February is AMD Awareness Month

We’ve created a campaign to help promote ocular health and drive patients to ask doctors about their risk for developing age-related macular degeneration.

The attached photo can be uploaded to your practice website and social media pages, as well as printed and displayed in-office to increase patient awareness of AMD risk.

Our clinical exam during that era was supplemented with an Amsler grid test, whereby a patient would cover one eye, look at a black piece of cardboard with horizontal and vertical white lines printed in a grid pattern, and note where the lines appeared to be wavy, distorted, or missing.  Alternatively, the Amsler grid was white paper with black lines.  The defects in the grid were circled and this test was repeated with the other eye.  In the late 80’s most eye physicians felt that the Amslergrid was the most useful diagnostic test for detection of macular degeneration.

Additionally, whenever a patient experienced vision loss, a Goldmann Peripheral Visual Test was performed to rule out or monitor glaucoma, macular degeneration, and other ocular maladies.  The Goldmann test provided somewhat valuable information, especially for glaucoma, but testing results varied with each examiner performing the test and the methodology that they employed.  Therefore, there was limited value in following the progression of the field test for macular degeneration.  The Goldmann test took about 30 minutes per eye, with fatigue setting in, making the examination on the second eye less reliable.

The third test that was performed for suspected or known macular degeneration was a medical procedure known as fluorescein angiogram (FA), whereby a fluorescent dye was injected into the blood stream while photos were simultaneously taken of the back of the eye.  This dye accentuates the retinal vasculature so that problems such as an incipient subretinal neovascular membrane (SRNVM) can be detected.  Additionally, this procedure was utilized to ascertain the origin of retinal bleeding, swelling of the back of the eye, and other maladies.  This procedure has always been disliked by patients due to the approximately 10% incidence of nausea, vomiting, itchiness, and irritation.  Tragically, about 4 patients per one million died due to an anaphylactic response to the fluorescein dye. 

If the macular degeneration were atrophic, or dry, there was little that we could do for our patients, except to show empathy, provide comfort, and work with them on low-vision aids.  This prognosis was gut wrenching for the physician, the patient, and family members.  When the FA demonstrated a SRNVM, or a bleed, we were now in the extremely difficult position of deciding whether we should perform a laser procedure, known as macular grid pattern, or not.  Ruefully, this was the proverbial “catch-22.”  By not pursuing treatment, it was inevitable that the macula would take a significant permanent hit, with marked loss of vision.  However, depending on the precise location of the SRNVM, or bleed, the laser procedure could potentially worsen the patient’s vision. Centrally located bleeds, when treated with the laser, would stop the bleeding, but would result in a large blind spot in the visual field, referred to as a scotoma.  Perhaps 30% of patients with a macular bleed who had laser treatment subsequently deeply regretted it, because they were left with worse vision and a huge blind spot.  Without a crystal ball, both the ophthalmologist and the patient were unsure about the optimal path to take.

Complicating matters in the late 80’s and early 90’s was the fact that cataract surgery was far more invasive and replete with more frequent complications.  Therefore, we would wait to proceed with cataract surgery until the patient was severely limited in the performance of activities of daily living.  Just as light rays have a difficult time penetrating through a dense cataract, the eye physician’s view of the back of the eye is suboptimal with a dense cataract.  In that era, getting a good look at the back of the eye was problematic for several reasons:  First of all, a subtle SRNVM would not be detected by the patient nor the examining physician until a later date, when damage was already irreversible.  Second of all, the actual performance of a macular laser procedure was impeded by the presence of the visually obstructing cataract.  Third of all, the cataract surgeon was tasked with making a professional guess of the degree to which the cataract was causing a decrease in vision versus the degree to which the macular degeneration was causing a decrease in vision. With moderate or severe macular degeneration, it would be very unlikely to proceed with cataract surgery.  But at times, a surgeon could incorrectly guess, for example, that the cataract was 75% of the cause of diminished vision, while the macular degeneration was 25% cause of the limited vision.  If these percentages, in actuality, were the opposite, then the patient would be very disappointed with the post-operative visual results.

Preventive care for macular degeneration during the end of the 20th century consisted of recommending carrots, salads, and green vegetables to patients.  The renown Age Related Eye Disease Study (AREDS) did not commence until after the turn of the century.  Furthermore, there was speculation about the increased incidence of macular degeneration with smoking and concomitant diabetic retinopathy, but nothing was scientifically proven.  Our innovations for almost all other ocular diseases moved forward at an amazing rate, but those for macular degeneration lagged considerably, leaving countless distraught patients and families.

The first few years of the 2000’s finally brought us out of the dark ages of macular degeneration into a new world of preventive research, wonderful new diagnostic testing, and exciting new treatment options.  All three transpired concurrently and have changed the configuration of how we approach macular degeneration.

In the 21st century, OCT (Optical Coherence Tomography) testing has become an invaluable diagnostic aid for the very early detection of macular degeneration and its sequalae. This testing is extremely valuable in monitoring disease progress and treatment responses.  Very helpfully, an OCT will frequently detect a macular problem even before the patient is symptomatic, thereby enabling expedient care to preserve eyesight, as opposed to waiting for damage to present itself on an Anslergrid test. With the current 3rd generation OCT machines, such as the Zeiss Cirrus OCT, the number of fluorescein angiograms has plummeted nationally.  This is excellent for quality of care as well as patient safety as the OCT has zero health risks, while the FA is fraught with potential complications.

Macular laser treatments were the sole option in the latter portion of the 20th century for SRNVMs and macular bleeds. These laser treatments brought with them an inherent loss of vision with blind spots.  This all changed with the advent of intravitreal injections in the early 2000’s, which are dramatically more effective. These injections contain a medication called anti-VEGF, which counteracts the vascular endothelial growth factor (VEGF), a dangerous substance that propels the bleeding in macular degeneration.  Macular laser treatments, widespread in earlier decades, have now been largely supplanted by the more beneficial intravitralinjections.

Age Related Eye Disease Study (AREDS) has become a prominent fixture in the world of ophthalmology and outstanding preventive care.  Currently, certain nutrients and vitamin supplements are highly recommended, especially carotenoids, to those afflicted with macular degeneration. These key nutrients contained within the supplemental vitamins are of paramount importance. It is commonplace for supplemental vitamins touted to promote macular health to contain two of the carotenoids, lutein and zeaxanthin.  Several researchers believe that adding a third carotenoid, meso-zeaxanthin (a structural isomer of zeaxanthin), is even more beneficial because it works in tandem with the former two to provide an even higher degree of macular protection.  This is the strategy behind MacuHealth.  These caretonoids are pigments contained in the cell body of photoreceptors, hence the name macular pigments.  The macular pigments protect the eye from oxidative damage, and concurrently, improve visual function.

Other research teams have identified additional very important steps one can take to significantly protect macular health:

1.  Refrain from smoking

2.  Wear sunglasses when outdoors during daylight hours with UV-400 blocker and

polarization on both lens surfaces.

3.  Eating food, such as fish, or supplement with alpha-omega-3 fatty acid

4.  When using digital devices, wear eyeglasses with lenses that have blue blocker embedded within the lens

During my 30 years of practice as an ophthalmologist, the bleak outlook for patients with macular degeneration has now transformed into a more optimistic picture. This rosier outlook is a result of the triumvirate of OCT testing, intravitreal injections, and possibly, most importantly of all, our expanded knowledge of nutrient and vitamin supplements, especially carotenoids, as effective preventative measures. 

Dr Alan Mendelsohn works at Eye Surgeons and Consultants. He has worked as an ophthalmologist in the South Florida area for the past 30 years.

· a classic dish originating in the south of France ·

INGREDIENTS

4 Zucchini- medium size

2 Yellow squash- medium size

2 medium sized Spanish onion or Vidalia or even red onion works

1 red bell pepper

1 orange bell pepper

1 yellow bell pepper

1 medium can whole peeled tomato (San Marzano)

1 medium can crushed tomato (San Marzano)

6 cloves garlic

2 medium sized eggplant.

4 Tablespoons Extra Virgin Olive Oil.

Basil- or Italian Parsley

S&P (Optional)

TECHNIQUE

1. In a medium sized pot add the oil and chopped onions and cook 3-4 minutes on medium high heat, then add the chopped garlic stir and cook 20 seconds careful not to burn the garlic.
2. Pour can of tomato in a bowl and crush with your hands, then add to the pot, with the crushed tomato.
3. Remove the seeds and stem of the peppers and cut in a medium sized dice, add to the pot.
4. Trim the ends of zucchini and squash and cut length wise and chop in a medium dice, add to the pot.
5. Add 2 cups of filtered water, bring to a boil and simmer for 45 minutes.
6. Need to stay close to the ratatouille and stir every 5-8 minutes so as not to burn.
7. You can either peel the eggplant or leave the skin on, cut in slices length wise and chop medium dice, add to the pot.
8. Simmer covered for another 30 minutes until the eggplant is cooked thru.
9. Chop the herbs and add at the end.

TO PLATE THE DISH

Place on a plate or a medium bowl, add some fresh herbs, and even drizzle a little olive oil at the end for added richness.

Ratatouille is a great summer meal, served hot or room temperature, you can even add some olives or a few capers to the plate before you serve it up.  Very versatile dish, great on its own or with pasta, rice, over chicken or fish as well.  The best thing is it is better the second and third day so make sure to make extra, or double the recipe.

Lastly, Ratatouille is extremely healthy and packed with carotenoids to maintain good ocular health.  ENJOY!

Carotenoids are a group of more than 700 pigments, ubiquitous throughout nature and synthesized de novo mainly by photosynthetic organisms (plants and algae). Three carotenoids in particular — lutein (L), zeaxanthin (Z) and meso-zeaxanthin (MZ) — make up the macular pigment (MP). Located in a central and prereceptorial location at the macula, the anti-inflammatory, antioxidant, and blue light-filtering properties of these macular carotenoids make them ideal candidates to not only help protect against age-related macular degeneration (AMD) but also enhance vision for all patients, including those who are young and healthy.

Filtering Blue Light

In terms of negative impact on visual performance, blue light exposure is a problem for everyone. The primary source of blue light comes from the sun, but now artificial sources of blue light include electronic devices such as cell phones and laptop computers, as well as energy-efficient fluorescent bulbs and LED lights. The light absorbance spectrum of MP peaks at 460nm and, therefore, this optical filter has the capacity to absorb/filter high-energy short-wavelength (blue) light before it reaches the photoreceptors (the cells of vision). Importantly, MP filtration occurs at the central retina only, which allows for blue light to reach the peripheral retina, where it impacts positively on sleep cycles, alertness, and mood. There are several reasons why blue light is deleterious for visual performance and experience. First, there are no blue sensitive cones at the centre of the fovea, thus, visible blue light cannot contribute to visual performance and experience at the location of maximum acuity. Second, given that only visible wavelengths of light are incident upon the retina, and because incident blue light is myopically defocused to an extent of 1.2 diopters, blue light actually contributes to chromatic aberration, which causes a blur around the image. Finally, and most importantly, it is only the blue wavelengths of light that are appreciably scattered and contribute to a phenomenon known as veiling luminance. MP is crucial, therefore, if the deleterious effect on visual performance of veiling luminance is to be minimized and vision is to be optimized.

Better Vision For All

Recently, the Central Retinal Enrichment Supplementation Trials (CREST)² study, a double-blind, randomized, placebo-controlled trial, demonstrated that supplementation with the macular carotenoids in a MZ:L:Z (mg) ratio of 10:10:2 (i.e., MacuHealth LMZ³) versus placebo results in a statistically significant improvement in vision in subjects with a healthy macula. Furthermore, this formulation is shown to be superior, in terms of both MP augmentation and visual performance, when compared with alternative formulations lacking MZ.³

In other words, and for the first time ever, vision can be improved with simple over-the-counter supplementation, but the formulation must contain all three macular carotneoids. This discovery has particularly important implications for those who rely on their vision for professional reasons, such as athletes, pilots,  and military marksmen, as well as for those who simply want to optimize their vision-related quality of life.

Reference(s):

1. The Vision Council. 2017 Blue Light/Digital Eye Strain Report. Available https://www.thevisioncouncil.org/sites/default/files/TVC_BlueLight_one-pager_FINAL.pdf. Last accessed Feb. 17, 2017.
2. Nolan JM, Power R, Stringham J, et al.
3. Akuffo KO, Nolan JM, Howard AN, et al. Sustained supplementation and monitored response with differing carotenoid formulations in early age-related macular degeneration. Eye (Lond). 2015;29(7):902-912.

Dr. Nolan is the Principal Investigator of the Macular Pigment Research Group at the Waterford Institute of Technology in Ireland. He specializes in the role of eye nutrition for vision and prevention of blindness, and the link between nutrition and brain health and function. He has presented at more than 100 international scientific conferences and has published more than 85 peer-reviewed scientific papers.

INGREDIENTS

2 Whole Butternut Squash

1 Can Pumpkin Puree 29 oz.

2 Sweet Potatoes

1 Tsp. Nutmeg

1 Tsp. Cinnamon

1 Tsp All-Spice

1 Tsp each S&P (salt optional)

½ Stick unsalted Butter (optional)

1 Sprig Thyme

TECHNIQUE

1. Peel the butternut squash, remove seeds and cut into ½ inch cubes- set aside.
2. Peel the sweet potato, cut into ½ inch cubes- set aside.
3. Open can pumpkin puree, place in a small bowl- set aside.
4. Fill a large pot with water, bring to a boil, add the butternut squash and sweet potato, simmer until fork tender about 30 minutes, strain- set aside.
5. In the same pot add the cooked butternut squash and sweet potato with the canned pumpkin, add all remaining ingredients (blend together with a potato masher) and cook on low heat for 15 minutes.  Stir continuously as to not scorch the bottom.  Adjust the seasoning.

TO PLATE THE DISH

 Place in small ramekins with a sprig of thyme for garnish, or place in a large casserole dish (family style) and garnish with a sprig of thyme.

Sweet potatoes add good texture to this Thanksgiving side dish and are nutrient rich for your ocular health.  Butternut squash and Pumpkin are packed with powerful antioxidant carotenoids lutein and zeaxanthin, essential to maintain healthy eyes!

 HAPPY THANKSGIVING!

· with Hard Cooked Eggs ·

INGREDIENTS

3 Cups Kale

2 tablespoon extra-virgin olive oil

5 Baby Carrots ( can substitute regular carrots)

5 Asparagus spears

2 tablespoons dried cherries ( can substitute dried cranberries or blueberries)

½ cup Red wine

½ cup Balsamic vinegar

1 teaspoon sugar (optional)

S&P to taste (salt optional)

2 Hard Cooked Eggs

1 Tablespoon Capers (can substitute 2 of your favorite olives sliced)

1 Clove Garlic

1 small heirloom tomato (can substitute cherry tomatoes or regular tomatoes)

1 Bay Leave

TECHNIQUE

1. Add the wine and balsamic vinegar with bay leave and dried cherries to a small pot on medium high heat reduce to a glaze, discard bay leave, add capers and set aside.
2. Peel carrots, and asparagus and( blanch) cook in boiling water 4 minutes set aside.
3. In a small pot add 2 eggs cover with water bring just to the boil and reduce to a simmer, cook 8 minutes and shock in ice water, peel and set aside.
4. Wash kale well, chop garlic add the oil to a sauté pan and on medium heat sauté the kale and garlic for 3 minutes until wilted, set aside.

TO PLATE THE DISH

1. Place the cooked kale in center of the plate
2. Arrange carrot and asparagus and sliced heirloom tomato around the kale
3. Slice hard cook eggs and place in each corner of the plate.
4. Spoon cherry balsamic red wine glaze with capers and cherries over kale and around the plate.
5. Enjoy!

This is an excellent healthy salad packed with carotenoids that are beneficial to your ocular health.  Great lunch entrée or a light dinner.  Try this one out!

By Hank Schultz, 18-Jul-2016

http://www.nutraingredients-usa.com/Research/Meta-analysis-concludes-meso-zeaxanthin-improves-performance-of-eye-health-formulations

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