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VISION WELLNESS: How to SEE Your Way to 100!
Dr J.H.Maher, ABAAHP
Osteoporosis, diabetes, heart disease, cancer
and senile dementia are major well publicized
chronic diseases that afflict us in our later
years.
Less well publicized is age related visual impair-
ment from the "big four", cataracts, macular
degeneration, glaucoma, and diabetic
neuropathy, which are the leading causes of impaired
vision and blindness in the United States.
As we continually see an increase in life expectancy
in each succeeding generation, we need added emphasis
on early diagnosis methods and new treatments,
as well as preventing and lowering the risk for these
increasingly common age-related eye diseases.
Approximately 4,000,000 people have some degree
of vision impairing cataract, and at least 40,000 people
are blind in the US due to cataract. Those of you who
are between 52 and 64 have a 50% chance of having a
cataract. But you probably won't see a change in
your vision until you reach age 65!
Degeneration of the macula of the retina is the leading
cause of severe visual loss in Europe and the US in patients
55 and older. It used to be second to cataracts as the leading
cause of blindness in those over 65, though the new surgical
procedures have now returned sight to millions. It is
estimated that over 150,000 Americans are legally blind
from age related macular degeneration with 20,000
thousand new case every year in the US alone.
Glaucoma is now the second-leading cause of blindness
in America. Over 2,000,000 are affected. It has no early
warning signs. In fact, up to one half million Americans
or more may currently have glaucoma and not
even know it! Glaucoma is the number one cause of blindness
in African-Americans according to the American Academy of
Ophthalmology. Chronic glaucoma, which accounts
for most glaucoma cases, often goes undetected for years,
resulting in significant and permanent damage to the eyes.
Once you've lost your eyesight to glaucoma,
it never comes back.
People with diabetes are highly susceptible to "diabetic
retinopathy". The development of laser surgery has
reduced this formerly leading cause of blindness.
Still those of you with diabetes are 25 times more
likely to become blind than those without diabetes!
CATARACTS
Cataracts are the white, opaque blemishes on the
otherwise normally transparent eye. The damage is
much like that which occurs to the protein of an
egg when you cook it.
Age-related cataracts are known as senile cataracts.
Cataract surgery is the most common Medicare re-imbursed
surgery, approaching a cost of $1,000,000,000 a year.
Though cataract are common past 60, anti-aging
specialists do not consider them normal!
Though cataracts are detectable by exam many years before they
cause obvious visual defects, they eventually cause "foggy" or
"cloudy" vision. Fortunately, now ultrasonic surgery can destroy
most cataracts in minutes.
Cataracts form when the lens can no longer defend itself against
the free radical attacks. A major cause of free radical formation
in the lens is the slow oxidation (literally cooking) ionization
radiation of ultra- violet and violet light. Individuals
with high levels of antioxidants have a much lower risk of
developing cataracts.
Indeed, a study at Tufts University of patients age 50 to 70
who took plenty of Vitamin C had fewer cataracts.
Low serum beta carotene are indicators of high risk for
cataracts.
According to a study at thew University of Sydney
other nutrients that protect the lens include thiamin,
riboflavin, niacin (Vitamins B1,B2,and B3), vitamin A, and
amino acids. Melatonin and various flavonoid rich botanicals
have also been found prophylactic.
Riboflavin, AKA Vit B-2, re-cycles "spent" glutathione.
Glutathione is such a major antioxidant free radical quencher
that levels are considered a bio-marker of biological age.
WARNING! Levels of 10 mg a day are photosensitizing and,
like St. John's Wort, mega- dosing should be avoided by
those with cataracts.
Sulfur containing amino acids, like methionine, cystiene
and glutathione are important building blocks for
antioxidant enzymes in the eye (Catalase, SOD and GSH).
Indeed cataracts are diagnostically characterized by low
levels of glutathione. Selenium, vitamin C and the amino acid
methionine all enhance glutathione.
Melatonin is a powerful antioxidant shown in animal studies
to inhibit cataracts.
Botanicals such the bilberry (an herb), grape seed and pine bark
(sources of what is commonly called OPC's), blueberries (a fruit)
and Curcumin (from the spice tumeric) are all sources of powerful
antioxidants called the "biological flavonoids", which are
particularly useful in ocular anti-aging.
Bilberry, also known as the European blueberry, are rich
in anthocyanosides, as is the American blue berry. Bilberry
is reported to be affective in a number of eye diseases including
glaucoma (with Vitamin C), macular degeneration, night blindness,
improved contrast in day vision and reducing hemorrhage in diabetic
retinopathy.
Diets high in fat, especially rancid fried fats, and salt
increase risk for cataracts. Smoking does as well, as it loads
the body with the heavy metal cadmium which interferes with
zinc metabolism.
GLAUCOMA
The vision loss from glaucoma results from the pressure of the
built-up fluid within the eye. This appears to be due to a
abnormality in the supportive (collagen) structures of the eye.
In chronic Glaucoma pressure can be twice the maximum of normal;
in acute glaucoma it can be four times maximum normal.
This pressure can damage the optic nerve, which is the nerve
that transmits vision. Glaucoma thus reduces your ability to see.
In chronic glaucoma, the peripheral vision is gradually lost.
The process can be so gradual that it goes unnoticed by the
person affected. Central vision, the ability to see straight
ahead, to recognize objects and to read, remains essentially
normal until the last stages of the disease. This results in
tunnel vision.
THEREFORE IT IS ESSENTIAL AS PART OF YOUR ANTI-AGING
PROGRAM TO INCLUDE ANNUAL EYE EXAMS AFTER THE AGE OF 60.
Elevated intra-ocular pressure (IOP), peripheral vision check, and
optic
nerve tests are ALL important. African-Americans over 40, those of
you severely nearsighted, diabetic, or taking certain blood
pressure meds. or cortisone need to be checked starting after 39.
Acute glaucoma causes severe throbbing eye pain, unilaterally,
with a fixed, dilated pupil and usually nausea and vomiting,
IMMEDIATE medical attention is mandatory to prevent permanent
blindness. There can be sudden tunnel vision!
Keeping the supportive structures of the eye healthy may reduce
your risk of glaucoma. Vit. C, berries, especially blue berries,
the herbs bilberry (a collagen stabilizer) and ginkgo biloba,
citrus bio-flavonoids are even used therapeutically,
so are indicated for prevention. Magnesium, nature's calcium
channel blocker, lowers elevated eye pressure much like
it lowers blood pressure. Omega 3 fatty acids and cold water
fish oils also can lower both blood and eye pressure.
Chromium is important for diabetics who are a much,
much greater risk for glaucoma.
MACULAR DEGENERATION
The macula, Latin for "spot", is the area of the center retina
in the back of your eye where images are focused for fine vision.
It is not only the number one cause of blindness in those over 65,
affecting over 13,000,000 of us, but 25% of you over 65 all ready
have some manifestation of macular degeneration, though many
of you do not know that is what you have!
The major risk factors for macular degeneration are smoking,
hardening of the arteries, high blood pressure and aging. Like
cataracts, the damage seems to be caused by free radicals
"burning" (oxidizing) the retina. However, decreased blood and
oxygen supply to the retina is the prelude and associated key
factors leading to macular degeneration (MD).
The two types of MD are age-related macular degeneration (ARMD)
are the uncommon "wet" (neovascular) form, and the usual dry
(atrophic) form.
In dry ARMD, a waste product called "lipofuscin" engorges the
retina, causing an extrusion of the deeper retinal tissues
called "drusen". These appear on eye exam as yellow spots on
the retina. Though this dry form rarely causes total
blindness, there is currently no standard medical treatment
for ARMD.
Fortunately, the wet form can be treated with photocoagulation
laser therapy, IF it is treated in time.
In either form, one might experience blurred vision, straight
objects might appear distorted or bent, a dark purple or gray
spot may manifest in or by the center of the visual field.
While reading, parts of words might appear to be missing.
There is difficulty going from bright to dark. Glare sensitivity
increases. Though central vision is disturbed, peripheral vision
remains intact, just the opposite of glaucoma. Sometimes one
eye is effected where the other is not, delaying symptomatic
warnings, again underlying the importance of regular exams as we
age.
The treatment for the dry form, and the prevention for both, is
to reducing the risk factors from hardening of the arteries, and
maximizing antioxidants with diet and supplements.
The Archives of Ophthalmology (117,1999;1384-1390) confirm that
low levels of Vitamin E increase the risk for ARMD. Indeed
those with the highest levels of Vitamin E were 82% less likely
to suffer macular degeneration! Yet the American Journal of
Epidemiology (150,1999;290-300) reports that 27% of the US
population has low levels of Vitamin E and 41% of African-Americans
were low.
Various "non-essential" food components, such as the NON-
Provitamin A carotenes leutien, zeaxanthin, and lycopene, along
with flavonoids, are proving to be more significant than the
more well known Vitamins C and E, and selenium. Plus
Individuals with low levels of lycopenes have twice the risk of
ARMD. The yellow carotenes lutein and zeaxanthin are the major
antioxidants of the retina and help to filter light. This is
especially important for light eyed individuals.
Pro-vitamin A supplements should not just be from beta-carotene.
Look for a multi-vitamin with mixed carotinoids.
The above mentioned botanical flavonoids are important as well,
especially bilberry and blue berries (anthocyanoside rich).
Once again, zinc, manganese, and copper as needed to maximize
SOD, GSH, and catalase, the free radical destroying enzymes.
As hypoxia and restricted blood flow, usually secondary to
atherosclerosis, bilberry ability to improve circulation to the eye
makes it most indicated for retinal health.
Both gingko biloba and Vinpocetine (periwinkle) can not only
deliver extra blood and oxygen to the brain, but to the retina as
well. (The retina IS an extension of the brain!) They both
enhance glucose utilization by the brain and retina. Vinpocetine
enhances energy production in the retina (via increased
ATP production) and prevents vaso-constriction, thus
facilitating optimal brain and retina nutrition.
Of the two, Vinpocetine shows the greatest promise.
(Vinpocetine is also great for memory disorders, post stroke
symptoms like loss of facial expression and co-ordination,
dizziness/vertigo, tinnitus, depression. and even vasoconstricitve
headache!)
The amino acid taurine has been shown to reduce oxidative damage
caused by sunlight to the eyes, and stimulate the bodies ability
to clean up the lipofuscin waste products that accumulate in
the eye (drusen).
DIABETIC RETINOPATHY
Diabetic Retinopathy is a leading cause of blindness here in the
U.S. One in twenty Type I sufferers and one in fifteen Type II
diabetics will develop retinopathy. Again, laser therapy has
reduced the prevalence of this once leading cause of blindness.
However, laser therapy is NOT indicated in milder cases since
occasional side effects outweigh the benefits. As the basic
pathology is the infiltration of advanced glycation end products
(AGE's) in the retina, causing damage by cross-linking retinal
proteins, the best preventative measures are those that
enhance insulin sensitivity as such.
THE OPTIGRAM VISION TEST
The Optigram is a visual aid to measure visual impairment and to
measure the success of any therapeutic interventions. It is
available on line at http://www.visualaid.com. The test
is done at arms length from a computer screen, with both eyes
open. As this is NOT a test for near or far sightedness,
but rather visual impairments, you may wear your habitual
corrective glasses for computer work. The number of correct
letters on each line is recorded weekly as a measure of
therapeutic success. (You may also call 1-800-473-3195.
By the way, The product sold there, Pure Focus, is the same
formula as LRI's Vision Wellness)
TEN STEPS TO VISUAL HYGIENE
Though many of us will suffer from one of the big four above,
most of us over 40 already have experienced Presbyopia, or
"old eyes". As we age the lens of our eye loses flexibility,
and by 50 most of us need glasses and are holding the "small
print" further and further from our eyes. The lens' ability
to change shape to accommodate to objects brought close to the
eye is called "accommodation". Indeed the ability to accommodate
is a basic "biological age" test bio-marker.
Modern living exacerbates this AGE -RELATED tendency to
lose accommodation. The theory of evolution says that our
eyes are designed for hunter-soldier vision based on a
need to spot game and enemies at a distance.
Only recently have the majority of us been
occupied in sustained daily near vision tasks for
year after year from a young age.
So the following TEN STEPS TO VISUAL HYGIENE
are recommended to reduce the heightened visual stress
this admittedly mostly unavoidable modern near vision
predominance produces.
1) Look up and away from near vision tasks often.
2) Lighting illumination should be three times brighter
than the rest of the room. DO NOT read under a single lamp.
Eliminate all glare.
3) Sit straight and have your work at eye task level.
4) Best distance is 14 to 16 inches for adults.
5) Avoid reclining postures. Sit up right while reading
or watching TV in bed.
6) Writing: Hold your pen at least one inch from the tip
so you do not need to tilt your head to see your words
as you write.
7) TV: View at a distance at least 7 times the width of the
TV screen.
8) Participate in outdoor activities that require seeing
at a distance.
9) Eat a diet high in a wide variety of fruits and vegetables
all the colors. Supplement with anti-oxidants and botanicals
known to promote eye health like lutein, zeaxanthin and bilberry.
10a)Wear black-gray and green-gray because they allow the full
spectrum of colors evenly without distortion.
10b)Blue is bad for it scatters light. Pink and yellow allow
more light and strain the eyes on bright days. Cataracts
sufferers should use brown for its softer tones. Polarized
means a plastic film between the lenses that cuts off harmful
glare and reflection.
10c)Most prescriptive sun glasses today have built in UV
protection for both UVA and UVB which are the next two
wavelengths after ultra violet on the visible spectrum.
Check for the word filtered on the tag. Transitional
lenses are clear indoor and dark outdoors, have a gray
hue all the time, which is caused by UV from indoor fluorescent
lighting.
10d)Best to wear at the computer and for night driving to
reduce the halo effect are lenses with anti-reflection
coatings that let in more light
For more information contact Dr Grossman at
http://www.visionworksusa.com or call 1-800-735-8475.
THE SIGHT SAVING DIET
Certain nutrients have been shown to be vital in reducing
the risk for such age-related visual impairments like
macula degeneration and cataracts.
Researchers at the University of Sydney found that higher intakes
of Vitamin A, riboflavin, thiamin, and protein
As is so often the case, Vitamin C and E are important
antioxidants to help prevent cataracts. Vitamin A and zinc
are essential for night vision. (Hypothyroidism interferes
with the conversion of betacarotene to Vit A.)
Also important are the carotinoids, a family of nutrients
not classified as vitamins, but similar to them. They
are found in leafy greens, corn, kiwi and many other green,
yellow and red fruits and vegetables. the queen of the
carotinoid clan is beta carotene (found most plentifully in
carrots, sweet potatoes, apricots and cantaloupe) but there
are many others- including alpha carotene, the Lycopenes
(tomatoes are rich in these), lutein and zeaxanthin.
All the carotinoids function as antioxidants and the last
two are particularly rich in the tissues of the eye. it
is no surprise therefore that those of you who eat the most
of the above fruits and vegetables have the healthiest eyes.
Carotinoids also act as filters to the particular destructive
violet blue bands of light.
As lutein and zeaxanthin have proven to be the most beneficial
carotinoids the following list may prove helpful. In
descending order:
HIGHEST IN LUTIEN: corn, kiwi, pumpkin, zucchini squash,
spinach, yellow squash, red grapes, green peas, cucumber,
butternut squash, green bell pepper, and celery.
HIGHEST IN ZEAXANTHIN: orange bell pepper, corn, orange juice,
honey dew melon, mango and orange.
In one small preliminary study, (J Am Optom Assoc 1999 Jan;
70(1):24-36),participants who ate a half-cup of cooked spinach
four to seven times a week for a year had an improvement
in night vision, in contrast vision, and in their adjustment
to bright lights. Researchers speculate that spinach consumption
may even be able to restore vision lost to ARMD.
Green Note: Collards, Swiss chard, beet greens, and other dark
greens have not been studied bit are likely high in the above
vision wellness supporting nutrients as well.
HIGHEST OF ALL; the food highest in lutein and zeaxanthin,
though only slightly higher than corn) is egg yolk. This
is just another reason to consider including several eggs a
week into your diet. Some doctors even speculate that macular
degeneration is the leading cause of cause of blindness in the
elderly because they have avoided eggs! Be reminded that eating
eggs are a great source of choline for memory, a source of DHA
fatty acids your brain needs, and raise GOOD cholesterol (HDL).
Even a Harvard study in the JAMA found no relationship between
eating whole eggs and risk of heart disease or stroke in men or
women.
Side Note: Lutein has also been reported to reduce colon cancer
incidence by 17%.E
SUPPLEMENTING NUTRIENTS FOR THE EYE
While clearly the best route to eye health includes a diet
rich in a wide variety of colored fruits and vegetables,
supplementation has its place, especially if the diet is not
optimal, which is the usual case, is it not?
A broad spectrum mega-multivitamin mineral phytonutrient
supplement. It should have at least 1000 mg of Vit C
and 100 IU Vit E, 100 mg Bioflavonoids,
25 mg quercetin, 3 mg lycopene, 100 mcg leutien,
100 mcg zeaxanthin, 15000 Vit A as mixed carotinoids
(not just beta-carotene), 200 mg selenium, 15 mg of zinc
and 5 mg of manganese. IT SHOULD HAVE NO IRON!
(Those who need iron should take it away from
a true multi-mineral as it will interfere with the
absorption of iron.)
IF you can not always get 5-9 servings of fruits and
vegetables into your diet, (and 9 of 10 Americans don't!)
add a powdered fruit and vegetable concentrate to your
supplementation program.
For those already suffering from or at high risk for visual
impairment, or even those who want to just "see" there way
to 100, supplementing bilberry and Vinpocetine, along
with extra lutein and zeaxanthin, is the recommended
program to consider.
Those at risk for diabetic retinopathy would do well to
concentrate on those supplements that increase insulin
sensitivity lower glucose and inhibit infiltration on
AGE's into the retina. (For the latter, Vitamin C in
particular.)
The elderly, who are often protein deficient, may consider
amino acid rich whey supplementation, which promotes
glutathione, a powerful antioxidant (GSH).
END
Must include the byline:
Vitally yours,
Dr. John H. Maher, A.B.A.A.H.P.
Editor, "Longevity News"
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