Dry Eye Diagnosis

It has been dry in this area of Florida for quite a while, and we appreciate the rain. It is raining this morning, a soft gentle rain that has lasted for hours. This is not typical in this area. Usually we get bursts of intense rain and then sunshine. This is a little like dry eyes, some people suffer from a chronic, consistent irritation, others have short episodes that vary in intensity.

There are many challenges in the diagnosing and treatment of dry eyes. There is not one definitive diagnostic test that will reliably distinguish between those WITH dry eyes and those without. Also, there is no consensus as to which test or tests should be used to definitively diagnose dry eyes. I mentioned in the last blog that the estimated incidence of dry eye is anywhere between 5% and 30%, depending on the study one reads. The generally accepted consensus is that older women seem to be more predisposed to dry eyes than the rest of the population, though millions of people suffer from this condition.

Another challenge is that the natural history, such as progression, prognosis and long term effects of treatment, is unknown. This can confound the decisions made regarding the treatment path to take.

Dry eye is a symptomatic disease which affects the activities of daily living. This can have an adverse impact on reading, driving, working on the computer and can also affect your level of comfort throughout the day.

Being a symptomatic disease with such variability in the diagnosis, one of the best ways to deal with dry eye is prevention and symptomatic relief.

EyeScience Dry Eye formula is one thing that may improve the symptoms of dry and could provide long lasting relief. This formula contains omega-3 fatty acids that have been demonstrated to decrease the risk of dry eye in some women.¹ This is important in light of the fact that many people who have dry eye do not have adequate intake of omega-3 in their diet.

It is interesting to note a new study that suggests the possibility of gender specific omega-3 roles. This study, published in Nutrition, Metabolism and Cardiovascular Diseases, suggests that males may benefit more from eicosapentaenoic acid (EPA) supplementation while females are more responsive to docosahexaenoic acid (DHA). These findings may change how omega-3’s are delivered and formulated in dietary supplements in the future. EyeScience Dry Eye formula has both.

There is a study that is recruiting participants being conducted by Penn State assessing the use of an omega-3 supplement in the treatment of dry eye syndrome. This new study is using a corn oil capsule as a placebo control. The hope is that a longer study with significantly more participants will give a definitive answer in the use of omega-3 to prevent and treat dry eyes.

The rain has stopped, but the need for real answers in the diagnosis, treatment and prognosis of dry eyes remains. As always, prevention may be the best defense.

Be well.

Dr. Peg

Dry Eyes and Quality of Life

Late summer in Florida is far from dry. The humidity, along with the temperature, is often in the 90’s. Though this far from comfortable, we find comfort in the consistency of the ocean breeze and the presence of water everywhere.

With dry eyes and dry eye symptoms, there is not water everywhere. The definition of dry eyes, or dry eye syndrome (DES) is a disorder of the tear film due to tear deficiency or excess tear evaporation which can cause damage to the cornea, which is the front surface of the eye. This causes ocular discomfort and visual disturbance in the form of dryness, and a scratchy, gritty or sandy feeling. Other symptoms of dry eye can include pain, light sensitivity, itching and/or redness. These symptoms can be intermittent or cause constant irritation.

Dry eyes can be caused by a number of situations. Environmental factors such as air conditioning, heating in the winter, windy conditions and smoke can cause dry eyes. Systemic conditions can cause dry eyes, such as hormonal changes, menopause, Sjogrens syndrome, rheumatoid arthritis and other collagen vascular diseases. Dry eyes can be a side effect of certain medications like antihistamines and birth control pills.

The prevalence of dry eye is from 5% to 30% in people 50 years old or older. Many people may have dry eyes and only realize it when there is some contributing factor such as low humidity, being in an air conditioned environment or contact lens wear.

The American Journal of Ophthalmology reported that dry eye syndrome is one of the most common ocular problems in the United States. In a survey of nearly 40,000 women conducted in 2003, it was determined that approximately 3.2 million women aged 50 and older suffer from dry eyes.¹ Yet, many people in their 40‘s and 50‘s also experience dry eyes. It was also noted in this same survey that there was a slightly higher incidence of women reporting symptoms of dry eye in the south.

Artificial tears and ointments, oral medications and minor surgical procedures are all used to treat dry eyes. EyeScience Labs Dry Eye formula may be one way to help alleviate the symptoms of dry eyes. Key ingredients such as omega-3, flax seed oil, vitamin E and other nutrients, have been shown in some studies to provide symptomatic relief of dry eyes. This formulation is designed to address the causes of dry eyes through antioxidants and essential Omega-3 and Omega-6 sources.

Dry eyes affect quality of life and have an impact on public health. More research is required to determine more precisely what that impact is. Certainly, anything that can cause constant irritation, and affect the way we see the world and accomplish our daily tasks is a significant detriment to our quality of life.

Be well.

Dr. Peg

Reference: 1. Am J Ophthalmol. 2003 Aug;136(2):318-26.

The Age Related Eye Disease Study 2 (AREDS 2) was started in October of 2006. The anticipated completion of the study is December, 2012. As with the first AREDS study, there should be some published reports prior to the completion of the study. AREDS 2 is a very large, placebo controlled study. The target population for this study was 4,200 participants between the ages of 50 and 85 with drusen, a sign age related macular degeneration (AMD), in both eyes or drusen in one eye and advanced AMD in the other eye. The purpose of the study is to evaluate the effect of two dietary xanthophylls, and two omega-3 fatty acids on progression to advanced AMD and also if there is vision loss in those people who are at moderate to high risk for progression. Xanthophylls are yellow pigments found in most leaves and are from the carotenoid group. The yellow yolk of an egg is due to the xanthophylls lutien and zeaxanthin that originate in the chickens diet. AREDS 2 includes lutein and zeaxanthin in the formulas that are being studied.

Also included in the AREDS2 formulas that was not in the AREDS formula is the omega-3 fatty acids that are derived from fish oils. One of the interesting things about the omega-3 fatty acids is that many consumers are not aware of the health benefits of this supplement. It was reported in a recent Consumer Trend report that 56% of consumers lack knowledge of the benefits of the omega-3 fatty acids. Some of the purported benefits include improved cardiovascular health, improving memory, decreasing inflammation and alleviating some symptoms of depression.

EyeScience Labs is concerned with protecting and preserving your vision. Their Macular Health Formula includes lutein, zeaxanthin and omega-3 to give you a dietary supplement that conforms to the recommendations of AREDS and takes into consideration the mounting evidence in support of including xanthophylls and omega-3 fatty acids for optimal ocular health.

Dr. Emily Chew, the study chair and deputy director of the Division of Epidemiology and Clinical Research at the National Eye Institute (NEI) said, “Until we get the result from AREDS2, we encourage people with AMD to visit their eye care professional to see if they need to take the AREDS vitamin and mineral formulation. This alone could save more than 300,000 people from vision loss over the next five years.”

Most of us can use more leafy green, nutritional foods in our diets, and most of us can also use a dietary supplement to help us get all of the vitamins and minerals we need for optimal health, for our bodies and our eyes.

Be well.

Dr. Peg

We all live with a certain amount of risk in our lives. Whether we surf, bike, swim or walk for exercise, there is some risk associated with all of these activities, even though we know they are good for us. We want to minimize risk and make good decisions.

The best way to make good decisions is to be informed and educated. Consumer Reports has recently published an article that warns the consumer about 12 ingredients found in supplements which may cause serious side effects and that have not been demonstrated to do what they claim to do. First of all, EyeScience Labs does not use any of these ingredients in their Macular Degeneration formula, or their Dry Eye formula. I am mentioning this article to point out that there are valid points in it that we should all heed to minimize our risk. One point is the importance of discussing all medications with one’s doctor, including all dietary supplements, to avoid any drug interactions or side effects that may occur. This will help to minimize our risk. One must also consider that there are benefits associated with our actions. There is a great deal of benefit in regular exercise. Swimming, surfing, running, walking are all very good for us, especially when done on a regular basis. Each of these activities involves some risk. We do all we can to mitigate this risk by wearing a helmut when we bike, swimming with a lifeguard on duty, and never surfing alone. In a recent interview, Dr Andrew Shao of the Council for Responsible Nutrition explains that there is unequivocal evidence that dietary supplements will fill nutrient gaps. One way to mitigate our nutritional risk is to fill the nutrient gaps.

Dr. Shao’s comments were in response to the Dietary Guidelines Advisory Committee (DGAC) report that was recently published. These guidelines are reviewed every 5 years. This report discourages the use of dietary supplements, especially multivitamins. There is conflicting evidence about multivitamins preventing chronic disease, but multivitamins do fill nutrient gaps that many of us are subject to in our own active lives. Interestingly, the Dietary Guidelines do admit that there are nutrient gaps. The Council for Responsible Nutrition has submitted documents in response to this report.

No one should rely exclusively on supplements to get the nutrition they need, dietary supplements are just that – a supplement. Healthy, nutritional food is one of many aspects of a healthy lifestyle. It is also of note to point out that surveys show that supplement users tend to have a healthier lifestyle by eating better, getting regular exercise and maintaining a healthy weight. They make many healthy choices and healthy decisions that combined help to provide a healthy lifestyle. It is best to stay informed and educated in the areas of health, including diet, exercise and dietary supplements to make the best decisions and minimize our risk.

Be well.

Dr. Peg

Dietary Supplements and Age Related Macular Degeneration

In discussions about nutrition, age-related macular degeneration, dry eye, or any other disease there are a number terms used that may seem confusing or redundant. What is a drug, what is a dietary supplement, what is the difference? Are herbs, botanicals and teas considered dietary supplements?

The FDA defines dietary supplements as products taken by mouth that contain a “dietary ingredient.” Dietary ingredients include vitamins, minerals, amino acids, and herbs or botanicals. Probiotics and metabolites also fall under the dietary supplement umbrella. Dietary supplements can come in many forms, such as tablets, capsules, powders, teas, and other liquid forms.

A vitamin is a dietary supplement, but not all dietary supplements are vitamins. The protein mix that you may pour into your morning juice is classified as a dietary supplement as is the calcium or multi-vitamin tablet that your child takes. Some teas are considered herbal remedies, and in large enough quantities they can have an effect on your physiology and can also potentially react with drugs or other dietary supplements you may already be taking.

Dietary supplements are NOT drugs, though they may have a drug-like action. Dietary supplements may react with drugs or medicines you are already taking, so it is always best to check with your physician before adding any dietary supplement to your nutritional regimen.

Dietary supplements are considered food and therefore are not subject to the same regulations with respect to labeling, testing or manufacturing. They must indicate on the front label that it IS a dietary supplement, and they are very restricted in the claims that they can make. Beware of claims that sound too good to be true, and keep in mind that medical claims are usually substantiated by good clinical studies, and many years of research.

I mentioned some of the research done in the Age Related Eye Disease Study (AREDS) in the last blog. Though this was a comprehensive and quite lengthy study, the last publication was in 2001. By research standards that is sometimes considered old news.

A more recent study in The New Zealand Medical Journal (N Z Med J. 2009; 122(1299):32-8 ) concluded that dietary supplementation is required to achieve the AREDS nutrient intake recommendations. This study also suggests that dietary supplementation may prevent the progression of age related maculopathy, or macular damage.

This is not the only recent study that seems to support dietary supplements in the prevention of eye disease. In Current Opinions in Ophthalmology another study states, “patients with intermediate risk of AMD or advanced AMD in one eye should consider taking AREDS-type supplements.” (Curr Opin Ophthalmol 2010 May;21(3):184-9.)

The evidence seems to mounting for supporting the use of dietary supplements to prevent the progression of AMD. Though the AREDS 2 study is still years away from a conclusion, many researchers are anxiously awaiting those results. The AREDS 2 study hopes to answer some significant questions regarding the prevention, progression and treatment of age-related macular degeneration and the development of cataracts.

Be well.

Dr. Peg

Macular Degeneration Threatens Our Life Saga

Life is a series of memories, many of those are visual memories. The author Ivan Doig writes about memories being the saga of our lives. Our visual memories help to tell of the adventures of our lives, it helps us to share these memories with others, and pass them on to the next generation. We want to do what we can to prevent age-related macular degeneration from threatening our visual memories and diminishing our quality of life.

Many of you reading this blog have heard of the Age Related Eye Disease Study, or AREDS study. This was one of the most comprehensive longitudinal studies with respect to the use of nutritional supplements and age-related macular degeneration. It was a study designed to assess the clinical course, prognosis and risk factors of AMD and cataracts. It was also designed to evaluate the effects of pharmacologic doses of antioxidants and zinc on the progression of AMD and antioxidants on the development and progression of lens opacities, or cataracts. A pharmacological dose is the minimal dose of a drug required to make it medically effective.

Briefly, the results of this longitudinal study found that people at high risk of developing advanced stages of AMD lowered their risk by about 25 percent when treated with a high-dose combination of vitamin C, vitamin E, beta-carotene and zinc. There were many publications from the study, and the AREDS formula has now become the standard of care. The last publication to come from that study was published in 2001. AREDS was not designed to determine whether earlier intervention with micronutrients would have been effective in the prevention of AMD. There is another study underway, AREDS2, which is evaluating the progression to advanced AMD. I will be referring to these, and other relevant publications in upcoming blogs.

Diet alone, or even the addition of a daily multivitamin, is not sufficient to obtain the high levels of vitamins, minerals and antioxidants suggested in the AREDS study. EyeScience Macular Health Formula was created for those in any stage of AMD, and also for those interested in the possible protective and preventative benefits of an ocular supplement.

Some of the components of the EyeScience Macular Degeneration formula include:

• Vitamin C – Works together with other antioxidants like Selenium and Vitamin E to help protect the eyes agains the development of macular degeneration. Vitamins C and E are the principle nutrients which possess radical quenching properties.
• Lutein and Zeaxanthin – Thought to help shield the macula and retina from the oxidative stress generated by exposure to light.
• Fatty acids/Omega-3 – potentially lessen the effects of exposure to light, stress, inflammation and other factors.

The preservation and protection of our vision and our memories, and the continuation of our own life’s saga is dependent upon our ability to maintain good health through nutrition and exercise.

Be well.

Dr. Peg

Additional information:

http://www.nei.nih.gov/health/maculardegen/armd_facts.asp

http://www.nlm.nih.gov/medlineplus/maculardegeneration.html

www.nei.nih.gov/amd

I moved from New Jersey to Florida a year and a half ago. There is something about living in a state where shorts and swimming suits are approved attire for most venues that motivates one to be more health conscious. Health is more than what we look like on the outside, it is a healthy lifestyle, the whole picture of both inner and outer health.

We are all familiar with the saying that the eyes are the window to the soul. I believe that the eyes are also the window to our health. As eye care professionals, we look INTO the eyes of our patients to help us determine that patient’s ocular, or eye health. The interesting thing is that this can also provide us with some information regarding our patients overall, or systemic, health. Diabetes, high blood pressure, hyperlipidemia and some infectious diseases are a few of the systemic problems that can be directly observed by looking a the retina, or the back of the eyes.

I mentioned in the previous blog that in my years of private practice I observed that when a patient looked good and healthy on the outside, the inside of their eyes revealed superior ocular health, as well. They generally were living a healthy life by eating right, not smoking, exercising and taking care of their whole person, their whole health, inside and out. These patients were the ones that looked good on the inside, AND the outside, and they usually looked younger than their chronological age. We have the power to look younger, feel better and be healthier.

A large part of taking care of our health is nutrition. The National Cancer Institute believes that about 30% of cancer is due to poor diet and lack of exercise. Just think, if we improve our health with proper diet, nutrition and exercise we may be able to prevent up to one third of cancer cases!

One of the easiest ways to improve our nutrition is through the wise use of supplements. There are approximately 155,000 cases of macular degeneration diagnosed each year, and even though there is conflicting evidence with respect to oral supplements preventing the onset of macular degeneration, there is strong evidence that the appropriate dietary supplements can slow the progression the diagnosis has been made. I believe that it is only a matter of time, and the appropriate, valid studies to be run, before there is strong evidence to support the use of dietary supplements in the prevention of macular degeneration, and other ocular conditions.

In future blogs I will be defining and describing many of the terms used in the world of nutrition, pharmaceuticals and nutraceuticals. This will help clear up some of the confusion surrounding the use of these terms and help you to decide what is the best choice for your own health.

Please remember, one must always check with their physician before adding any supplement to their daily health routine.

Be well.

Dr. Peg

Welcome to the EyeScience Labs “Eye on Health” blog.

The purpose of this blog is to inform, to acquaint you with the facts, and to educate by giving you knowledge in the areas of age-related macular degeneration, dry eyes, nutritional supplements and other eye health related topics. Specific aspects of these conditions, as well as preventative measures, will be topics of discussion in upcoming blog entries. I will also be summarizing some of the past and present research conducted in these areas to give greater understanding of these conditions, the treatment for them, and how this research can be used to improve and maintain your health and well being.

I was in private clinical practice for 16 years and observed that my patients who looked younger than their age, also looked “younger” and healthier on the inside. These patients were interested in preserving their overall health as well as their eye health. This involved diet, exercise and participating in a healthy lifestyle, which many times included dietary supplements. (link to the company’s dietary supplements page)

I then spent 8 years researching in the areas of cancer, infectious disease, dermatology and dietary supplements. The research done in the area of dietary supplements included the specific challenges of the dietary deficiencies of people living with AIDS. There is a very fine balance, right down to the molecular level, that must be achieved for these patients to survive and thrive. Balance is key in maintaining our own health, and nutritional supplements are one way to help us achieve that balance in our diets.

There are a number of studies that have been in the news with respect to dry eyes and macular degeneration. Many of you reading this blog have heard of the AREDS study. This was a study designed to assess age-related macular degeneration (AMD) and cataract. I will be describing this study in more detail in the near future and comparing it to the follow-up study currently being done, AREDS2.

Diet alone, or even the addition of a daily multivitamin, is not sufficient to obtain the high levels of vitamins, minerals and antioxidants suggested in the AREDS study. EyeScience Macular Health formula (link to this) was created for those in any stage of AMD, and also for those interested in the possible protective and preventative benefits of an ocular supplement. EyeScience Dry Eye formula (link to this) may improve dry eye symptoms, and the discomfort associated with those symptoms. The science behind these formulas will be addressed in future blogs.

Information on the dietary supplement industry, the government’s role in regulation, how supplements are different than drugs, and the definition of common terms will be included along the way to help clarify and educate to assist you in making the best health and nutritional decisions.

I believe it is a responsibility to educate and inform. Information is power, and it gives us the power to make the right decisions for our lives and our health. Armed with accurate and up-to-date information, I hope to help you make the best decisions for your eye health.

Be well.

Dr. Peg

Peg Achenbach, OD, FAAO

We understand the value of gathering information from various sources when investigating any health care issue. We hope to provide you with a representative cross-section of scientific studies, consumer information and product information relative to your eye health.

Dr. Peg Achenbach, a member of our Scientific Advisory Board, is authoring and editing the EyeSciences “Eye on Health” blog. She has years of experience in private practice and research. Her work in the areas of cancer, HIV, dermatology and contact lens care gives her a unique perspective, both from an ocular and a holistic point of view.

EyeScience offers specialized nutritional supplements for your ocular health needs.

Please browse our website and determine for yourself how our products can help you achieve the optimum ocular health that you deserve. We also invite you to visit www.EyeScience.com and encourage you to take advantage of the “Watch and Learn” videos to assist you in making the best decision for your long term eye health.

We hope you find this blog helpful and informative, and that you return on often to stay up to date on all eye health issues.

Thank you for your interest in EyeScience and our products and please let us know if there is a way that we can assist you.

Sincerely,

Jeff Northup

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