Can Nutritional Supplements Prevent Macular Degeneration?

At least once every clinic I encounter a new patient with eye findings that indicate early signs of Age-Related Macular Degeneration (ARMD) Without alarming the patient I explain that ARMD is the leading cause of irreversible vision loss in people over 55, more than glaucoma. WebMD features accurate and timely information about all aspects of ARMD.

Most patients are eager to preserve their precious eyesight, so the discussion invariably shifts to the role of vitamins, nutritional supplements, and antioxidants.

We know that damage from ARMD accumulates from life-long biochemical changes to the delicate layer of pigmented cells underneath the retina called the Retinal Pigment Epithelium. Genetics, sunlight, diet, and other environmental factors all play a role in causing the oxidative damage.

Current recommendations for ARMD patients include supplemental vitamin A, vitamin C, vitamin E, carotenoids like lutein, as well as the minerals selenium and zinc. Click here to learn more about nutritional supplements and their role in preventing ARMD. You and your doctor can decide which specific formula is best for you.

Now here's the hook. Given that these supplements are known to delay or halt the damage, wouldn't it also make sense for younger adults (even children) to consume appropriate doses of these nutrients throughout life in order to maintain the health of the retina? They recommend sunblock for infants to protect their skin from UV damage, right? Skin, eye, what's the difference?

Think of it this way: Asking a 65 year-old to begin taking antioxidants is like asking Mrs. O'Leary to install a fire extinguisher in the barn after the cow has already knocked over the lantern! Maybe it wouldn't hurt, but it would have been even more useful if it happened years earlier.

Related Topics: New Eye Drugs Treat Macular Degeneration, 10 Overlooked Reasons to Quit Smoking

Technorati Tags: supplements, macular degeneration, ARMD

Clinic Practices: Joining the Fray

Have you been following the unholy fracas taking place over at Rod Moser's WebMD blog All Ears? Scroll down to the posting dated January 20. He wrote a candid and contentious tome regarding clinic booking practices and the many reasons why patients are left waiting.

I encourage you to visit and add your two cents.

The response was overwhelming!

= Overwhelmingly hostile

= Overwhelmingly sarcastic

= Overwhelmingly judgmental

= Overwhelmingly passionate


Everybody hates to wait. There, I've said it!
Everybody wants more time with their provider. There, I've said it again!

It makes no difference how busy or how (in)efficient my individual clinic may be. I was surprised that so many respondents blamed the waiting on GREED. If that were the case only private practice clinics would have problems with overbooking. University-based clinics, institutional, military, and missionary charitable health care facilities would hum along. Ha! Ha! Ha! In Honduras they wait for DAYS in order to be seen by the visiting eye doctors and no money changes hands.

About time management. Is it possible that all clinic administrators are idiots? They usually prepare the schedules. Many have MBA degrees. The core struggle is the provider's inability to dehumanize the practice of medicine: listening, thinking, educating, comforting, balancing so many conflicting priorities while trying to compress 16 hours of compassion into 8 hours of clinic.

For example, a walk-in patient with a new corneal ulcer (serious threat to eye!) will unmercifully consume at least one hour of my clinic. One hour, POOF! What happens to the four waiting patients?

In 25 years' practice the following gesture has never failed me. When things get backed-up I walk into the waiting room and ask for everybody's attention. Without violating HIPAA I inform the group that the schedule has been sabotaged. I give my promise that patients who are willing to wait will receive the same care and attention. Those who cannot wait are invited to rebook. My final word is that I will not leave the clinic until every patient is seen and satisfied. Usually there is some soft laughter and a little applause. It really decompresses things.

Congratulations to Rod Moser for giving all of us a change to express our perceptions and our attitudes about outpatient health care delivery. Now, Rod, when are you going to tackle serious issues like hospital food?

Guide Dogs: Adorable, but Do Not Pet!

Much of the writing I contribute to WebMD concerns prevention of vision loss and innovative ways to restore lost eyesight. Unfortunately, for some folks with serious eye conditions, permanent blindness occurs despite everyone's best efforts. Given these tragic circumstances, the story does not need to have an unhappy ending.

Guide Dogs provide a valuable service to blind individuals. They offer independence, continued mobility, and physical protection to the legally blind. You've likely encountered Guide Dogs in the mall or at the airport. I've never seen an unattractive or unhappy Guide Dog.

Do you know the four common breeds that are the best candidates for training?

= Labrador Retrievers

= Golden Retrievers

= Lab/Golden Retriever crosses

= German Shepherds

These animals are always so beautiful and docile. You just want to run up to the Guide Dog and pet the animal! Trainers will tell you that is a bad idea; not because the dog will bite but because the distraction will interfere with the Guide Dog's primary function. Both the Guide Dog and its partner require extensive training in order to become a reliable team.

Want to learn more? Click here for interesting stories about Guide Dogs for the Blind.

Related Topics: Animal-Assisted Therapy , Health Benefits of Having a Pet

Technorati Tags: blindness, guide dog, handicap, disability

Glasses: Anti-Scratch Lenses and UV Protection

Patients often ask me about anti-scratch lenses, additional UV protection and anti-reflective coating. Here's my take on all three:

Extra UV protection isn't necessary, the lens material (glass or plastic) already has an effective UV filter. Think of it like buying 'undercoat protection' at the new car dealership. Didn't Detroit already take care of this?!?

Don't buy anti-reflective coatings unless you are a TV personality (in which case have the broadcaster buy your eyewear). This add-on spray utilizes a clever optical principle called destructive interference to eliminate the harsh reflection of lightbulbs on the front surface of your glasses. Yes, the observer is the beneficiary, not the wearer!

Those indestructable anti-scratch polycarbonate lenses have a soft surface that tends to scratch fairly easily. Plastic (CR39) lenses should not scratch. The protective coating will likely wear out before the lens does.

Related Topics: Eyeglasses & Contacts, Eyeglass Prescriptions


Technorati Tags: eyeglasses, UV, antiscratch lenses

Welcome, Grand Rounds Readers!

Months before WebMD launched its own blogs each of us bloggers were encouraged to surf the web and research other health-related blogsites. I quickly found a few favorites. One of the most consistently interesting health blogs is the self-titled Kevin,MD posted by Dr. Kevin Pho, a New Hampshire internist. Kevin has a strong interest in medicolegal issues, ethics, medical malpractice, and contemporary health stories in the media. His blogs are terse, logical, and well written.

Good doctors share what they know and this applies to medical blogs as well. A consortium of medical bloggers hosts a weekly collection of contributed posts that are appropriately labeled Grand Rounds. This week Kevin,MD hosts Grand Rounds and WebMD was included. Thank you for the warm welcome!

We're grateful to Kevin,MD and all partner blogs for generously inviting us to join this outstanding online forum.

Speaking of Grand Rounds, where are the doughnuts?

Technorati Tags: Medicine, Medical Blogosphere, Blogs

Visual Acuity in Newborns

Parents of newborn children are always anxious. Chief among their concerns is learning how well their baby can see.

At birth the healthy infant has not yet developed clear eyesight. Although the eye anatomy is intact there is still some last-minute wiring that needs to be completed. Over two million nerve fibers connect the healthy eyes with the brain at various locations, and the brain has to learn how to integrate the visual signal.

It might not surprise you to learn that during the first few weeks of life the newborn has very crude vision. They are aware of moving images, shadows, and they can recognize dark versus light. Parents may become alarmed because they sense that the child cannot see their faces; there is no cause for alarm.

By age three months visual perception develops to the point where the baby can recognize specific images such as a caregiver's face and the baby will usually greet the person with a smile. Thereafter visual resolution steadily improves.

So, how can a parent tell if a genuine vision problem exists?

If an infant consistently does not appear to respond to different sounds, gentle touching, or visual stimuli you should also have the baby examined by the pediatrician. Find answers to other questions about healthy vision by visiting the WebMD Message Board


Related Topics: Strabismus Infant Milestones

Daily Temptation - Elements of a Good Diagnosis

A good amount of my time is spent replying to visitors' inquiries posted at the WebMD Eye & Vision Disorders message board. It is a lot of fun helping others learn more about their eyes. Folks often visit with questions about recent diagnoses or proposed treatments. Many are anxious to know more about their symptoms and this anxiety can lead to impatience. They are hoping that the Internet will render an accurate diagnosis for them. In theory it sounds good; fast and free - does it get any better?

How tempting it is to bundle a visitor's findings and burp-off a diagnosis. Truth be told, it is often possible to discern the most likely cause for an individual eye problem, whether it be refractive, medical, or even a lid lump. Consider this - I've been listening to people's complaints in a dimly lit exam room for 25 years - is it really that different?

"Doc, why can't you just tell me if this scaly lid lump is cancer?!?"

First of all, I am not your physician. That's a pretty good reason right there. Sure, I meet folks at social gatherings who want me to look at their eyes, their eyelids, or their glasses. However well-intentioned, these folks are asking for substandard care. In other words, "Don't bother with a careful history and exam - just guess!"

Good medical care is more than answers (or guesses). It is the composite experience: conversation, examination, testing, treatment decisions, and more dialogue. Patients are denied good care if their problems are analyzed in a vacuum. The physician-patient relationship is more valuable to good health than any expensive scan.

Let me summarize by saying that the practice of rendering online diagnoses without the benefit of a comprehensive evaluation (history, examination, pertinent testing) is unhelpful, potentially harmful to the patient, and downright arrogant on the part of the provider. Last time I looked medicine was still considered a healing profession.

WebMD strives to provide the best information possible; see your doctor for the best care possible!

Related Topics: Eye Problems Symptoms, Health Information Online

Technorati Tags: eye health, healthcare

Exploiting the True Power of PowerPoint

Okay, this installment is not about eyes or vision disorders. WebMD encourages us to talk about other experiences from time to time. Consider yourself warned!

As a full-time faculty member at UC Davis School of Medicine I have the responsibility to deliver lectures and presentations, many lectures and presentations. I am always on the lookout for ways to improve my teaching technique and my visual presentations.

These days, regardless of the venue, almost every kind of oral talk is supported by a PowerPoint presentation. I remember using PowerPoint to make 35mm word slides before it was a Microsoft product; back when the top software was a clunky DOS product called Harvard Graphics. PowerPoint remains popular because it is a quick and easy way to organize your thoughts and clearly deliver those thoughts to an audience.

The current version of PowerPoint has so many bells and whistles I am overwhelmed. Nevertheless, I want to discover and fully exploit PowerPoint innovations that will make my lectures memorable. Scientific content is always top priority, but why not a little sizzle with that juicy steak?

Hey, 'Dummies' and 'Idiots'! I have finally found a comprehensive guide to help me prepare consistently attractive and dynamic PowerPoint presentations. I think this is the one book you've been looking for.

This blog is not a commercial endorsement. Consider it a strongly-worded recommendation from an experienced educator. Get hold of a copy of Perfect Medical Presentations by Irwin (a physician) and Terberg (a graphics artist). It won the 2005 Best Book Award (Basis of Medicine) by the British Medical Association.

No, you do not need to be in the medical profession to appreciate this book. It is loaded with extremely practical and outrageously creative tips for basic and advanced PowerPoint users. It comes with a CD loaded with original templates and useful graphic examples.

Besides helping you navigate PowerPoint, this book shows you step-by-step how to create your own high-end graphics with Adobe Photoshop Elements (a software program bundled with most scanners). If you already use the full version Adobe Photoshop you are good-to-go!

PowerPoint simplifies my job as a teacher. Perfect Medical Presentations has helped me do that job better.

Related Topics: Top 10 Stories of 2005

Technorati Tags: review, software, powerpoint, medicaleducation

Timing Cataract Surgery

Although it's only January I can already predict with confidence that cataract surgery will be the #1 most commonly performed surgery in the United States during 2006. Two million or more procedures will be performed, far more than hernia repairs, tonsillectomies, even hysterectomies.

The reasons eye surgeons are kept so busy are pretty obvious: America has a maturing population (some baby boomers have already reached their 60th birthday) and both eyes eventually need cataract removal.

Patients and families often ask, "When is it the right time to have cataract surgery?" Because of the superior technology available today cataract surgery is very effective and carries a low (maybe 1%) potential risk of long-term complications. Forty years ago cataract surgery was feared because one-third of all cataract surgery patients ended up worse after their operation.

Cataract surgery should be considered when the cataract interferes with daily activities like reading and driving. The eye surgeon first needs to be sure there are no other active eye conditions that need attention.

There is no hurry to operate on both eyes. Symptomatic cataract in one eye often advances faster than the fellow eye. Many people function very well after having the first cataract removed and can wait months or years before returning for more surgery.

So, cataract removal will be number one in 2006. Check back with me in December and see if I'm right!

Related Topics: Cataract Surgery: The Innovations Continue, Eyes and Age

Technorati Tags: cataract,surgery,webmd

Nine Lives, One Eye!

Here's your dose of weekend weirdness.

Check out this story about a kitten born with one eye. They named it 'Cyclops' - how adorable! Other eye doctors have sent it to me to ask if I felt it was legitimate. Click here for an enlarged photo of this phenomenal feline. (Someone stop me, I can't help myself!)

It's probably not truly one eye, but two eyes that failed to divide...something called synophthalmos. I can't speak for cats, but this kind of anomaly is incompatible with life in humans because other structures besides the eye (like the brain) are also maldeveloped. It would require a CAT scan to know for sure!

Enjoy this blog while you can before WebMD's editors use it to line the kitty litter box!

Seeing Beyond Cataracts

Most folks are surprised to learn they have developed a cataract in one or both eyes. The drop in vision is usually very gradual, that is, until the person cannot get their driver's license renewed!

Before consenting to undergo surgery curious (or skeptical) patients ask how the surgeon can accurately attribute the vision drop to the cloudy lens. Maybe there's a tumor, bleeding, a detached retina. Put another way, 'How do you know that the rest of the eye is healthy; how can I be sure that I will see better after cataract surgery?' Good question!

New technology permits doctors to carefully examine the complete eye even if a dense cataract is present. Although the patient has difficulty seeing out, the eye surgeon is usually able to see inside the eye - behind that cataractous lens. Maybe you've been exposed to the eye doctor's bright head lamp during an exam called indirect ophthalmoscopy. Oh yeah, there's plenty to see when there is adequate illumination.

For dense cataracts noninvasive ocular ultrasound ( two types: A-scans and B-scans) apply the same physics used to examine a pregnant mother's womb. It can reveal all kinds of changes that might be obscured by an opaque lens.

Gadgets aside, don't neglect the value of a good old-fashioned eye exam. Simple tests like pupil responses and color discrimination provide powerful information. For example, if an optic nerve problem was actually responsible for a patient's poor eyesight, more so than the cataract, then the pupil in the affected eye would behave abnormally.

Sad discoveries after cataract surgery occur far less often compared to a generation ago. Before scheduling cataract extraction the experienced eye surgeon always reflects, "Have I proven to myself that cataract alone is responsible for this patient's decreased vision?"

Related Topics: Cataract Surgery, Cataract Awareness

Technorati Tags: eyesurgery,cataract,webmd

Sour Notes About Retinal Detachments

Medical textbooks explain health problems in very technical, very dispassionate terms. I guess by keeping things 'objective' the reader can move on without getting emotionally involved with every disorder they study. How tidy!

At the far opposite end of the spectrum are patients' accounts of their problems. Equally detailed, their stories are dripping with fear, confusion, pessimism and lots of personal bias. Such is the case with this recent blog entry from a harpist who experienced a vitreous detachment.

First hand, first time experiences can be dramatic. After nicely describing the familiar constellation of symptoms, all of a sudden, the blogger starts worrying about blindness!

All of us will someday encounter a vitreous detachment but few (very few) have problems once the floaters, flashes, and meteor storms settle down. A small percentage can develop small holes in the retina but, once again, few need treatment and even fewer ever go blind. Less than 1-in-10,000 adults sustain a retinal detachment. Yep, most of them get completely fixed and preserve their eyesight.

So, what's my point? Don't ever let yourself leave the doctor's office afraid. A bit more information about vitreous detachments could have completely changed this dedicated musician's outlook regarding this normal, everyday, physiologic milestone in life. Instead of dwelling on an inaccurately dismal prognosis this blogger should be concentrating on the next recital, the next composition, the next blog.

Sure, know the warning signs of a possible retinal detachment and know what to do if it occurs. Meanwhile, get back to enjoying your life.

Related Topics: Vision Problems, Diabetic Retinopathy

Technorati Tags: retinaldetachment, floaters

Glaucoma: Symptom-Free Loss of Vision

January is designated 'Glaucoma Awareness Month'. I'm not sure who makes these 'designations' but it's a great time to determine if you or a loved one is at risk for this invisible thief of sight that can leave you without vision.

All adults 40 and over should have their eye pressure measured. It is quick and painless. Since most types of glaucoma generate no symptoms whatsoever, an intraocular pressure measurement is the essential method to identify affected individuals.

The damage to the eye caused by glaucoma is irreversible and the vision lost is gone forever. On the other hand, there are many effective ways to successfully maintain a healthy intraocular pressure.

WebMD has a very helpful webpage devoted to Glaucoma Diagnosis and Treatment.

When was the last time you were screened for glaucoma?

Related Topics: Cholesterol Drugs May Fight Glaucoma, Signs of Glaucoma Damage

Tags: glaucoma,visioncare,webmd

Another Option for Treating Myopia

Folks with significant nearsightedness (myopia) now have another treatment option. Traditional spectacles optically shift the visual image onto the retina but these are often heavy and unattractive eyeglasses (think Henry Kissinger). Besides, there are all kinds of optical aberrations that emerge with 'high minus' corrections.

Soft and hard contact lenses eliminate these drawbacks and are very popular except for those with a history of previous corneal inflammation or dry eyes.

Refractive surgery was invented for myopes. Nearsightedness can be greatly reduced with tiny corneal incisions, silicone bands, corneal flaps, laser ablation or any combination of the above. Unfortunately these refractive surgery procedures do not always fully correct the refractive error. Patients often need eyeglasses afterwards. Hmmmm...spend $2000 and still need new glasses?!?

Extreme nearsightedness can be reversed by surgically removing the natural lens inside the eye. Think of it as removing an +18.00 diopter lens from the eye. Removing the eye's own lens also removes the eye's ability to see things up close (accommodation). Life is full of tradeoffs. Clear lens extraction is the same operative procedure as cataract surgery except there is no cataract, however, all of the potential complications of cataract surgery persist!

You may have recently heard about the Visian implantable lens - a different kind of artificial intraocular lens. The Visian implantable lens is a foldable device that is surgically inserted through a tiny corneal incision. It opens up and rests between the colored iris and the natural lens. The neat thing about this approach is that all of the nearsightedness can be eliminated without sacrificing the eye's ability to accommodate because the procedure preserves the eye's natural lens. That's important for anyone wanting to read the fine print!

No surgery is perfect for every patient and some patients are not good candidates for any surgery. Having said that, it's always good to know that options exist.

Related Topics: Implanted Lens Approved for Nearsightedness, Implantable Contact Lenses Safe, Effective

Tags: myopia,surgery,nearsightedness,Visian,webmd

Vision Changes and Stroke Warnings

Everyone is concerned regarding the tragic news that Israeli Prime Minister Ariel Sharon has suffered a major stroke. The term 'stroke' simply means 'shutdown' due to lack of oxygen, whether due to a clogged blood vessel (ischemic stroke) or due to bleeding within the brain (hemorrhagic stroke). In both situations there is inadequate fresh oxygen reaching the brain. Loss of function (speech, motor skills, cognition, etc.) corresponds to the specific area of the brain damaged.

Patients often experience visual symptoms before stroke occurs. These visual symptoms can be a warning that could save a life.

A little anatomy would be helpful here. Each eye relies on a single artery for oxygen and nutrients, the Ophthalmic Artery. This vessel happens to be the final branch of the critical Internal Carotid Artery - think of it like the last stretch of a very long highway, the end of the road. Anything that affects blood flow to the Ophthalmic Artery automatically affects the vision. For example, small bits of cholesterol (called plaques) can enter the circulation and eventually end up trapped inside the narrow Ophthalmic Artery because it is the end of the line.

These small vascular occlusions often precede more significant vascular blockages. Bigger plaques don't make it to the Ophthalmic Artery. They block larger branches of the internal carotid that serve the brain. By then it may be too late.

Risk factors for stroke include high blood pressure, obesity, smoking, and high cholesterol levels.

Adults who notice any sudden change to their vision should seek immediate medical attention. Do not wait for things to clear on their own. Time is critical; not merely to treat the vision problem, but also to identify and treat any possible stroke-causing medical emergency.

Related Topics: Act Fast To Stop Stroke's Brain Damage, Simple Changes to Lower Your Stroke Risk

Tags: ArielSharon,stroke,vision,webmd

Adults with Crooked Eyes

Know anyone with crooked eyes? The medical term for crooked eyes is strabismus (pronounced struh-BIZ-muss). If the eye turns inward it's called esotropia - outwards it's exotropia. There are many different patterns.

Strabismus is a common condition among children, with about 4 percent of all children in the United States diagnosed with strabismus. Most adults with the condition have had it since childhood. Strabismus can also be acquired in adulthood because of medical conditions including diabetes, thyroid disease and head trauma. Strabismus can occasionally occur after cataract or retinal surgery.

A recently published study in the Journal of American Association for Pediatric Ophthalmology and Strabismus suggests that the benefits of surgically-corrected adult strabismus include not only improved health and vision, but also improved self-image, better job performance and promotions, and more hope for the future. In the study 101 patients completed a six-question survey. They reported large differences between before-surgery and after-surgery ratings of the severity of problems associated with their strabismus.

Because adult strabismus is frequently dismissed as cosmetic, older patients rarely seek treatment. Instead, they are encouraged to "just deal with it." Patients as old as 90 completed the study's six survey questions and ranked on a scale of one to 10 how strabismus affected their lives before and after surgery. Categories included social interaction (maintaining eye contact, social confusion), concerns about the future (blindness, inability to work or read), and job-related concerns (not being hired, retained and/or promoted).

In all six areas, patients indicated a significant improvement after their surgery.

Surgery is not the solution for every case of strabismus. For example, crookedness due to a refractive problem responds better to prescription eyeglasses. An experienced ophthalmologist can determine the best way to manage each individual case.

Related Topics: People With Visible Eye Deformities Face Prejudice, Vision Problems in Aging Adults

Tags: crossedeye,crookedeye,strabismus,adults,eyesurgery,webmd

Why Fly with Dry Eye?

This has been a wild week for me! Even though it is the holiday season, during the past week I have logged over 10,000 frequent flier miles on too many flights to remember.

If your upcoming travel plans include an airline flight make sure you bring two things: some food (now they even charge for those tiny pretzels!) and a bottle of artificial tears.

I can't give you too much help regarding high-altitude fasting, but there's plenty to share about protecting your eyes during cross-country travel.

The air inside commercial aircraft is dry, very dry. At 25% relative humidity, the arid environment inside the passenger cabin is comparable to the Sahara desert. On top of that you may need to use that little overhead air vent. Next, you will likely spend many hours reading or watching in-flight movies (I typically skip the flick as most of them are box office duds). The point is that you blink less frequently while reading, computing, or viewing a film.

The combination of dry air, exposed eyeballs, and inadequate blinking all add up to misery. Folks already diagnosed as having dry eyes are first to suffer, but many folks without previous complaints also are vulnerable to dry eye symptoms while stuffed inside a commercial jetliner.

Take the advice of a weary passenger; avoid wearing contact lenses during air travel. Switch to spectacles and frequently apply an artificial tear supplement during the flight. Take a break every few minutes while reading or while using the laptop and close your eyes so as to keep your peepers moist.

WebMD wishes you many comfortable journeys in 2006!

Related Topics: Planes, Trains and Germs, Put Food in Your Belly Before Boarding

Tags: dryeye,airtravel,eyedrops,webmd