Care in Mount Pleasant, SC. At our practice, we are dedicated to providing our patients with the highest quality eye care. But in addition, we want to keep our patients informed and up to date on nutrition and how one's diet can affect the health of his/her eyes. Research suggests that more than 40 vitamins, minerals and antioxidants are required on a daily basis for optimal health and disease prevention. So here goes...

I just read an article in an optometric magazine that discussed the importance of zinc and why it should be incorporated into your daily diet. Zinc is actually an essential trace mineral that helps reduce the number of free radicals in the human body. What is a free radical you ask? According to Answers.com, a free radical is defined as an atom or group of atoms that has at least one unpaired electron and is therefore unstable and highly reactive. In animal tissues, free radicals can damage cells and are believed to accelerate the progression of cancer, cardiovascular disease, and age-related diseases.

In addtion, zinc is vital in helping your body absorb Vitamin A and transport the Vitamin A from the liver to the retina. Vitamin A plays an important role in producing melanin, which is a protective pigment in the eyes. Because of this, it is actually fair to say that zinc plays a role in preventing nyctalopia (night blindness).

It has also been suggested that zinc can reduce the risk of Age-Related Macular Degeneration (AREDS study). In addition, supplementing with zinc could help prevent cataract formation (Blue Mountains Eye Study, Beaver Dam Eye Study).

So, as you can see, consumption of daily zinc is very important for the health of your eyes! Zinc is found in red meat, poultry, oysters, fortified breakfast cereals, nuts, baked beans, milk, and of course in multivitamin/mineral supplements. Keep in mind that high doses of zinc may cause stomach upset. The recommended dietary allowance (RDA) is 11 mg for men and 8mg for women.

Now you are thinking...ok great information, but what can I make for dinner that will be a good source of Zinc? Try an old favorite of one of MY favorites, (Ms. Julia Child)...Beef Bourguinon. Bon Appetit!

Much more to come on nutrition and the role it plays in keeping you and your eyes healthy! Thanks for reading.

Keeping an Eye on You,

Betsy W. Fraser, O.D.

Sources include: Review of Optometry (March), American Optometric Association, and The Optometric Nutrition Society