The Eye Practice

Macular Degeneration we know is a serious issue.  It accounts for the greatest number of people going blind in an age group greater than 50 years of age. With an aging population this potentially will become an enormous burden on society in the near future.

Finally though we seem to have some great news from a study done in Denmark.  In the last 5 years or so a treatment finally has been developed, which seems to have halved the rate of new cases of blindness appearing.  The study compared new cases of blindness documented in the year 2000 versus new cases in 2010.

This treatment does not sound great because it involves injecting a drug called Lucentis into the eye, as often as every month!

Even though this treatment might sound very pleasant, the alternative of going blind you have to admit is even less pleasant.  What is clear from the many patients we have referred for this treatment is that once you have experienced the process it is not so bad.  In fact some patients will go as far as saying that giving blood is more unpleasant.

The drug Lucentis is from a family of drugs called anti vascular endothelial growth factors (anti-VEGFs).  The company that makes Lucentis specifically for macular degeneration makes another drug from this family called Avastin.  Avastin is used for treatment of colon cancer.

So why I are we talking about a colon cancer drug in a macular degeneration article?  Very simple reason is that because both these drugs are similar in chemical formula retinal specialists a while back started to use Avastin off label for macular degeneration.  Off label means that the drug has not gone through extensive trials for macula degeneration.  It had only been extensively tested for colon cancer.

The results though seem to be equivalent to Lucentis and very importantly, Avastin is around 1/10th of the cost.  This is such a big issue that the American government body NEI has now sponsored a trial using the two drugs head to head.  Preliminary data seems to show that they are equivalent and maybe interchangeable.  In an era where health care is becoming horrendously expensive, this type of trial is very important.

Anti-VEGFs are now the standard of care for macular degeneration around the world and it will be interesting to see whether the Denmark experience is repeated in other countries.  We suspect it will!

The article mentions that Israel seems to be experiencing a significant lowering of blindness, which seems to be related to the use of anti-VEGFs.  For those interested the article can be found by CLICKING HERE.

Even though these studies are exciting news for macular degeneration, this is not a cure.  The key is still to have regular comprehensive eye examinations.  Always ask your eye practitioner if they have checked your macula. The later macular degeneration is discovered the less effective any treatment will be.

At The Eye Practice detection of eye disease and preserving your vision is our priority.  Call us on 92901 1899 or BOOK ONLINE HERE.

Macular Degeneration has been associated with many risk factors.  We have discussed these before but some risk factors include:

• Age
• Having light coloured eyes
• Being female and long-sighted
• Smoking
• Being overweight
• Lack of green vegetables, Omega 3 and an anti-oxidant called Lutein in the diet

A recent study seemed to link a lack of Vitamin D now to macular degeneration.  Vitamin D is a very important vitamin.  Historically a lack of Vitamin D caused rickets.  Rickets weakens and softens bones and was very prevalent in England in the 1600's.  In was not until the 1900's that the association of Vitamin D and rickets was discovered.

Lack of Vitamin D today is associated with lack of outdoor activity.  Some exposure to sunlight is needed to manufacture an appropriate amount of it.  This does not mean to get hours of sunlight but at least 15 minutes per day.  The darker your skin the more you need.

Some foods are rich in Vitamin D, while some milk is fortified with it.  Salmon for example has some some Vitamin D but the best and easiest source is the sun. Remember everything in moderation. Don't get sun burnt just 15 minutes per day and preferably if its summer not in the middle of the day.

What is interesting is that lack of Vitamin D seems to be associated with a whole host of things other than just rickets.  Lack of Vitamin D seems to be associated with asthma, some cancers, autoimmune diseases, obesity and cardiovascular issues.

Ok so let's get back to the study that seemed to imply that lack of Vitamin D was related with macular degeneration.  We have to admit it is a bit far fetched! The study was done on mice!

It showed that mice that were deficient in Vitamin D compared to a group of mice that were not had all sorts of irregularities with their eyes.   Does this mean that this study can be extrapolated to human eyes?  Probably not at the moment.

For those interested CLICK here for a link to the newspaper article.  What is important to know is that Vitamin D today is lacking in many people, while the incidence of asthma, some cancers, autoimmune diseases, obesity and cardiovascular issues are on the increase.  Being associated is not necessarily a cause.  Medical science proceeds slowly and with caution.  What is clear though is that if you can't get the sunlight or you are scared of getting skin cancer from too much sun, then supplementing with a vitamin tablet containing Vitamin D might be the way to go.

On your next blood check get your GP to look for Vitamin D deficiency and get on top of it if it is an issue.  If lack of Vitamin D does proved to cause macular degeneration by taking enough Vitamin D will put you ahead later in life.

In the mean time you should also keep getting you macula checked.  Make an appointment at The Eye Practice on 9290 1899 or BOOK ONLINE HERE.

Cataracts are quite common but...

Did you know that at least 50 million people around the world lose vision as a result of cataracts, annually?

If cataracts are detected early they can be treated and vision restored. Left undetected, would mean permanent vision loss.

So, what are cataracts? Basically, when a cataract develops, there is a loss of transparency on the lens of the eye. It is like a clouding effect on the lens of the eye. This limits the amount of light that can pass through the lens to the retina. Over time, as cataracts progress, less light can pass through the lens and you slowly yet painlessly lose vision. This can often occur as a natural result of aging, but all too often it is found in younger people.

Why?

One risk factor is smoking! Compared to non smokers, smokers of 20 cigarettes or more per day are twice as likely to develop cataracts. The more cigarettes smoked per day, the higher the risk.

Studies show that cigarettes contribute to the formation of cataracts in two ways.

1. Free radicals found in tobacco smoke attack the eye directly, potentially damaging lens proteins and the fiber cell membrane in the lens.*

2. Smoking reduces the body's level of antioxidants and certain enzymes which may help remove damaging protein from the lens.**

Smoking has been associated with a myriad of negative ocular health effects including Age Related Macular Degeneration and Dry Eyes.

As eye care professionals we strongly recommend that smokers seek help to stop smoking. Health campaigns have certainly improved public awareness on the connection between tobacco and visual impairment, so if you are a smoker and  concerned about your ocular health, come in and see one of our highly trained optometrists for a comprehensive eye health evaluation.

*McCarty CA, Nanjan MB, Taylor HR. Attributable risk estimates for cataract to prioritize medical and public health action. Invest Ophthalmol Vis Sci 2000;41:3720–25.

**Shalini VK, Luthra M, Srinivas L et al. Oxidative damage to the eye lens caused by cigarette smoke and fuel smoke condensates. Indian J Biochem Biophys 1994;31:261–66.

Macular Degeneration is more likely to occur as we get older. What is also more common as we get older is that we will be advised by our doctor to start taking a low dose of aspirin.

Low dose aspirin is known to thin the blood so the likelihood of blood vessel blockages is significantly reduced hence life expectancy is increased - what a great thing!  But...

A recent study published in a world recognised medical journal (Ophthalmology) concluded that there was a significant risk of more severe macular degeneration in a group of people taking aspirin daily.  Potentially this is a huge issue if proven to be a real risk factor.

The study involved over 4000 participants who were all at least 65 years of age.  Like any study there were some limitations but some very solid data was able to be extracted with a high level of confidence.

As the frequency of aspirin increased so did the likelihood of more dramatic macular degeneration. 

Patients taking aspirin monthly or less had a similar rate of macular degeneration than those not ever taking aspirin. 

Patients taking aspirin at least weekly but less than daily had an increased risk of macular degeneration of around 30%, whilst the group taking aspirin daily, increased the risk to greater than 2 times.

The best conclusion that can be made from this study is (with the advice of your doctor and your expert optometrist or ophthalmologist) to consider at least reducing your intake of aspirin for the time being, until a more definite study gets published.

If you have a high risk of stroke and do not have any signs of macular degeneration then continuing with aspirin is absolutely advisable.  On the other hand if your risk of stroke is low and you have moderate macular degeneration then a reduction of dosage with the supervision of your treating practitioners might be advisable.

Never change your medication without the direct supervision of the prescribing doctors.

What is amazing about this study is that aspirin had been hailed as a miracle drug to the point that some people had recommended its use in everyone over the age of 40, irrespective of health.  As usual the best perspective is one of balance. 

Another classic example of balance is UV exposure and the risk of melanoma.  In Australia especially, we have the highest rate of melanoma in the world - this is for a number of reasons.  Over the last 20 years the has been a huge education program in getting out of the sun.  This has probably resulted in a huge increase in Vitamin D deficiency, which is possibly related to an increased risk in bowel cancer!

We just can't win, but what seems to be clear is that moderation is the key and every person is unique in how they react.

An individualised approach to every patient with macular degeneration is the best way to minimise the risks for that individual.

If you are concerned about macular degeneration make an appointment to see Dr Jim Kokkinakis at the Eye Practice.  He will guide you in the right direction.  Call 9290 1899 or Book Online.

Macular Degeneration is a huge concern because it is the leading cause of blindness in an aging population over the age of 50.  The problem is that this age bracket is increasing dramatically in numbers and no cure exists.

Macular Degeneration comes in two forms: Dry and Wet.  

Most of the current research has been directed towards the Wet form, as even though it represents only 10% of the macular degeneration patients, it causes significantly more severe vision loss.  If one has the wet form of macular degeneration, the best drugs to treat this are called anti-VEGFs.  These drugs currently have to be injected into the eye as often as every month.

More and more research has been directed towards the inconvenience and significant cost of having to front up every month to try and preserve vision.

So what about the Dry form of macular degeneration?

Even though Dry Macular Degeneration usually does not lead to severe vision loss like the Wet form it is still responsible for significant problems in some people.  As Dry Macular Degeneration progresses it can develop into a condition called Geographic Atrophy (with associated vision loss) or it can progress to the Wet Form and its associated problems.

Bottom line, currently other than recommending weight loss, cessation of smoking, better diet, exercise and specific vitamin and antioxidant supplements Dry Macular degeneration runs its course.  Maybe by implementing the above interventions we are able to slow the process down.

It seems though that we have stem cell options that are being developed.  Dry Macular Degeneration as it progresses destroys a layer of the retina called the Retinal Pigment Epithelium (RPE).  It makes sense that if we could transplant a new Retinal Pigment Epithelium layer, maybe the macula could be regenerated again and prolong vision.

Japanese researchers have transformed skin stem cells into retinal pigment epithelium eye cells in a mouse.  To date they have successfully transplanted this tissue into 100 mice with no apparent rejection.  Another very dangerous side effect of stem cell transformation is the possible production of tumours.  Apparently in these mice there have been no tumours, so human trials are likely to begin within 3 years.

The above image is a group of stem cells that can be caused to differentiate into RPE cells for the macula.

The human stem cell experiments that are likely to begin in a few years for macular degeneration will firstly be safety trials.  They are likely to be performed on blind eyes that have no visual potential.  This is done so that if unexpected outcomes occur, at least the eyes were blind anyway.

What is always a little scary is that if tumours are formed, could they possibly spread to the rest of the body.  Where the person only had an eye problem, now could possibly be risking their life!

Progression in science occasionally comes with significant risk.  Unless these risks are taken science could not possibly progress.  Further information can be found about these macular degeneration experiments by CLICKING HERE.

Macular Degeneration we now know is the most common cause of legal blindness in an age group greater than 50.  With life expectancy increasing, we will have a potential tsunami of new cases of macular degeneration.  This will create a huge burden on the individual, on their families and on society in general if we do not take a stance against this debilitating condition from now!

To take an effective stance we need to know what risk factors can be modified and what cannot be modified. 

So what are the risks factors for Macular Degeneration

• Age - the older we get the more likely we are to develop MD.
• Female
• Caucasian - especially with light coloured eyes.
• Long Sighted (Hyperopia)
• Family History
• Smoking
• High Blood Pressure
• Overweight
• Lack of Exercise
• Poor Diet
• Ultraviolet exposure

It is not difficult to work out from the risk factors above what you can influence and what you cannot.  What you can influence for macular degeneration or for any other chronic disease are called modifiable risk factors.

What is interesting is that by improving your exercise level and your diet, not only will you reduce your chance of developing macular degeneration, but also reduce your risk of heart disease, strokes and Alzheimers.   Smoking of course is a given, and wearing sunglasses outdoors is easy.

As an aside macular degeneration seems to be linked with lack of Vitamin D, which we create by ultraviolet exposure.

Reducing your weight seems to be a function of controlling portions, increasing protein intake and reducing carbohydrate and saturated fats.  If you can then add at least 4 brisk exercise sessions per week you are done.

Appropriate nutrition is also important so the following should be added to your diet:

• Green Leafed vegetables
• Fish Oil or Flaxseed Oil (Omega 3)
• Take a Lutein supplement

What defines brisk exercise?

This is most important as whoever designed human bodies designed them to move.  Resistance training as well as cardiovascular training are just as important as each other in obtaining weight loss and general fitness and well-being.

Getting your diet right and getting an appropriate level of exercise is harder than it sounds.  It is not surprising that there is such a massive industry around weight loss - the problem is most people try and ultimately fail.  Why?

There are many reasons but the main one is that one needs to make a life time commitment to eating differently and exercise.  Dr Jim Kokkinakis this year joined the Exercise Franchise called Vision Personal Training in Kogarah.  For an investment of $50 per week (yes this might not be cheap enough for everyone) you can use the gymnasium and the fitness classes they run as much as you like, whilst having a one-on-one personal training session per week.  The key to this is that they monitor and advise about your diet, while inspiring you to great fitness. You are accountable to someone and every week you have an appointment that you will keep.

Within 4 months Dr Kokkinakis lost 20 kilos and now fits in to his wedding pants from 25 years ago!

Changing the way you eat and exercise is achievable - it requires an honest commitment.  It certainly can be done by yourself, but being accountable to someone else really helps.

Macular Degeneration potentially could be a huge, huge issue if we do not pounce on it now.  By modifying our lifestyle it is possible to reduce the enormous burden of this disease significantly.

As we have discussed, Macular Degeneration is the leading cause of blindness in an age group over 50 years of age.

The macula which is at the back of the eye called the retina is very susceptible to damage as it needs a big blood supply to function properly.  The blood supply is made up of many little capillaries, which can break down due to being more fragile than the larger blood vessels of the retina.

When categorizing macular degeneration we normally refer to it as either the "DRY" form or the "WET" form.  Both forms of macular degeneration cause vision reduction but normally the WET form is more likely to cause severe vision reduction.

Luckily the WET form occurs less frequently. In fact for every 10 cases of macular degeneration; 1 is of the WET variety and 9 are of the DRY variety.

                The image above is of the DRY form                                                           The image above is of the WET form

The WET form of macular degeneration tends to cause more vision loss because blood and fluid is released due to new vessel formation.  These new vessels are typically very fragile and break down very easily.  If blood and fluid leaks in the macula area it will normally slowly resolve but leave damaging scar tissue, which ultimately causes severe vision loss.

At The Eye Practice we pay particular attention to making sure we look carefully for the earliest possible signs of macular degeneration.  Dr Jim Kokkinakis lectures other optometrists about this terrible condition, so is therefore right up to date with the latest treatments and uses the latest technology to detect it.

Macular degeneration has a number of risk factors, which are modifiable and therefore it is imperative to find it early and implement appropriate strategy to slow down its progression.

In future posts about macular degeneration we will discuss what can be done to reduce your risk in developing it.

If the WET form develops we now have a great treatment using drugs called anti-VEGFs, which have been shown to be very effective in preserving vision.  These also will be discussed in detail.

Macular Degeneration has been talked about extensively in the media.  And for good reason.  As we have mentioned before it is the leading cause of legal blindness in a population over 50.  With an aging population, which is living longer, the numbers of legal blindness from Macular Degeneration will escalate dramatically over the next 20 years, if nothing is done to stem the wave.

Eye Nutrition seems to be very important to possibly protect us from Macular Degeneration. 

There are two important ingredients that we need in our diet to protect our eyes.  They are:

1. Omega-3 (commonly known as Fish Oil or Flaxseed Oil for the vegetarians) is an essential building block of the cells that make up our whole body.  The eyes also are many up of cells.  It is thought that the average person needs to consume around 3 to 4 servings of lightly grilled fish per week to load the body with enough Omega-3 to sustain our cells at a healthy level.  I am not sure about you, but I would be lucky to have a serving a month! Supplementation then is a must for the majority of us.  At the Eye Practice we commonly prescribe Thera Tears Nutrition Gel capsules, which not only gives you the necessary dosage of Omega-3 for Macula protection but also treats the very annoying dry eye syndrome.
   
2. Lutein and Zeaxanthin are two less well known antioxidants that are highly concentrated in the macula area and are thought to protect the macula from damage.  The best food source for these two very important antioxidants is from lightly cooked spinach.  Add some garlic and lightly stir fry a serving at least 3 times per week and you have the basis for very healthy eyes.

Lutein and Zeaxanthin also can be obtained from supplements such as Blackmores Lutein-Vision.

There is even a cookbook that has been written on behalf of the Macular Degeneration Foundation.  This is for people that really want to stay on top of their eye-health - especially if you have significant signs of macular degeneration.  CLICK HERE FOR MORE INFO.

And now that we have our diet correct, stay tuned for the next Macular Degeneration fact.  It will also be an important one.

Macular Degeneration is the leading cause of blindness in the over 50 year old age bracket.  The Australian government has done a great job of raising awareness about this eye condition. It realises that by educating the general public about the risk factors involved and to encourage them to seek comprehensive eye examinations from optometrists and ophthalmologists, it is possible to preserve many peoples eyesight as they age.

A day does not go by at The Eye Practice that we do not hear a concerned story from a patient.  Most people will admit that one of the things they fear most in life is going blind.  Making sure that our patients' do not have macular degeneration and advising about things they can do to minimise their risk of developing it is a big parcel of what we do.

                 Normal Macula                                             Moderate Macular Degeneration

As can be seen in the photo on the right macular degeneration is an accumulation of white deposits called drusen. Even with this type of presentation it is very likely that the vision is still normal.

Click here to find out more details about Macular Degeneration.

FACT#1: Macular degeneration progresses slowly.

To progress from the first photo to the second photo it can take many years.  It stands to reason then that just by having a comprehensive eye examination once every year or two, macular degeneration will be picked up by your optometrist as early as possible.

In up coming posts we will reveal the remaining 6 facts. Once you understand and apply the tips we will share, you can be sure to minimise any impact this devastating eye condition can have on you or your loved ones.