Original AREDS

The first AREDS study looked at these vitamins for the treatment of AMD:

- 500 mg Vitamin C

- 400 IU Vitamin E

- 15 mg beta-carotene = 25,000 IU of Vitamin A

- 80 mg Zinc

- 2 mg Copper (as cupric oxide)

The study found that this vitamin combination prevented AMD progression and central vision loss in patients who had intermediate dry AMD or worse. However, there was concern about the beta-carotene/Vitamin A component of this formula — it may lead to a higher risk of lung cancer in smokers. Thus, the followup AREDS2 study sought to eliminate Vitamin A from the formula and replace it with the carotenoids naturally found in the retina: lutein and zeaxanthin. The study designers also added omega-3 fatty acids to see if that would also reduce the risk of AMD progression in the study population.

AREDS2 Results

In short:

- Omega-3 fatty acids did not help reduce the risk of AMD progression

- Elimination of beta-carotene/Vitamin A did not have a detrimental effect on the risk of AMD progression

- Replacing beta-carotene with lutein and zeaxanthin resulted in a slight reduction in the risk of advanced AMD when compared to those who took AREDS with beta-carotene

Current Recommendation

Based on these data, my current recommendation for those with mild dry AMD is to take a regular multivitamin (like Centrum Silver).

If you have intermediate dry AMD or advanced AMD, I recommend taking:

- 500 mg Vitamin C

- 400 IU Vitamin E

- 80 mg Zinc

- 2 mg Copper (as cupric oxide)

- 10 mg Lutein

- 2 mg Zeaxanthin

(Note that beta-carotene/Vitamin A has been eliminated from the original AREDS formula and replaced with lutein and zeaxanthin). Patients can take omega-3 fatty acids if they wish. While there were no additional ocular benefits found in the AREDS2 trial, omega-3 fatty acids may have other positive health benefits.

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(Note: I have no financial relationship to any of the commercial products described)

The Virus

Shingles is caused by the varicella zoster virus. The primary infection causes chicken pox, which many of us had as children. (You may remember this as a rash with a fever that kept you out of school for a few days). After the chicken pox are over, the virus remains dormant in the body, where it can remain inactive for decades.

When it reactivates, it causes a rash that is often preceded by a few days of pain, tingling or burning. This can happen randomly, or it can be the result of a stressor like illness or immune suppression.

The Rash

The rash begins with red patches followed by small blisters. Sometimes these blisters are described as looking like “dewdrops on rose petals.” Eventually the blisters crust over and fall off in two or three weeks.

If shingles affects the face, there is a 10 to 25 percent chance it can involve the eye (especially if the tip of your nose involved). If not properly treated, it can cause vision loss.

Herpetic eye disease can manifest itself in many ways: pink eye, corneal ulcers, or inflammation in the front of the eye, retina or optic nerve. Sometimes the eye pressure can also become elevated.

If you have herpes zoster in your face, I recommend that you get examined by an ophthalmologist to see if the eye is involved.

Treatment

The treatment will likely involve antiviral medications like Valtrex (valaciclovir). In most cases,  you can take this medicine by mouth, but sometimes treatment has to be intravenous acyclovir. These medications reduce pain and shorten the time course of the disease.

Avoid giving it to others

Shingles is contagious, so don’t expose young infants, pregnant mothers or people who are immunocompromised  to the open sores or materials that come in contact with the rash.

What about the vaccine?

A vaccine is available to prevent herpes zoster. The vaccine has been shown to be effective in either preventing shingles from occurring or lessening the symptoms should it develop.

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(Image credit: numaderm.com)

A red eye with a watery discharge are key features in viral conjunctivitis

Given the number of colds and viral infections this season, I’ve seen a lot of pink eye. Some of my friends and people I work with have even caught pink eye, or viral conjunctivitis.

Definition

The term conjunctivitis refers to inflammation of the thin membrane that covers the white part of your eye and the insides of your eyelids. It has a lot of tiny blood vessels that become swollen and more noticeable when the conjunctiva becomes irritated. This makes it look pink.

What causes it?

Pink eye is often caused by the same viruses that cause the common cold and it’s very contagious. (You probably already know that if you’ve ever had pink eye.) Symptoms of viral conjunctivitis can last from a few days to two weeks. Fortunately, the symptoms will disappear on their own. You can use cool compresses or artificial tears that have been chilled in your fridge (my favorite) to help relieve some of the symptoms while you are waiting for it to go away. These typically are the only treatments that are necessary. Rarely, a severe case of pink eye can benefit from anti-inflammatory drops prescribed by an ophthalmologist. Contrary to popular belief, antibiotic eyedrops and urine do not cure viral conjunctivitis.

How do you get it?

Since pink eye is very contagious, you can get it by:

• Forgetting to wash your hands often and touching your eyes
• Reusing tissues and towels when wiping your face and eyes
• Not cleaning your contact lenses properly and using poorly fitting contact lenses or decorative contacts

Children are very susceptible to getting pink eye because they are in close contact with so many others in school or day care centers.

Signs of pink eye

Crusty eyelids and watery eyes with a light discharge is likely. You can also have eyelid swelling, a foreign body sensation, eye irritation, itchiness, blurry vision, and your eyes glued shut in the morning from the goop.

While pink eye usually starts in only one eye, it commonly spreads to the other eye.

What you can do to prevent it

Practicing good hygiene can help prevent the spread of infectious conjunctivitis. You should:

• Wash your hands often
• Avoid touching your eyes and face
• Don’t share towels, washcloths, or pillows
• Replace your eye makeup regularly with new ones, and also do not share them
• Always clean your contact lenses properly

How long are you contagious for?

The general rule is that if you have symptoms of pink eye and a watery discharge, you are contagious. So try not to infect others. Let the infection run its course and you will be back to school or work within a few days to a few weeks.

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(Photo credit: answers.com)

What it is

Acupuncture broadly applies to the use if procedures that simulate the skin. Usually, these techniques employ solid thin metal needles that are manipulated manually or by electrical stimulation. Acupuncture has been used in the Chinese health care system for thousands of years to correct imbalances in energy flow (Qi). Previous studies have shown that acupuncture can alter blood flow, immune functions, the secretion of neurotransmitters and neurohormones, and the release of opioid peptides.

What can it treat?

Dry eye – one small study found favorable results for using acupuncture to treat dry eye (p<0.01). This is an area of interest in ophthalmology as there are currently no great treatments for dry eye and dry eye affects millions of people.

Headache – looking at 16 studies that treated headache with acupuncture, 7 of them found acupuncture to be equally as effective as standard therapies. Of the remaining 9 studies, 8 found that acupuncture was more effective than standard therapies.

The downside to all of these studies (dry eye and headaches) was that they were not as scientifically rigorous as one would want.

There were some more studies that looked at acupuncture for the treatment of myopia, paralytic strabismus, retinitis pigmentosa, optic atrophy, retrobulbar neuritis, maculopathy, iritis, conjunctivitis, and cataracts. They were all inconclusive.

Risks

While there are risks with anything in life, the risks of acupuncture are low. Complications arise from improper needling and can lead to organ puncture and pneumothorax. The use of unsterilized needles can also lead to infections.

The bottom line

The National Institutes of Health (NIH) concluded that there is insufficient evidence to make a ruling on the effectiveness of acupuncture for the treatment of headaches, but in the studies reviewed, two of them showed a positive trend toward the benefit of acupuncture for relieving headaches. For other ocular conditions, they believe that there is not enough evidence to demonstrate the safety and efficacy of acupuncture when compared to standard therapies.

So while the official jury is still out, I recommend to my patients to try acupuncture if they want. It just might work.

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(Photo credit: freedigitalphotos.net)

The report describes 96 cases (from 1985 to 2012) of children aged 1 month to 5 years old who inadvertently ingested the contents of allergy eyedrops or nasal decongestant sprays. Some children had been chewing or sucking on the bottles, which are not child-resistant. No one died, but half of the kids ended up in the hospital for symptoms like: heart rate abnormalities, decreased breathing, stupor, hypothermia, drooling, nausea/vomiting, and coma. The children had swallowed anywhere from 0.6 mL to ~45 mL of the medications. (These drops come in 15 mL and 30 mL bottles.)

The bad stuff

These “get the red out” eyedrops contain imidazoline derivatives (tetrahydrozoline, oxymetazoline, or naphazoline) — that work by constricting blood vessels on the surface of your eye. When ingested by a small child, they can produce a coma. Just because these drops are “over the counter” doesn’t mean that they are harmless.

What you can do

• Keep all medications out of the reach of your kids. Store them up high.
• Don’t use them in front of your children. I don’t know about your kids, but if do something like putting on lip balm in front of my kids, they immediately want to do the same thing.
• Close the bottles after every use (this will also help prevent the eyedrops from becoming contaminated).

If you think your child has swallowed some of your eyedrops, call Poison Control 800-222-1222 and then seek immediate emergency care.

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Note: I have no financial relationship to any of the products discussed in this post.

This is exciting news because the Second Sight device is the first bionic eye approved for patients in the US.  The Argus II is the first treatment in existence that can replace the function of lost photoreceptors (light sensing cells) in the eye.

How it works

The device transmits images from a small, eye-glass-mounted camera to a microelectrode array implanted on a patient’s damaged retina. The patient gets about 20 degrees of visual field.

Who can get it?

The FDA approved the device for people who have lost sight from retinitis pigmentosa (RP), which affects one in every 4,000 Americans.

What can they see?

The implant allows RP patients who are completely blind to locate objects, detect movement and discern shapes such as large letters. Pretty amazing considering that these patients were completely blind prior to the surgery.

Long time coming

The research team began their work in he 1980s and have received close to $200 million in funding from both governmental (NSF, NIH, DOE) and private sources to bring this device to market.

The price of this device is speculated to be around $100,000. There is no word yet about insurance coverage.

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Photo credit: nsf.gov

(Note: I have no financial relationship to the company or products described in this post.)

This week the results of a research study looking at the risk of aspirin use and the development of wet age-related macular degeneration (AMD) was published in the journal, JAMA Internal Medicine. This is a very important topic as many elderly people use aspirin on a daily basis (e.g. to reduce the risk of heart attacks and strokes) and AMD is the number one cause of blindness in the elderly population of western countries, like Australia and the US. There are two forms of the disease, a dry (non-exudative) form and a wet (exudative) form. Wet AMD can lead to rapid vision loss and blindness if not properly treated in a timely manner.

The Study

The study looked at 2389 Australians during a 15-year period (1992-1994 to 2007-2009). In that time 257 (10.8%) were regular aspirin users and 63 (24.5%) developed wet AMD.

Results

The authors found that aspirin users had a 9.3% incidence of wet AMD, compared to 3.7% in nonusers.  This resulted in an odds ratio of 2.46 for developing wet AMD with aspirin use. Also, the more frequently someone used aspirin, the more likely they were to develop wet AMD (2.2% in those who never took aspirin, 2.9% for those who used it only occasionally, and 5.8% for those who took aspirin routinely). Lastly, aspirin use was not associated with risk for the advanced form of dry AMD (called geographic atrophy).

What does this mean?

While this one study showed a correlation between aspirin use and the development of wet AMD, correlation does not imply causation. There could have been other associated factors that the researchers did not uncover that was related to the development of wet AMD. It’s too early to jump the gun and recommend that our elderly patients stop taking aspirin if they are at risk for wet AMD. There could be many ill consequences to stopping aspirin, like increased strokes and heart attacks, so changing aspirin use recommendations should not be taken lightly.

Also, in Australia, the average aspirin dose is 150 mg, while it is 81 mg in the US. It is unclear whether the dose of aspirin is related to the risk of developing wet AMD, as the researchers in the study did not look at different doses.  It could turn out that the American 81 mg dose does not increase the risk of developing wet AMD.

The bottom line is that it is too early to make any recommendations on the use of aspirin in patients with AMD. Further research is needed to delineate the relationship of aspirin to to AMD.

The Study

The authors examined 20,963 subjects aged 40 to 69 over a 3 year time period. (That a lot of people!)

The Results

They found that drinking more than 20 g of alcohol per day (more than 2 drinks) was associated a ~20% increase in the odds of developing early AMD when compared with non-drinkers. It did not matter if the alcohol came in the form of wine, beer or spirits, the result was the same. There was also no difference found between men and women — both were at risk with high alcohol consumption.

More results

We’ve all heard that drinking a glass of wine per day may be good for our hearts.  Well unfortunately, this study found no protective effect for the eye with mild wine consumption. Also, there was no evidence that those who concentrated their consumption into fewer days had higher odds of early AMD than those who drank every day.

Reading this, do you think you or someone you know needs to cut back on drinking?

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(Photo credit: freedigitalphotos.net)

Since our launch in April, the number of visitors has steadily increased and includes visitors from 85 different countries.

The 5 most viewed posts in 2012 were:

The retina – a compilation of facts about the sensory nerve tissue in the back of the eye

Urine and other things you shouldn’t put into your eye – what happens when bad things get into your eyes

Pregnancy and the eye – information about the possible visual changes during pregnancy and childbirth

Are my eyes going to be OK? I haven’t taken my contacts out for a month – a story about poor contact lens care and what can go wrong

Do antibiotics cause retinal detachments? – addressing concerns about a recent article that may link the use of certain antibiotics and retinal detachments

Thanks for visiting in 2012. See you in 2013!

The light of the flash on most cameras is usually located only a few inches away from the camera lens. When the flash goes off, light goes straight into the pupil and gets reflected off the back of the eye, and straight in to the camera lens. The effect is magnified with dilated pupils–that’s why “red eye” mode of cameras involve a pre-flash before the main flash: so pupils become smaller before the real picture is taken and the red eyes are minimized.

Why red?

As flash light enters the eye, it is reflected back into the camera lens. The retina (nerve tissue in the back of the eye) is essentially transparent, but the underlying choroid has pigment and a lot of blood vessels. It’s the choroidal blood that gives the reflected light coming out of the eye its reddish hue.

Other ways to minimize red eye

Besides using the red eye mode of your camera’s flash. Reducing red eye can be accomplished by using physics. If red eye is caused by the flash light being sent in a straight line into the eye and then directly reflected back out, it can be decreased by having the flash source away from the camera lens. Angled light going into the pupil will be reflected out at an angle, so less of it will hit your camera’s lens. Consider using a detached flash unit located several feet away from the subject you are shooting, or reflecting the flash off the ceiling.

Does anyone else have any tips for eliminating red eye in photographs?

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(Photo credit: freedigitalphotos.net)