Dr. Steensma's Viewpoint - Whats new in eyecare

Low dose aspirin and eye disease

A recent study published January, 2011 indicates daily aspirin use among seniors may double their risk of developing "Wet" age-related macular degeneration. Aspirin use was not found to be associated with increased risk for developing the more common dry age-related macular degeneration. The study involved 5000 patients from medical centers across the country.

The studys authors cautioned that further research is needed. Meanwhile, they suggested that doctors generally should not alter their current advice for aspirin use among older patients coping with heart disease risk. They suggested that patients taking small amounts of aspirin without a past history of cardiac arrest or problems like stroke and without risk factors for these diseases consider stopping the aspirin.

The study did not determine cause-and-effect.. Cardiac disease itself is a risk factor for macular degeneration and patients with cardiac disease are more likely to be taking aspirin.

Until a definitive study is done I personally am going to continue taking my 81 mg aspirin daily.

Vitamin D and Age Related Macular Degeneration

A new University of Buffalo study suggests that women under the age of 75 with higher amounts of vitamin D in the blood are less likely to develop macular degeneration. Vitamin D blood concentration can be increased by spending moderate amounts of time outdoors, eating fish, fortified milk, fortified cereal, and by taking supplements.

If you or someone in your family has macular degeneration, I would suggest a daily vitamin D supplement.

Now order your Contacts on-line through our web site and it costs a lot less

Now you can now order contact lenses on-line through our web site (www.visioneyedoctor.com) and to make it even better most lenses are priced even less than the biggest on-line contact lens source (www1800contacts.com).

Check out our web store on our web-site under "Our Services". I put up a table comparing our prices to the big guy. It's really pretty cool..

A very strange day

Yesterday was a strange day. I moved to Port Hueneme in 1976 and joined an established optometric practice started by Dr. Ralph Moses in 1952. At that time he had been providing quality optometric care to this community for 24 years. We were partners for 13 years and then he retired in 1989. Ralph died last Wednesday and was buried yesterday.

There were several hundred people at his service. Everyone truly did love Ralph. I will miss my mentor.

Last night at the 2011 Port Hueneme Chamber Of Commerce Annual Dinner I was recognized as "The 2011 Port Hueneme Business Person of the Year". I was very surprised and didn't make much of a speech, but looking back now I wish I had taken a moment to thank Ralph for setting the tone of our practice. We really do try our best to provide the best optometric care possible and always with a unique interest in that particular patient as a unique individual.

Thanks Ralph.

Retinal injections for "Wet" Age Related Macular degeneration

One way to slow a cancers growth is to limit the cancers blood supply. Avastin is a drug developed to slow the growth of blood in colon cancer. A similiar drug called Lucentis has been developed to slow the growth of blood vessels in "wet" ARMD. Avastin costs ten times as much as Lucentis.

A recent study found that both drugs were equally effective in treating ARMD.

The drugs are also used in other ocular conditions in which there is neovascular growth like diabetes,

Retinal Implants for the blind

A recently developed retinal implant has allowed three blind people to identify shapes and objects. It's a long way from a bionic eye but it is a step in the right direction.

Vitamin D may reduce diabetic retinopathy

One of the causes of diabetic retinopathy may be an insufficient Vitamin D intake.

A study at Emory University measured vitamin D levels in the blood from normals and diabetics with or without different degrees of diabetic retinopathy.

The study found that 81% of the patients with the worst type of diabetic retinopathy (Proliferative retinopathy) were vitamin D deficient. Approximately 70% of other diabetic patients with non-proliferative diabetic retinopathy or no retinopathy at all were vitamin D deficient.

Only 55% on non-diabetics were vitamin D deficient and only 44% of the non-diabetics were deficient if they took a multvitamin supplement.

My conclusion from this study is that those patients who are at risk for diabetic retinopathy should be taking vitamin D supplements.

For more information about diabetic retinopathy read my article @ http://visioneyedoctor.com/dr.-steensma-s-articles/diabetic-eye-disease.htm

New hope for macular degeneration patients

A drug used to treat rheumatoid arthritis may slow the progression of age related macular degeneration (ARMD). A study at the New York University School of Medicine evaluated the effects of fenretinide on ARMD patients at 30 sites across the country. .

Fenretinide is a synthetic derivative of vitamin A, It has very strong anti-inflammatory properties and inhibits abnormal blood vessel growth. It is taken orally once a day.

The study found that "dry" ARMD patients taking the fenretinide were 50% less likely to progress to the more serious "wet" ARMD. ( See my website http://www.visioneyedoctor.com/ for a detailed explanations of "dry" ARMD vs the "wet" ARMD).

This appears to be a very exciting break through. But, I hope the link between vitamin A supplements and lung cancer in smokers or ex-smokers is investigated throughly. See: http://visioneyedoctor.com/dr.-steensma-s-articles/macular-degeneration-nutrition.htm

We are seeing more diabetes

More than 50 percent of Americans may have diabetes or prediabetes by 2020 if current trends continue, according to a new report. And the related health care costs could reach $3.35 trillion over the next 10 years. With more diabetes comes a higher prevalence of blinding diabetic retinopathy, as well as other health problems, such as heart and kidney disease, nerve damage and limb amputation

New treatment for dry eyes maybe

Evoxac (Pilocarpine) capsules are used to increase saliva production in patients with Sjogren's Syndrome (dry eyes, dry mouth, and an autoimmune disease). A recent study has shown that Evoxac will also increase tear production in dry eye cases. The problem is there are multiple interactions with other medications. Because the possible side effects I probably will not use it to treat dry eye patients.

Vitamin E & C and cataracts

An eight year study was just completed which determined that taking vitamin E or vitamin C supplements had no effect on the incidence of cataracts.

There is no blood supply to the human lens so over time metabolic waste products build up within the lens. These products disrupt the precice alignment of the lens fibers making the lens more opaque. When it becomes cloudy enough to effect vision we call it a cataract.

It has always been assumed that antioxidants like Vitamin E and C would slow down the formation of cataracts. Now we know that is not true,

Web Reviews

Web reviews are very important factors in on-line searches. We have about 50 video testimonials on the website now. Now I am going to start a campaign to get 100 on-line reviews at Google, Yahoo, MSN, etc.

Very cool video animations on the website now

I have leased an animated video package for use on the web site as well as in the office. It consists of 50 professionally produced animated videos illustrating eye anatomy, eye diseases and vision problems. It's pretty cool.

Patients that have certain eye conditions can be directed to a particular point on the web site for more information about their specific eye problem. I am also using it in the exam room as a teaching tool for patients.

As of today we have an Internet connected computer in the frame selection area of our office. The videos can be viewed there by a patient trying to decide what type of lens or lens treatment is best for them. We also can access our frame suppliers so we can show the patient different frame colors and styles available. Another fun benefit is that you can now photograph yourself trying on a new frame so you can really see how it will look. You can even email a copy to your boyfriend or spouse for their approval.

Patient Satisfaction Survey

The office is doing another patient e-mail survey of our patients regarding our office and services. Only partial results are in so far, but they are very encouraging. Overall satisfaction with our practice was listed as "Very Satisfied" by 91% of the responding patients so far. I guess I need to try harder with that 9% who are only "Satisfied" but not "Very Satisfied".

You can see the survey results at this link:

See Survey Results

A short vacation to recharge my batteries

I took a week off away from the office to recharge my batteries. North to Alaska. We saw lots of awe inspiring views of mountains, glaciers, vast forests, and waterfalls every where. Nature thrives up there. We saw many whales, grizzly bears, brown bears, moose, and caribu. It was a lot of fun. Here are a few pictures:

http://www.facebook.com/album.php?aid=208614&id=688084377&l=730fc62414

Now, back to work.

Over our lifetime our eyes change in many ways

Baby
Our eye color is determined by how many melanocyte pigment cells are present on our iris. If we have many our eyes appear brown. If their are fewer pigment cells the irises may appear blue, green or grey. Hazel eyes are an indeterminate color - maybe dark in some areas and light in other areas.

Our babies eyes may change color. Many baby's irises are gray at birth, and they may stay that color or they may darken over the first six to nine months of life. So gray or blue eyes can turn brown, green, or hazel, but brown eyes won't lighten and become blue.

The gene for blue eyes is recessive, meaning it does not produce a blue eye unless it's matching gene from the other parent is also for blue eyes. So even if both parents have brown eyes, they may both have a recessive blue gene and have a 25% chance of having a baby with blue eyes. If both parents have blue eyes their is a 0% chance of having a blue eyed baby.

It's thought that blue eyes arose in a solitary genetic mutation partially towards albinism. The fully albino eye has no iris pigment cells and appears pink.

A babies eye at birth is 75% of their adult size. Their eyes appear large because the body is so small. During the first two years of life, the optic nerve, visual function and internal eye structures continue to develop. The newborn’s visual acuity (sharpness of vision) is approximately 20/400. This is equivalent to seeing only the big letter “E” on an eye chart. Newborns don't pay much attention to the visual world, but by 6-8 weeks of age they will follow an object. They will begin to enjoy seeing their mothers face.

Testing has proved that Vision slowly improves to 20/20 by age 2 years, but most kids will measure about 20/40 untill age 5-6. At 4 months they start to work as a team and develop binocular vision. Color vision is present at birth.

The most common problems with a babies eye are infections and excess tearing due to a blocked tear duct. The infection is treated with antibiotics. In most caes the blocked tear ducts open on their own, but sometimes they must be probed to open them. Some babies are born with cataracts and some have binocularity problems preventing the eyes from working together and ambylopia or "Lazy Eye".

Child
Most first graders see pretty good but maybe 10% have vision problems. By grade 5-6 some kids are developing myopia and need glasses for distance tasks. That might bring the percentage of students with vision problems to 30%.

High School / College

The extended time spent reading results in a greater percentage of kids developing myopia and needing glasses for distance visual tasks.

Adult

If the myopia doesn't get you, vision is fairly stable untill about age 42. When we focus on near tasks, the ciliary muscle within the eye pulls on the lens within our eye, changing the focus. In a young person the lens is very flexible and focusing is easy. As we age the lens becomes less flexible, and even though the ciliary muscle is as strong as ever most people start to have focusing difficulty by age 42. During the 40's and into the mid-50's, near vision progressively gets worse, but then stabilizes by age 55, because all the focusing ability is lost. There is no more to lose. Many people, especially women, develop Dry Eye Disease in this age group.

In the later 60's most people start developing cataracts. That lens that has been getting stiffer over the previous 20 years now is becoming cloudy. When the clouding gets bad enough to impact vision significantly, we call it a cataract. The eye doctors challenge is to try and keep the vision good enough. When it's impacting the persons lifestyle significantly cataract surgery is necessary. This is a pain free out-patient procedure that is very straight forward these days. Diabetics tend to get cataracts 10 years earler than most.

In the 60's the body often starts to lose a little metabolic control and things don't function as well as when we are younger. Many diabetics develop diabetic retinopathy in the 60's. In the late 60's and into the 80's macular degeneration and glaucom becomes more prevalent.

We did a survey of patients seen in the last few months. The results were very reassuring.

We asked seven questions and listed six possible responses. The possible answers were:
Strongly agree
Agree
Neutral
Disagree
Strongly disagree

The questions and their responses were:

The staff was friendly - 97% "Strongly agree"
The staff was eager to help me - 97% "Strongly agree"
The doctor was friendly - 100% "Strongly agree"
The doctor answered my questions - 100% "Strongly agree"
The examination was thorough - 97% "Strongly agree"
I will return in the future = 100% "Strongly agree"
I will refer my family and friends - 93% "Strongly agree"

Thanks everybody. We will make every effort to continue to deserve your trust.

Can Eye Exercises Improve Your Vision?

I was recently interviewed and was quoted in an optometric magazine's (Review of Optometry) Blog about "Eye Yoga".

http://www.revoptom.com/blogs/john_murphy/entryid/65/eye-yoga-now-there-s-a-subject/

Some people believe that practicing certain eye exercises can improve vision. People that have eye control problems such as difficulty converging their eyes at near to read can benefit through "vision training" exercises which are pretty much the same things as done in "eye yoga".

In 1920 a Dr. William Bates published a book. "Perfect Sight Without Glasses". His theory was that sight problems were due to "strain" and learning to relax the eyes would improve vision. He used a technique called "palming" in which you press the eyes with the palms of your hands. He also encouraged gazing at the sun as being good for the eyes when in fact it can cause permanent damage to the eyes.

It would be nice if his theory worked, but it doesn't. If it did I wouldn't be wearing glasses as I write this. Every couple of months I see a patient who has read some book or some website about the Bates method and is using it. Now 80 years after the Bates method was disproved people are still looking for that magic cure.

Nutritional suplements are the only treatment available for Dry Macular Degeneration

– An update

In the year 1999 the AREDS report demonstrated that nutritional supplements could significantly slow the progression of macular degeneration. The AREDS report was based on 4,000 subjects followed over a minimum of five years. They study participants took supplements of Beta Carotene, Zinc, Vitamin C and Vitamin E and they had 25% better outcome than those not taking the supplements. Since then these supplements have been frequently used in the management of ARMD.

In the last ten years since AREDS several studies have impacted the use of the AREDS supplements. Beta Carotene has been shown to increase the risk of lung cancer in smokers. Zinc supplements can cause genitourinary problems. Vitamins C and E are strong antioxidants and are still recommended.

Other studies now point to other supplements that might be effective. Omega-3 fatty acids, Co-enzyme CoQ10, Trans-reveratrol, EGCG, Vitamin D, Lutein and zeaxanthin are now all thoght to be important to macular health.

The AREDS 2 study began in 2008. It will make its recommendations in 2012.

For the full story go to my website: http://visioneyedoctor.com/articles/macular-degeneration-nutrition.htm

Computer Vision Syndrome

Almost everyone these days is using a computer for work or play.

We spend a lot of time staring at our computer screens and many people are experiencing vision related problems. The eyestrain, blurred vision and headaches that often come with computer use are called Computer Vision Syndrome (CVS).

Studies indicate that up to 80% of computer users have vision related problems or CVS. Many computer users don't associate their symptoms with the time they spend on the computer. Some assume that their headaches or eyestrain are from job stress, or that their tired eyes are an expected part of their job. Computer glasses are special glasses designed for your computer environment. They will make your computer time more productive and comfortable.

If you are experiencing eyestrain, blurred vision and headaches associated with your computer use, see your eye doctor. Why put up with the eyestrain, blurred vision and headaches if you don’t have to?

To see this article go to: http://visioneyedoctor.com/articles/computer-vision-syndrome.htm

Age Related Macular Degeneration (ARMD) Is A Leading Cause Of Blindness

Age-Related Macular Degeneration (ARMD) is the #1 cause of blindness among Senior Citizens. Because the Baby Boomers are now becoming seniors, vision loss from macular degeneration is a growing problem. About 1.75 million Americans have ARMD now and it's projected that it might affect 3 million Americans by 2020. Approximately 300,000 will become legally blind.

Although anyone can have it, Age-Related Macular Degeneration (ARMD) occurs most often in Caucasian females over age 65. Smoking increases the risk 6 times and living with a smoker doubles your risk. Being overweight also can double your risk. Another big risk factor is the excessive light exposure that surfers, sailors, farm workers, etc are exposed to.

Most of our retina (the light sensitive tissue inside the eye) has light detail and color perception. The macula supplies the straight-ahead vision. In ARMD the macular cells are damaged and central straight-ahead vision becomes blurred or distorted.

Phase two of the AREDS study (http://www.areds2.org/) began in 2008. It is trying to determine if omega-3 supplements have a protective effect against ARMD. The study is not due to be completed until 2012, but most researchers think that omega-3 will be shown to be beneficial. If I had macular degeneration, or it was in my family history, I would take a supplement containing Omega-3, as well as vitamins C and E, but not vitamin A.

To see the rest of this article go to: http://visioneyedoctor.com/articles/macular-degeneration-nutrition.htm

One Year Anniversary For Our Digital Retinal Camera

As of this month, I have been taking digital retinal photographs for one year. I have really been surprised at some of the eye problems we are finding. I have taken regular analog retinal pictures for years, but the digital camera offers much more detail. Because it's digital the image can be made larger showing details that can not be seen with traditional examination techniques.

I probably have seen 10 patients in the last 6 months where I can see a problem in the photograph that I could not see otherwise.

Another cool thing is that images can be made into "movies". The current image and an earlier image of the same eye alternate back and forth making any change in the structures very obvious.

Diabetes is the #1 cause of blindness in our country!

Diabetes is a disease involving the production and use of insulin. Insulin is a very powerful hormone that is made in the pancreas. Digestion of sugar, starches and other foods creates glucose. The glucose travels throughout the body in the blood vessels to the individual cells. If insulin is present, the individual cell allows the glucose into be converted into energy. If there is not enough insulin present the glucose cannot enter the cells and the cells will be starved for energy. Over time, high glucose levels in the blood can damage the eyes, kidneys, nerves and heart.

There are 2 main types of diabetes. Type 1 diabetes results from a lack of insulin production in the pancreas. These people must take insulin injections or they will die. Approximately 0.12% of Americans (400,000) have this type. We do not know it’s cause, but it might be genetic or viral. It is usually diagnosed in children and young adults.

Type 2 diabetes results from insulin resistance. The cells do not respond normally to the insulin and do not allow the glucose into the cell. Approximately 5.8% of Americans (18 million) have this type and it is often associated with obesity. It is sometimes controlled with diet, exercise and weight loss, but oral medications or even insulin are often needed. Approximately 19% of Americans (57 million) have pre-diabetes in which the blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. Many of these people will eventually become diabetic.

Diabetic retinopathy can only be detected with an eye examination. Having an annual eye examination is important for everyone, but it is extremely important if you have diabetes.

To see the rest of this article go to: http://visioneyedoctor.com/articles/diabetic-eye-disease.htm

Dry eye is a very common problem

The term “dry eye” refers to a wide spectrum of ocular conditions. The most common symptoms are dry, red, gritty, and even watery eyes. It often feels as though there is something foreign on your eye. Every time we blink, tear glands within the eyelid secrete tears. These tears lubricate the eye and help prevent infection. A healthy tear film consists primarily of a delicate balance of two layers. A thin outer oily layer reduces evaporation of the tears. Below the outer oily layer is a watery layer called the aqueous layer, which makes up 98% of the tear film. It helps rinse and clean the front surface of the eye. These normal tears nourish and refresh the eyes.

When the normal tear film breaks down, the eye begins to dry out. When that happens our eyes begin to burn and often the tear gland releases watery tears. These tears normally are only released to rinse out a foreign body or during emotional crying. They cause inflammation and irritate the eyes. That’s why dry eyes leads to red, burning,irritated eyes just like crying does.

There are four basic causes for dry eye and three basic treatments for dry eye

If you have red, burning, irritated, tearing eyes see your eye doctor. With the new treatments available these days, why put up with the irritation?

To read the rest of this article go to: http://visioneyedoctor.com/articles/dry-eyes.htm

Dr. Don Steensma's Viewpoint - What's new in eye care?

Low dose aspirin and eye disease

Vitamin D and Age Related Macular Degeneration

Now order your Contacts on-line through our web site and it costs a lot less

A very strange day

Retinal injections for "Wet" Age Related Macular degeneration

Retinal Implants for the blind

Vitamin D may reduce diabetic retinopathy

New hope for macular degeneration patients

We are seeing more diabetes

New treatment for dry eyes maybe

Vitamin E & C and cataracts

Web Reviews

Very cool video animations on the website now

Patient Satisfaction Survey

A short vacation to recharge my batteries

Over our lifetime our eyes change in many ways

Can Eye Exercises Improve Your Vision?

Nutritional suplements are the only treatment available for Dry Macular Degeneration

Computer Vision Syndrome

Age Related Macular Degeneration (ARMD) Is A Leading Cause Of Blindness

One Year Anniversary For Our Digital Retinal Camera

Diabetes is the #1 cause of blindness in our country!

Dry eye is a very common problem

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