Eye Health JULY/AUGUST 2018
A Publication of the
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bye-bye dry eyes available exclusively at
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rachel crips philips kay jennings, bsn, mhsa, msn, pmhnp-bc greenshoot media
People in Missoula and western Montana want to feel good, look good and live well. Available at more than 150 newsstand locations throughout the area, Western Montana Living Well is well suited to more than 23,000 readers monthly who want health tips on fitness, nutrition, family, wellness, therapy and beauty.
The opinions, beliefs and viewpoints expressed by the various authors and forum participants in this publication do not necessarily reflect the opinions, beliefs and viewpoints of the Missoulian or Lee Enterprises. The author of each article published in this publication owns his or her own words. No part of the publication may be reprinted without permission. Š2018 Lee Enterprises, all rights reserved. Printed in the USA.
may/june 2018 VOL. 46
IN THIS ISSUE eye health lipiflow
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ALSO IN THIS ISSUE 4
microbiomes and your health
Page 9
obesity and vision Page 13 keeping your eyes healthy Page 14 is lasik right for you Page 16 choosing the right glasses Page 17
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vision trouble in children
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importance of eye exams
Page 9
provided photo
Mild, moderate and severe gland loss.
Lipiflow helps address the symptoms of dry eyes As our windows to the world, the eyes serve a vital function in day to day life. With such delicate organs carrying such a large responsibility, it is critically important to maintain eye health with routine exams and preventative care. There are several things you can do to keep your eyes functioning at their best and prevent age-related macular degeneration. The first is to eat a healthy diet with lots of greens. Also, wear sunglasses anytime you venture
Rachel Crisp Philips
outside and avoid smoking cigarettes. Finally, yearly vision check-ups can go a long way to preventing future eye issues, and more. Many people are surprised to learn that regular visits to an eye health professional are crucial to overall health, and not just vision concerns. Certain afflictions, such as glaucoma, can only be detected with a thorough eye exam as it does not present signs or symptoms on its own. Other conditions, such as rosacea and autoimmune disorders, July/August 2018 ~ living well
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may contribute to the deterioration of parts of the eye as a side effect of their more prominent manifestations. Eyes themselves can present a number of problems all their own. Dry eye is one of the most common complaints, affecting over 30 million Americans. The symptoms of dry eye can range from mild annoyances such as redness, sensitivity to light, itching or burning, to visual disturbances that blur vision and negatively impact quality of life. Factors such as climate, lifestyle, surgery, age, contact lens wear, systemic illnesses, and hormonal changes can exacerbate the symptoms of dry eye. Although dry eye is very common, many people suffer without diagnosis, unaware that they have the condition. Contrary to assumptions, watery eyes are actually one of the most common symptoms of a dry eye problem. When dry eyes feel irritated, the tear glands begin working overtime to lubricate, soothe, and promote healing. However, the type of tears produced by this reaction don’t contain the oil that is needed to truly moisturize the eyes. 6
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The most common form of dry eye is evaporative dry eye caused by Meibomian Gland (oil gland) Dysfunction (MGD). Without treatment, evaporative dry eye has the potential to lead to further damage, degradation of vision, and overall discomfort. Once the glands have deteriorated, they do not regenerate. To combat dry eyes, blinking is one of the most important things to maintain eye health as it is the only mechanism of action that pumps oil up and out of the meibomian gland. By failing to blink fully and deliberately, the oil will sit in the glands and become harder and cloudier over time. Once this oil has solidified, the glands will die and there is no way to restore them. To retain proper gland function, be sure to practice blinking completely, and more frequently, throughout the day. This is especially important when engaging in focused activities such as reading, driving, and viewing computer screens. Another factor that contributes to dry eye is the fact that a majority of people sleep with their eyelids slightly open, a condition called
provided photo
Example of Meibography images taken at an Ocular Surface Disease Evaluation. Mild, Moderate, and Severe gland loss.
lagophthalmos. When functioning properly, the oil in the tear film helps seal this gap and protect the eye surface overnight. But if there is not enough oil in the meibomian glands, the tear film will be too watery to provide proper protection. To treat this condition, there are ointments and gels available to keep the eyelids comfortably sealed. Other treatments to relieve dry eyes include daily hot compresses and manual lid massage to help keep glands functioning correctly. Wetting drops, ointments, and gels can relieve symptoms, but do not aid in treating the root cause of chronic and progressive diseases such as MGD. To help tackle the underlying issue, and prevent further degeneration, there is a procedure called LipiFlow recently available at Rocky Mountain Eye Center. This technology unblocks the meibomian glands, improving the quantity and quality of lipid oil, and helps address the symptoms of dry eye by evacuating obstructions in the glands. This preserves the gland structure by improving gland function. A single in-office treatment can produce years of benefits. “We’ve had great success with the treatment here in our clinic. The majority of the people are coming back with an improvement in their symptoms,” said Shelby Lang, the LipiFlow Coordinator at Rocky Mountain Eye Center. LipiFlow works by applying a non-invasive combination of heat and gentle pulsating pressure to simultaneously liquefy and evacuate obstructed glands. Aside from an
initial anesthetic drop, no drugs are required and no recovery time is needed. During the twelve-minute procedure, gland function can be improved by up to three times, and can continue to improve for up to a year or longer depending on the severity of the disease. Aside from dry eye, other conditions may be improved with the LipiFlow treatment. Those suffering from regular styes or blepharitis, inflammation of the eyelids, may benefit from the procedure. Using LipiFlow before undergoing eye surgery can ease recovery
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by improving eye lubrication and result in a better surgical outcome. Even people who are otherwise healthy can reap rewards from a screening consultation to reveal any underlying issues. Lang cites herself as a good example of this aspect. Young, healthy, and with no history of contact wear, eye surgery, or autoimmune disorders she had no symptoms and thought her eyes seemed fine. However, the consultation revealed significant gland loss likely caused by partial blinking from working on a computer most of her life. “Once they did the scan, you see what your glands look like and it’s really kind of eyeopening. I knew I needed to do something about this because my dry eye symptoms might not be bad now, but how am I going to feel when I’m 50 or 75 years old and I have no glands left?” said Lang. Although it is impossible for dead meibomian glands to return, a LipiFlow treatment can
significantly improve gland function which leads to more comfortable eyes and heads off further damage. “Patients are able to tolerate their contacts longer with a healthier tear film, and use less artificial tear drops throughout the day,” said Lang. Even if you don’t feel like your vision is bad, or that your eyes are uncomfortable, asking for a LipiFlow scan at your yearly exam could detect signs of preventable degeneration. If you think you may be suffering from dry eye symptoms, or have any concerns about eye health, call Rocky Mountain Eye Center at (406) 541-3937 to schedule a consultation. Dr. Nedrud is the corneal ophthalmologist at Rocky Mountain Eye Center and oversees the LipiFlow Department
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DR. CHAD NEDRUD OF ROCKY MOUNTIAN EYE CENTER
“Bug-eyed” isn’t just about surprise! Microbiomes and your eye health
Kay Jennings, BSN, MHSA, MSN, PMHNP-BC
“Bug-eyed” is an everyday idiom that refers to a surprised expression when witnessing something amazing. But recently, I came across an article regarding microbiome (a community of micro organisms that inhabit a particular environment – i.e., “bugs”) and ocular (eye) health that gives “bug-eyed” an entirely different definition. For years, scientists have been finding new and
important connections between the microbiota and our physiology. Everyone has heard of how gut bugs affect our overall gut health. But few have heard about the ocular microbiome and eye health. The latest research has found that the surface of the eye supports a resident microbiome that is different than that of facial skin. The July/August 2018 ~ living well
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prominent bacteria living on the ocular surface are corynebacteria, propionibacteria, and staphylococci. Fungi and viruses are also normal residents of the ocular surface. If you’re a contact lens wearer, you should know that contact lenses can give bacteria something to adhere to, making it easier for pathogens to colonize on the surface of the eye. Extended wear lenses are associated with an increase in pathogenic (bad) organisms in the conjunctival tissues, so proper and hygienic handling of lenses is important. Research on treatment for ocular imbalance is far behind gut imbalance, but some studies are indicating there may be a relationship between the imbalance of “good” and “bad” bugs and inflammatory events that may subsequently lead to disease states and play a role in age-related ophthalmic disease. In cases of imbalanced microbiota in the body, I would recommend prebiotics and probiotics. In addition, you can take the following overall steps toward prevention: 1. Avoiding harmful chemicals around the eyes, such as harsh shampoos and face washes; 2. Wearing contacts sparingly and always washing hands prior to contact; 3. Getting enough sleep; 4. Cultivating a healthy whole-body ecosystem (dysbiosis, or a microbial imbalance, in 10
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one area of the body may affect others). Prevention steps #1 through #3 are pretty straightforward, but where do you start to bring your whole-body into balance? Attention to your individual nutritional needs is an ideal place to start. In my wellness practice, New Health, I use a non-invasive process called a biophotonic screening that measures the carotenoid antioxidant activity in your body. In less than one minute, you will find out if your diet, lifestyle, and supplements are providing the antioxidant protection you need for promoting health. Based upon the results, we can determine your optimal personalized nutrition and supplements program. Kay Jennings, BSN, MHSA, MSN, PMHNP-BC, is owner of New Health, a Functional Medicine practice based in Missoula and holds the designation of ADAPT Trained Health Practitioner from Kresser Institute, the only functional medicine and evolutionary health training company. To learn more about Kay and her Functional Medicine practice, call 406 721 2537 or visit www.NewHealthMontana.com.
Vision Trouble in Children Children are great about telling parents when something might be troubling them. You probably know your child’s communication patterns well enough to know when a serious problem exists. Don’t let signs of vision problems go untreated. Vision problems can be spotted in children as young as three months old. At this stage of development, a child should be able to follow an object with his eyes. If you notice he has trouble maintaining focus, be sure to discuss it with your pediatrician. VISUAL SIGNS THAT COULD MEAN TROUBLE Sometimes signs of vision problems can be easily spotted by inspecting your child’s eyes. The American Academy of Pediatrics recommends alerting your pediatrician if you notice any of the following symptoms in your child: • White or grayish-white color in the pupil; • Pus or crust in either eye, or constant watering; • Drooping eyelids or eyes that appear overly sensitive to light; and • Redness in
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either eye that doesn’t go away in a few days. BEHAVIORAL SIGNS TO NOTICE When your child reaches preschool age, she will begin relying more on her vision to accelerate her academic development. Activities such as stacking blocks, coloring, using scissors and even assembling puzzles help improve the eye-to-brain relationship. Tuning these fine motor skills assist with learning to read and write. However, if a child is experiencing troubles with his vision, he likely will struggle to keep up with the rest of the class. According to the American Optometric Association, you might notice some warning signs that must be brought to a pediatrician’s attention. Witnessing your child sitting too close to the television or holding books and magazines to close to their faces can reveal a struggle with vision. If a child displays a short attention span or avoids fun activities, such as coloring or puzzles, it is a sign of vision and focus problems. Children who frequently rub their eyes or complain of itchiness should see an eye doctor, so be aware of your child’s daily activities and behaviors.
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The importance of eye exams If visiting the optometrist is not a part of your preventative health routine, you risk developing serious vision problems that otherwise could have been treated. Signs and symptoms are generally so subtle you won’t even notice they are present until it is too late. Scheduling an appointment with your local optometrist allows him to spot problems early and determine the best strategy to maintain your vision. Through observation easy-toperform testing, it’s easy to learn the integrity of your eye health. U.S. Vision statistics According to studies conducted by the Centers for Disease Control and Prevention, only half of the estimated 61 million adults in the United States classified as being at high risk for serious vision loss visited an eye doctor in the past 12 months. Here are more unsettling facts revealed by the study, which should urge you to get on top of your vision health: • 3.4 million Americans age 40 and older are either blind or visually impaired; • 20.5 million Americans age 40 and older have a cataract; and • 5.9 percent of Americans age 20 and older have some form of visual impairment, most of which can be corrected. What happens at an eye exam The process of preparing for an eye 12
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examination is simple and painless. A division of the College of Optometrists, Look After Your Eyes, has laid out how you can prepare: Getting to know your optometrist: If you are a new patient, it is important to answer the questions asked by your optometrist honestly. By understanding family history, general health and medications you take, your doctor will have a good grip on conditions to expect and how to correct them. The exam: An important tool your optometrist will use is called an ophthalmoscope. It is a specially designed torch used to examine the lens inside your eye, revealing signs of a cataract or the health of your optic nerve and retina. After this examination, you will be asked to read the letters from a chart. You have likely seen this familiar chart in places such as the Department of Motor Vehicles, doctor’s offices and even schools. After the exam: Once you have completed your eye exam, your optometrist will have a detailed understanding of the health of your eyes. She might recommend prescription glasses or contact lenses. In serious cases, she might even recommend corrective surgery. Be honest about your concerns about your vision and create a game plan with your optometrist.
Obesity and vision
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According to the American Heart Association, more than 78 million adults in the United States are obese. This condition puts people at high risk for heart conditions, diabetes and high blood pressure. It might surprise you that obesity also causes great strain on vision. Obesity is measured through a body mass index, or ratio of weight to height. When the final number is 30 or higher, someone is considered obese. The AHA says this impacts one in three American adults. Maintaining a healthy lifestyle will ensure your weight doesn’t impact your vision. HIGH-BLOOD PRESSURE Being obese puts a tremendous amount of strain on the heart. The AHA reports that this encourages the development of cardiovascular disease, diabetes and high-blood pressure. Your eyes rely on major blood vessels to provide nourishment to important components, such as the optic nerve, and outer and inner areas of the retina. These fragile vessels are subject to damage that can result in diminishing vision. The extra pressure can be lessened by losing weight and lowering the amount of strain put on your heart and blood pressure. While someone suffers from high-blood pressure,
there is a risk of visual blood vessels bursting or becoming blocked, inhibiting healthy blood flow to the components of your eyes. DIABETES AND VISION Another dangerous disease often linked to obesity is diabetes. The American Diabetes Association recommends people with the disease have regular dilated-eye exams as vision problems are often experienced. Blurred vision is one of the most common vision symptoms caused by diabetes. It is caused when high-blood sugar levels make eye lenses swell, and the sudden change of shape throws off vision. It is often experienced after consuming high levels of carbohydrates, in diabetic patients. Low-glucose levels also are to blame in diabetic-eye problems. Instead of affecting lens shape, it might make it hard for the brain to focus. GETTING IN SHAPE Obviously, the easiest way to get your weight under control is to incorporate a healthy diet and begin a strict exercise regimen. Here are some recommendations from the American Heart Association for getting to a healthy weight. Cardiovascular health: To enhance overall heart health, perform at least 30 minutes of moderate-intensity aerobic activity at least five days per week. Lower blood pressure: In order to regulate blood-pressure levels, an average of 40 minutes of moderate- to vigorous- intensity aerobic activity is recommended at least three or four times a week. July/August 2018 ~ living well
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Keeping Your Eyes Healthy
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A poor sense of vision can be a nuisance and may even be dangerous if not treated properly. Poor vision could lead to delayed reaction time in situations that require immediate reaction to ensure your well-being. The Centers for Disease 14
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Control and Prevention estimate that about 14 million Americans ages 12 or older experience visual impairment. Learning how you can protect your vision or even correct it is critical to maintaining a healthy lifestyle.
YOUR DIET MATTERS You may not realize how much of an impact your diet has on your eyes. Many Americans consider a healthy diet as a way to keep their weight and heart health in check, but since your eyes also rely on small arteries to supply them with oxygen and vitamins, a good diet has a positive effects on vision. Keeping your diet high in omega-3 acids, vitamin C and leafy greens will provide your eyes with the nutrients they need. The American Academy of Ophthalmology recommends that you make fresh fish, kale and oranges major parts of your diet to provide your eyes with the healthy nutrients they need. EYE PROTECTION The sun is not only harmful to your skin; it also can promote the development of cataracts. Wearing sunglasses can prevent retinal damage by protecting your fragile eyelid skin. Be sure to find sunglasses that block 100 percent of both
UV-A and UV-B rays. The AAO estimates that there are 2.5 million eye injuries in the U.S. each year. Wear the proper eye protection during sports, gardening or home repairs. EYE EXAMS The AAO also recommends that adults schedule an eye exam at the age of 40, even if there are no signs of vision impairment. Experts say this is the time when early signs of disease or vision changes begin. Schedule a baseline exam to help identify early signs of eye disease. Knowing your family history can give you an eye health advantage before you reach 40. For instance, if your family has a history of diabetes, blood pressure or eye disease you should see an ophthalmologist as soon as you notice a decline in your vision. Catching vision problems early will make it easier for treatment to correct these issues.
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Is LASIK Right for You? If you have grown tired of your eye glasses or the high maintenance of contact lenses, you may have considered LASIK surgery. Laserassisted in situ keratomileusis (LASIK) is a procedure that uses a laser to reshape your cornea to correct eye ailments. If you are nearor far-sighted or are suffering from a certain vision problems, LASIK may be the solution. According to the American Academy of Ophthalmology, LASIK was approved by the U.S. Food and Drug Administration in 1998. Since then, this treatment has become extremely popular in the United States due to its high success rate and low risk of complications. BEFORE SURGERY Before you can be considered a good candidate for LASIK, you will need to make an appointment for an eye evaluation. After a thorough eye exam, your doctor will determine if LASIK is right for you or if you should consider an alternative. Stop wearing contact lenses a few weeks prior to your LASIK evaluation. Contact lenses cause a change in the shape of your cornea, and since LASIK focuses on reshaping your cornea, it should be in its natural state to prevent poor surgical planning. Switch to glasses before 16
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your exam to give your doctors an accurate measurement of your cornea. WHAT HAPPENS DURING SURGERY? According to the AAO, a typical LASIK surgery takes less than 30 minutes, during which you will be placed on your back. Your doctor will then place a clear plastic plate to flatten your cornea and use laser energy to create thousands of bubbles of gas and water to create a flap in the cornea. You may notice discomfort at this stage. Your doctor next uses a different laser to vaporize some of your corneal tissue. After this step, the flap is put back into its normal position. RECOVERY Just like any surgical procedure there are precautions to follow after and potential risks. Your cornea will not get stitches, so it’s important to wear a shield to protect from accidentally rubbing your eye. If you detect signs of infection, experience severe pain or notice your vision is getting worse, contact your doctor immediately. Most infections can be resolved with medication. Your eyes begin healing immediately after the surgery. You should notice improvements in your vision within just a couple of hours.
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If you notice blurred vision or headaches caused by squinting, it is probably time to see your eye doctor. Your local professional can give your eyes a series of tests to determine if eye glasses will solve your problem. Choosing the correct eye glasses may seem like a daunting task, but it will be easier if you know some key components to consider. DIFFERENT LENSES There are many different materials used in manufacturing prescription eye glasses. The first lenses were made from glass, but this material made glasses too heavy and highly subject to damage. Glass is typically no longer used due to the risk of potential harm a broken lens may cause to your eye. You will likely see the term “high-index plastics” when choosing your lens. During the past 20 years, this material has become incredibly popular. It is the thinnest lens available, which helps keep your glasses lightweight. Your eye doctor can offer you expert advice on which lens is right for your situation. COMFORTABILITY Your new prescription eye glasses will become part of your everyday wardrobe. It is important to choose a frame that makes you feel confident and comfortable. Your prescription may limit your choice of frames. Talk with your optician for advice on which frames will enhance your facial features. You want your glasses to be part function and part fashion, so don’t be afraid to try on numerous
pairs to make sure they fit your style and needs. AFFORDABILITY Your new prescription eye glasses may be costlier than you expect. Check with your health insurance company to see if eye care is covered. According to the Vision Service Plan, the national average cost of prescription eye glasses is $196. This number can vary depending on the type of lens you require. Lenses for more serious problems require special frames that can sometimes cost up to $600 overall. Check in with your insurance company so you can be mentally and financially prepared for the bill. Accepting the fact that glasses are necessary to correct your vision problems may be a difficult adjustment. It is important to choose a pair of glasses that offer comfortability, match your needs and fall within your budget. July/August 2018 ~ living well
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