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Eye Health, Exercise and Alternative Treatments

We are constantly bombarded with information in the newspapers, magazines, TV and radio regarding alternative forms of treatment and health management. Sometimes it is difficult to sift through all this material. There always seems to a “vitamin of the month” or “magnet treatment” for a particular disorder or a new “herb’ to treat cancer. Even as a physician, knowing what may be helpful to my patients is often frustrating to me.

Being trained as a scientist and with Western medical concepts, I still believe that any claim of medical effectiveness be backed up by solid studies. I have a very open mind with respect to alternative treatments. I believe that anything you can do to maintain your overall general health has to be good for the eyes. Over my almost twenty years in practice, I have developed what I call Dr. Kristan’s Common Sense Rules for a Healthy Life Style. These are based on my interpretation of what is in the medical literature and observations with my patients.

Dr. Kristan’s TEN COMMON SENSE RULES for a HEALTHY LIFE STYLE

1. Maintain proper weight: I believe that being overweight is the single most harmful thing that you can do to your body. Being overweight puts stresses on your heart, increases your blood pressure, makes you more prone to diabetes and increases your risk of stroke. I believe that people become over weight because of a lack of understanding of nutrition, little to no exercise and a lack of will power. I will discuss weight issues in more detail later in this chapter.

2. Understand proper nutrition: I believe that most people do not understand the difference between carbohydrates, proteins and fat. I do not believe that any of the fad diets make sense. I have always felt that a proper combination of carbohydrates, protein and fat makes the most sense. I personally eat about 35% carbohydrates, 40% protein and 25% fat. I think that everyone needs to discover what combination works for him or her—combined with adequate exercise.
3. Exercise, exercise, and exercise! I can’t stress this enough. I believe that the key to maintaining the proper weight is with exercise and good nutrition. Exercise increases the blood flow to the whole body. We know that that eye has a very high blood flow. This is required for good eye health. Anything that increases the blood flow to the eye has to be good for health maintenance. We also know that some forms of glaucoma may be related to decreased blood flow to the eye. Recently, some researchers have shown that aerobic exercise and strength training can reduce the intraocular pressure in both healthy and glaucoma patients. Some studies suggest a lowering effect of 10% to 20%. Exercise also helps to maintain normal blood pressure. My recommendation is at least 30 minutes of exercise/strength training three to four times a week. The level of activity obviously needs to be dictated by physical health. Exercise benefits not only physical health buy also mental health.
4. Maintain normal blood pressure and have your blood sugars checked regularly: High blood pressure can lead to heart disease, kidney disease and stroke. In addition, high blood pressure can cause hemorrhaging in the eye that can lead to permanent visual loss.
Diabetes can cause many problems throughout the body including the kidney, nervous system and the eye. If you have diabetes, keep in the best control you can. Keeping the HbA1C under 7 has been shown to decrease the incidence of complications.
5. STOP SMOKING: Smoking is a risk factor for a number of ocular diseases, including cataract and age-related macular degeneration. It is well known that smoking can affect the immune (the body’s defense) system. As discussed in a previous chapter, thyroid disease can seriously affect the eyes. Smoking has definitely been shown to worsen the eye problems associated with thyroid disease. Smoking can also change the tear film in patients with dry eyes resulting in exacerbation of symptoms. Smoking definitely disturbs the circulatory system and may contribute to retinal vascular disease and “strokes” within the eye. I also feel that smoking contributes to premature aging of the skin, accelerating droopy upper and lower eyelids. These risks are on top of the well-known smoking risks of heart and lung disease, as well as generalized strokes.
6. Maintain DISCIPLINE: The most difficult task we have is sticking to our healthy plan. It is too easy to stray away from. Holidays, parties, good tasting (fatty) food—it is all around us. One needs to develop the will power to resist. In addition, I have an exercise routine that I do every week. I exercise Monday, Wednesday, Saturday and Sunday every week at the same time. Everyone in my family knows it and it is my time. I think about it like taking a shower every morning. It is just something I always do. Treat exercise just like something you must do regularly. If I can do it with my busy schedule as a physician, you can too.

7. Think POSITIVELY: I am a firm believer that people who have a positive attitude perform better in everything they do. I am an optimist and expect everyone around me to be. I expect my patients to come into the operating room with positive thinking. This allows me to perform better and I believe contributes to a successful outcome. Thinking positively decreases the release of our stress hormones that cause wear and tear on our bodies.

8. Decrease STRESS: As I stated above, I believe that stress does contribute to disease. When we are stressed, various chemicals in the body called hormones are released to help us deal and cope. These hormones, however, lower our bodies’ defenses against infection, cancer and other diseases. There are many ways to deal with stress in our daily lives. I like to do yoga. Some people like to play golf. I also find that my exercise routine helps with my stress management. Some people like to meditate. I have even tried hypnosis and found it extremely relaxing. Whatever you like to do should be your time to relieve stress.

9. Spirituality: Whatever your beliefs may be, recent studies have shown that people who pray live longer. Maybe praying decreases stress and gives people a more positive attitude.

10. Get regular check-ups: Certainly regular eye check-ups are vital for vision. Many eye problems that are treatable can be picked up by a routine exam. Like most problems, the earlier they are found, the more likely they will be treated successfully. Apply this to your general health as well.

Recent statistics have shown that about 64% of the Americans are overweight. That amounts to almost 130 million adults. The incidence of obesity has practically doubled since the 1960s. Obesity now rivals smoking as a major health risk. Although most of us are well aware of the health consequences obesity has on heart disease, high blood pressure, diabetes and cancer, recent research indicates that obesity puts people at risk for eye disease. It would appear that overweight individuals tend to consume less of the healthy types of foods. There have been studies to link poor nutrition to increased risk of macular degeneration. A higher incidence of cataract surgery has been found in patients with elevated blood pressure and cardiovascular
(heart related) diseases. In addition, researchers have shown that an increase in body mass index strongly affects blood sugar levels, which is associated with an increased risk of cataract.

There has been a longstanding relationship between obesity and type 2 diabetes. Recent evidence has suggested that abdominal obesity may be a factor in retinopathy development. Remember that diabetic retinopathy can lead to blindness.

Also studies from Asia have found an association between elevated intraocular pressure, glaucoma and vascular disease. The authors conclude that obesity should be considered a risk factor for an increase in eye pressure. Interesting enough, there is evidence that patients who have glaucoma or are at risk of developing glaucoma can increase their intraocular pressure by 10% playing high resistance wind instruments (trumpet, oboe, French horn).

Vitamins and Eye Health

Not a day goes by in my practice that someone doesn’t ask me about the role of vitamins and eye health. This is a very confusing topic because there is a lot of information available that is frequently not based on sound scientific data. My initial comment is that a sound diet should be the best and safest way to obtain an adequate supply of all requisite vitamins and minerals. That being said the following is a list of nutrients thought to be important for eye health and some potential sources. These are included under the category of antioxidants.
1.Vitamin E: whole grain, nuts, vegetable oils (polyunsaturated) and olive oils (monounsaturated)
2.Vitamin C: citrus fruits, vegetables such as broccoli
3.Carotenoids (including luteins): fruits and dark leafy, yellow and green vegetables
4.Zinc: meat, poultry, fish and dairy products

There is evidence from a large clinical trial called the Age Related Eye Disease Study (AREDS) that antioxidant supplements may benefit people with age related macular degeneration (AMD). Patients with intermediate or advanced stages of AMD had a lower rate of clinical progression that was clinically significant. The supplements used were vitamin E (400 IU), vitamin C (500 mg), beta-carotene (15mg), and zinc (80mg together with 2 mg of copper). Since these are higher doses than usually recommended, I always require my patients to fully discuss these supplements with their internists so as not to interfere with any other medications, including other vitamins.
Patients with a family history of AMD also frequently ask me whether taking the AREDS supplements makes sense. To date, there is no evidence to support beginning this therapy.
In these patients I just recommend a good daily multivitamin. There is no evidence, however, that the use of multivitamins slows the onset or progression of AMD. Since we are not absolutely sure, I don’t believe it could hurt. There may be, however, a lower risk of cataract formation with multivitamin supplements. The value of antioxidant supplements in preventing or slowing down diabetic retinopathy is unknown at this time. My best advice is that multivitamins should not be a replacement for a sound diet.

As of this writing, lutein has received much attention as a treatment for various eye disorders including AMD. Lutein is in the carotenoid family, like beta-carotene. Currently, the evidence is far from conclusive.

Herbal supplements have also been marketed extensively. Bilberry and ginko biloba are most talked about. Bilberry is promoted as improving night vision and ginko biloba supposedly increases blood flow (could be important in glaucoma management). To date, their effectiveness remains unsubstantiated in the scientific literature.

In closing, I would like to address one additional area that I feel is a major threat to our health, especially the eyes, the eyelids and the face. I am talking about the long-term effects of excessive sun exposure. I believe that there is enough evidence to suggest a contributory role of UV exposure in cataract and macular degeneration development. There is a definitive relationship between excessive sun exposure and skin cancer development. The sun plays a major role in aging the skin, causing photodamage (sunspots) and wrinkles. I recommend limiting sun exposure and always wearing sun block. This is easy to do and you will be surprised how much better your skin will age.

Reference:

Seddon JM et al Progression of age-related macular degeneration: association with body mass index, waist circumference and waist-hip ratio Archives of Ophthalmology 2003; 121(6) pg 785

Lee JS et al Relationship between intraocular pressure and systemic health parameters in the Korean population Korean J Ophthalmology 2002; 16(1): pg 13

Van Leiden HA et al Blood pressure, lipids and obesity are associated with retinopathy: Diabetes Care 2002; 25(8) pg 1320

Mares JA et al Doctor, What Vitamins should I Take For My Eyes? Arch Ophthalmology 2004;Vol 122 Pg 628

Passo MS et al Exercise reduces intraocular pressure among subjects suspected of having glaucoma. Arch Ophthalmol 1991; 109 (8); 1096-1098

Aydin P et al Effect of wind instrument playing on intraocular pressure. J Glaucoma 2000:9:322-324

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