Review Category : Dr. Mark Siegel, MD FAAO

Exercise and lifestyle can affect visual impairment

By Mark S. Siegel, MD

In 2020, the number of people in the United States with visual impairment — sight loss often caused by eye disease, trauma, or a congenital or degenerative condition that cannot be corrected with glasses or contact lenses — is projected to increase to at least four million. This is a 70 percent increase from 2000 and is due to the growing aging population and prevalence of age-related eye diseases.

To help determine ways to decrease the incidence of visual impairment, researchers at the University of Wisconsin examined the relationships between the incidence of visual impairment and three modifiable lifestyle behaviors: smoking, drinking alcohol and staying physically active. The research was conducted as part of the Beaver Dam Eye Study, a long-term population-based cohort study from 1988 to 2013 of nearly 5,000 adults aged 43 to 84 years.

The researchers found that regular physical activity and an alcoholic beverage every now and then is associated with a lower risk of visual impairment. The data showed that over 20 years, visual impairment developed in 5.4 percent of the population and varied based on lifestyle behaviors. For example, people who were physically active had a 58 percent decrease in the odds of developing visual impairment compared to people who were not physically active.

The researchers also found that people who drank alcohol occasionally (defined as those who have consumed alcohol in the past year, but reported fewer than one serving in an average week) had a 49 percent decrease in the odds of developing visual impairment compared to people who had consumed no alcohol in the past year.

As with most epidemiologic research, the researchers caution that a limitation to their study is that the findings may be due, in part, to unmeasured factors related to both lifestyle behaviors and development of visual impairment. The data does not prove that these lifestyle behaviors are directly responsible for increased risk. The researchers still believe the research shows good promise for indicating ways that people can lessen their risk of visual impairment through lifestyle changes.

Dr. Siegel is medical director of Sea Island Ophthalmology, board certified, American Board of Ophthalmology, www.seaislandophthalmology.com. 525-1500.

 
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Prevent injuries with 10 eye safety tips during Workplace Eye Wellness Month

By Mark S. Siegel

More than 700,000 work-related eye injuries occur each year. March is Workplace Eye Wellness Month — a good time to refocus attention on your eye protection program. Get the facts here, plus 10 tips for injury prevention.

As the National Safety Council points out, “All it takes is a tiny sliver of metal, particle of dust, or splash of chemical to cause significant and permanent eye damage.”

OSHA’s eye and face protection standard requires employers to “ensure that each affected employee uses appropriate eye or face protection when exposed to eye or face hazards from flying particles, molten metal, liquid chemicals, acids, or caustic liquids, chemical gases or vapors, or potentially injurious light radiation.”

Share these injury-prevention tips with managers and supervisors.

1. Look carefully at plant operations, work areas, access routes, and equipment. Study injury patterns to see where accidents are occurring.

2. Conduct regular vision testing, as uncorrected vision can cause accidents.

3. Select protective eyewear based on specific duties or hazards.

4. Establish a mandatory eye protection program in all operation areas.

5. Have eyewear fitted by a professional.

6. Establish first-aid procedures for eye injuries, and make eyewash stations available, especially where chemicals are in use.

7. Make eye safety part of your employee training and new hire orientation.

8. Make sure managers and executives set an example by wearing protective eyewear wherever it’s worn by other employees.

9. Regularly review and revise your policies, and set a goal of zero eye injuries.

10. Display a copy of your policy where employees can see it.

It’s also a good time to remind employees of off-the-job eye hazards like do-it-yourself work on cars and homes, cooking accidents, sports injuries, yard work, and chemical splashes from cleaners and fertilizers.

So please protect your eyes — you only get two of them.

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Can cataract surgery help you live longer?

By Mark Siegel, MD, FAAO

A recent study indicated that people who suffer from vision loss related to cataracts that proceed with cataract surgery lower their long-term mortality risk by 40 percent compared to people that choose not to have surgery.  The data used for the research study came from the Blue Mountains Eye Study, a group that researches vision and common eye diseases in an older Australian population.

The study that was published in the Journal of the American Academy of Ophthalmology studied a total of 354 patients over the age of 49 who suffered from visual impairment that was caused by cataracts. This study took place over a 15-year time span and evaluated patients who elected to have cataract surgery and patients who did not have surgery to correct cataract-related vision impairment. The study took adjustments into account such as age and gender as well as mortality risk factors such as hypertension, diabetes, smoking, co-morbid disease and cardiovascular disease to name a few.

The correlation between living longer and the correction of cataract related vision loss is not clearly understood, but several plausible factors may include improvement in physical and emotional well-being, optimism, the ability to live independently, as well as greater ability to comply with prescription medications.

Cataracts are typically slow to change over time, and their effects on vision can subtly progress to the point that the cataract might have unnoticed negative impacts on visual functioning, mood, and as a result, personal independence.

Cataracts occur when the eye’s natural lens becomes cloudy over time. Cataracts are a leading cause of vision impairment and will affect more than 50 percent of Americans by the time they are 80 years old. Cataracts can develop at different rates for everyone, but once they begin to develop, they will only gradually worsen and become more opaque over time. The best way to correct visual impairment caused by cataracts is to undergo cataract surgery where an ophthalmologist removes the natural lens of the eye and replaces it with an artificial intraocular lens. If you notice difficulty in completing everyday tasks due to vision problems, you should contact an eye care professional to discuss cataract surgery to improve the quality of your life.

Many people who suffer from cataracts complain of issues driving, especially at night, problems seeing color and detail clearly, and difficulty performing day-to-day functions at home and work. If cataracts go a long period of time untreated, people often lose their independence, ability to work and their quality of life may begin to suffer.

I have many patients who say they’re “too old” for cataract surgery. After undergoing cataract surgery, one is able to realize the colors and clarity of vision that were missing from their world. No one is “too old” for better vision and possibly a longer life as a result!

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A healthy New Year’s resolution for your eyes

By Mark Siegel, MD, FAAO

Each year as the New Year approaches, people around the world resolve to make changes that will result in longer, happier and healthier lives. Often people are determined to lose weight while others are committed to kicking unhealthy habits such as smoking. This year I would like you to add, “Get a Glaucoma Eye Exam!” to the list of healthy resolutions, and Glaucoma Awareness Month in January is the perfect time to do it.

photoGlaucoma normally progresses so slowly that there are usually no warning signs before permanent damage has occurred to the eye. Therefore, it is vital to educate the American public about the importance of a yearly eye exam to increase early detection and treatment of glaucoma to help prevent vision loss.

What is glaucoma?

In a healthy eye, clear fluid is constantly being made behind the iris and leaving the eye through a microscopic drainage canal in the front of the eye. If this drainage channel becomes blocked, the pressure inside the eye goes up and often causes glaucoma damage to the optic nerve. This is the nerve that connects the eye to the brain so damage to it causes loss of vision.

Who is at risk?

While the causes of glaucoma are not completely known, we do know that risk factors for its development include a family history of glaucoma, race and older age. Glaucoma may affect people of any age from newborns to the elderly but is more common in adults as they approach their senior years. African-Americans, Hispanics and people with diabetes are also at increased risk of developing the disease.

How is it treated?

Most forms of glaucoma can be treated with pressure lowering eye drops. Some patients may also benefit from laser treatment (laser trabeculoplasty). A small portion of patients with severe glaucoma may require incisional surgery to permanently help shunt the aqueous fluid out of the eye.

So please call your local ophthalmologist today to schedule your glaucoma screening for the New Year.

Dr. Mark Siegel, MD, FAAO is medical director at Sea Island Ophthalmology, www.seaislandophthalmology.com.

 
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Choose safe toys this holiday

By Mark S. Siegel, MD

No one chooses gifts with the intent to harm, but some popular children’s toys can cause serious eye injuries. According to the U.S. Consumer Product Safety Commission, more than 265,000 toy-related injuries were treated in emergency rooms in 2012, and almost half of these injuries affect the head or face – including the eyes. Unfortunately, most of these injuries happen to children under age 15.

‘You’ll shoot your eye out’

Some propelling toys, like air soft guns, BB guns, paintball guns and darts can be particularly hazardous, with the potential to cause serious eye injuries such as corneal abrasion, ocular hyphema (bleeding inside the eye), traumatic cataract, increased intraocular pressure and even permanent vision loss.

Another dangerous toy category is toys with laser components, which have increased in power and decreased in price over the years. Lasers can be especially hazardous when used in toys that are aimed, such as a laser gun. Blue light lasers are particularly dangerous, as they are more likely to cause retinal injury compared with green or red lasers. Studies show that exposure for even fractions of a second to high-powered blue handheld laser devices can cause serious eye injuries — including macular holes — which often require surgical intervention. In addition, the FDA warns that laser pointers are not toys and should only be used with adult supervision.

The good news is that following these toy safety tips can easily prevent most eye injuries:

• Avoid purchasing toys with sharp, protruding or projectile parts.

• Make sure children have appropriate supervision when playing with potentially hazardous toys or games that could cause an eye injury.

• Ensure that laser product labels include a statement that the device complies with 21 CFR (the Code of Federal Regulations) Subchapter J.

• Along with sports equipment, give children the appropriate protective eyewear with polycarbonate lenses. Check with your ophthalmologist to learn about protective gear recommended for your child’s sport.

• Check labels for age recommendations and be sure to select gifts that are appropriate for a child’s age and maturity.

• Keep toys that are made for older children away from younger children.

If a child experiences an eye injury from a toy, seek immediate medical attention.

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Vitamins reduce risk of age-related macular degeneration

By Mark S. Siegel, MD, FAAO

More than a decade after the first age-related eye disease study (AREDS) showed that taking daily high doses of vitamins C and E, beta-carotene, zinc and copper can slow down the progress of age-related macular degeneration (AMD) a second study (AREDS 2) has revealed that adding certain antioxidants to the original formula does not provide any extra benefit to patients.

Advanced AMD can lead to significant vision loss, and in the United States it is the leading cause of blindness. About 2 million Americans have advanced AMD; another 8 million are at risk.

The first AREDS study was conducted by the National Eye Institute and concluded in 2001. It showed that the original AREDS formula could reduce patients’ risk of the advanced form of AMD by about 25 percent. The formula helps protect people’s central vision, which is needed for reading, driving, recognizing faces and other daily activities.

AREDS2, which concluded in 2011, tested several antioxidant nutrients that earlier research had suggested might protect the eyes: lutein, zeaxanthin, and omega-3 fatty acids. Omega-3 fatty acids are produced by plants and are present in oily fish such as salmon. Lutein and zeaxanthin are carotenoids, a class of plant-derived vitamins that also includes beta-carotene, and are present in leafy green vegetables. The body uses these nutrients to maintain the health of the retina, the part of the eye that can be damaged by AMD. Participants in AREDS2 were assigned to take one of four different AREDS formulas daily for five years.

The AREDS2 research team did find that two patient subgroups benefited from taking variants of the original AREDS formula. The risk of developing advanced AMD was reduced by about 18 percent in study participants who took the variant that included lutein and zeaxanthin but no beta-carotene, compared with participants who took the variant that had beta-carotene but no lutein or zeaxanthin. And those participants whose diets were low in lutein and zeaxanthin at the start of the study, but who took a variant with lutein and zeaxanthin during the study, were about 25 percent less likely to develop advanced AMD, compared with similar participants who did not take lutein and zeaxanthin.

The researchers say that removing beta-carotene from the AREDS formula and adding lutein and zeaxanthin will result in a single formula that is safe and effective for all AMD patients. Until now, people who were current or former smokers could only use a formula that excluded beta-carotene, because it had been linked to risk of lung cancer for these patients. About half of AREDS2 participants were former smokers.

Another recent AREDS report showed that the benefits of taking the AREDS formula appear to be long-lasting. Participants in the first AREDS study who took the original formula daily for five years continue to enjoy a 25 percent lower risk of developing advanced AMD. Most report that they are still taking the supplement.

It is recommended that you discuss these research results with your ophthalmologist and primary care physician before changing or adding a supplement to your regimen.

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Study finds tablets help people with low vision

By Mark Siegel, MD

When gift shopping this year, you have the opportunity to give back a priceless gift to a loved one with low vision: the joy of reading.

People who have eye diseases that damage their central vision can again read quickly and comfortably by using digital tablets, a study shows. On average, patients with moderate vision loss significantly increased their reading speed and comfort using an iPad digital tablet. The researchers think that other tablets that feature back-lit screens and font-enlargement capabilities would offer similar benefits.

Millions of people who have eye diseases such as macular degeneration or diabetic retinopathy struggle with the loss of their central vision. These diseases damage the light-sensitive cells of the eye’s retina, which relays images to the optic nerve for transmission to the brain. When treatments like eyeglasses, medications, or surgery are no longer effective, ophthalmologists and eye care professionals help patients make the most of their remaining sight by using low vision aids. Before digital tablets came along, reading aids were limited to lighted magnifiers, which are cumbersome and inconvenient by comparison.

Reading is a simple pleasure that we often take for granted until vision loss makes it difficult. The findings show that at a relatively low cost, digital tablets can improve the lives of people with vision loss and help them reconnect with the larger world.

All of the 100 participants in the study, conducted at Robert Wood Johnson School of Medicine, gained at least 42 words-per-minute when using the iPad2 set to 18-point font, compared with reading a print book or newspaper. People with the poorest vision showed the most improvement in speed when using an iPad or Kindle™, compared with print. The Kindle model used in the study did not have a backlit screen, although a newer model, the Kindle Fire, does.

Today’s high-tech gadgets have features that make living with low vision a bit easier. And if you or a loved one is using such devices for their built-in magnification and backlighting, consider adding apps to track eye health as well. You have more tools at your disposal than ever before to take control of your eye health.

Some features of these devices and their apps can include:

Enlargement. Smartphones, tablets and e-readers all have enlargement capabilities, though they will not enlarge text as much as a dedicated CCTV magnifier will. Not all e-readers can increase contrast, which can be a big help for people with low vision. Shop around to see if a particular e-reader will meet your needs.

Lighting. Apps for many tablets and smartphones use your device’s camera and light source to illuminate text or other things you need to see more clearly.

Voice interface. Many smartphones have some level of voice-recognition, which may help to send texts and emails among other things. Smartphone mapping apps will give turn-by-turn voice commands to help drivers with low vision to find their way when they have trouble reading street signs.

If you or someone you know has low vision, consider some of these latest high tech gadgets. They can be a big help, and they are getting better every year.

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Must-do’s to preserve vision in diabetics

By Mark S. Siegel, MD, FAAO

If you have diabetes, you are at higher risk of developing certain eye diseases, including diabetic retinopathy, glaucoma and retinal detachment. The good news is that you can preserve your vision and reduce your chances of eye disease. Follow these steps now to make sure you preserve your vision in the years to come.

Get a comprehensive dilated eye examination from your ophthalmologist at least once a year.
In its early stages, diabetic eye disease often has no symptoms. A dilated eye exam allows your ophthalmologist to examine more thoroughly the retina and optic nerve for signs of damage before you notice any change to your vision. Regularly monitoring your eyes’ health allows your ophthalmologist to begin treatment as soon as possible if signs of disease do appear.

Control your blood sugar.
When your blood sugar is too high, it can affect the shape of your eye’s lens, causing blurry vision, which goes back to normal after your blood sugar stabilizes. High blood sugar can also damage the blood vessels in your eyes. Maintaining good control of your blood sugar helps prevent these problems. If you cannot control your blood sugars in conjunction with your primary care doctor, then consider an endocrinology consult. An endocrinologist is a specialist in diabetes and other hormonal diseases.

Maintain healthy blood pressure and cholesterol levels.
High blood pressure and high cholesterol can put you at greater risk for eye disease and vision loss. Keeping both under control will not only help your eyes but your overall health.

Quit smoking.
If you smoke, your risk for diabetic retinopathy and other diabetes-related eye diseases is higher. Giving up tobacco will help reduce that risk.

Exercise.
Exercise is good for your eyes. It’s also good for your diabetes. Regular exercise can help your eyes stay as healthy as possible while helping to control your diabetes.

If you have diabetes, you can preserve good vision. Make sure you actively manage your disease with your ophthalmologist so that you reduce your risk of eye disease.

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The facts about cataracts

By Mark S. Siegel, MD, FAAO

What is a cataract?
We are born with a crystalline lens inside the eye located behind the pupil that helps the eye focus light onto the back of the eye.  A cataract is the clouding of the natural lens in the eye. When the natural lens is clouded, this can lead to decreased vision.

What causes a cataract?
Most commonly, this clouding occurs due to the normal aging process, usually after the age of 60. Other causes of cataracts include ocular diseases, medical problems (such as Diabetes Mellitus), trauma to the eye, the use of certain medications such as steroids and excessive UV radiation exposure.

How do I know if I have a cataract?
People with cataracts usually complain of blurred vision and sometimes experience difficulty reading or driving. Sometimes it may seem that you are looking through a cloudy window. Another common symptom of cataracts is increased glare. People with cataracts may notice significant glare around lights or oncoming headlights when they are driving which can make it harder to drive at night. Some people also notice that colors do not appear as vibrant or bright as they used to. If you have any of the above risk factors and are experiencing difficulty with your vision, you may have a cataract. Your eye physician can diagnose cataracts by performing a complete eye exam. Light passes through the normal lens properly to a focused point on the back of the eye. However, in the cloudy lens affected by cataract, light is bent in all different ways and prevents the light from focusing on the back of the eye. This causes blurred vision.

How are cataracts treated?
There are no medications or drops that can help treat a cataract. Once cataracts affect your vision to the point where your activities of daily life are affected, they can be removed in order to improve vision. Many people believe that cataracts can be removed with laser surgery. This is not true, as they can only be removed by microscopic eye surgery in the operating room by your eye physician and surgeon. Lasers are beginning to be used to perform portions of cataract surgery such as the incisions to enter the eye, the opening of the lens (capsulotomy) and dividing the lens into fragments. The laser is not covered by any insurance and is still performed in an OR. However, a phacoemulsification (ultrasound) probe is still required to remove the cataract fragments, which is covered by insurance.

What can I do to prevent the formation of cataracts?
Cataracts occur due to the natural aging process, but there are some steps you can take that may be helpful in delaying a cataract. First, if you are a smoker, quitting smoking may help delay the progression of a cataract. Also, protecting yourself from excessive exposure to UV light, by wearing sunglasses and a hat, may also help delay cataracts.

How is cataract surgery performed?
If the cataract is found to be affecting your activities of daily living, the cataract can be removed by your eye physician and surgeon in the operating room. First, the eye that is undergoing surgery will be numbed, typically with topical anesthesia. You will usually be made to feel sleepy during the surgery, but will still be able to hear the surgeon and staff interacting with you. You will not need to worry about keeping your eye open during the procedure because the surgeon will do that for you. Then, a small incision is made into the front window of the eye (cornea) and the cloudy lens is removed through this incision using ultrasound power and suction. After the cloudy lens is removed, a clear acrylic or silicone lens is inserted in its place in order to properly focus light onto the back of the eye again. Cataract surgery is one of the most successful surgeries performed in the United States. It is uncomplicated and successful in 95% of patients who undergo the surgery.

Are there different types of lens implants?
Yes, there are many different types and powers of lens implants. Your eye physician will determine the proper lens power to be implanted by taking measurements in the office before surgery. The standard lens implants are typically “monofocal” lenses, or lenses that focus the vision to a certain distance. In order to have clear near vision, reading glasses are still needed. There are other types of lens implants, such as “multifocal” or “accommodative” lenses, or lenses with more than one focus point. These lenses allow you to focus both near and far. Ask your eye physician for more information about multifocal lens implants.

What happens after surgery?
Immediately after surgery you will typically be monitored for about 30 minutes to an hour. You should have someone with you to drive you home. It is best that you rest for the remainder of the day after surgery. Your eye surgeon will have more specific instructions of what you should do after surgery. For more information, consult with your eye surgeon.

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Protect your eyes this Fourth of July

By Mark Siegel, MD, FAAO

As the Fourth of July holiday approaches and Americans make plans to celebrate the stars and stripes with a little red glare from celebratory rockets, ranging from professional public fireworks displays to amateur impromptu backyard shows, I’m urging the public to take important steps to prevent fireworks-related eye injuries. Parents and other adults need to exercise caution when handling fireworks themselves and to be especially diligent in managing and monitoring their use by children.

Of the more than 9,000 fireworks injuries that occur in the United States each year, approximately 45 percent are sustained by children ages 15 and under. Eyes are among the most injured body parts, and 1 in 6 fireworks-related eye injuries results in permanent vision loss or blindness.

I recall a particularly horrific firework injury while I was still an ophthalmology resident. A 6-year-old boy found an M-80 firework in his home and lit it with a grill lighter. The explosion resulted in a traumatic injury that impacted the boy’s throat, face and eyes. His parents called 911 for help and his eye injuries required an immediate cornea transplant, intraocular lens replacement, and he has undergone several additional eye surgeries since then with permanently reduced vision.

All fireworks are dangerous if not properly handled; however, sparklers cause the most injury and are particularly dangerous since many children handle them on their own. Sparklers typically burn at 1,200 degrees Fahrenheit. That temperature is nearly 1,000 degrees hotter than the boiling point of water, double the heat required to burn wood, hot enough to melt glass and cause third-degree burns to the skin. Out-of-control bottle rockets also cause some of the most serious eye injuries, including corneal abrasions, traumatic cataract, retinal detachment, optic nerve damage and rupture of the eyeball — all of which can lead to potential blindness.

I feel that the best way to avoid potentially blinding injuries is to attend a professional public fireworks display instead of putting on a backyard fireworks show. For those who decide to purchase and use legal consumer fireworks, here are a few safety tips to prevent eye injuries:

• Never handle fireworks without protective eyewear and ensure that all bystanders are also wearing eye protection.

• Never let young children play with fireworks of any type. If older children are permitted to handle fireworks, ensure they are closely supervised by an adult and wear protective eyewear.

• Clear the area of flammable materials and view fireworks from at least 500 feet away.

Leave the lighting of professional-grade fireworks to trained pyrotechnicians. If you find unexploded fireworks, do not touch them. Immediately contact your local fire or police departments. If you do experience an eye injury during a fireworks accident, seek immediate medical help.

Always remember our eyes are very delicate, and you only get two of them.

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