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Dr Bala Ambati
Dr Bala Ambati


Eye on the plate

Vision is precious to each of us, yet all too often we take this queen of the senses for granted. Some of the most common causes of vision loss and eye problems can be helped by nutritional intervention, including macular degeneration, glaucoma, dry eye, eyelid inflammation (blepharitis), hypertension and diabetic damage to the retina. In India, one other important cause of blindness is vitamin A deficiency, especially in children. I will share some “composite” cases of common situations that we see in practice, followed by some recommendations.

Case 1: Mrs Jones, 69, was recently diagnosed with dry macular degeneration in one eye; her mother had gone blind from macular degeneration at the age of 80. While Mrs Jones's vision remains good, she is deeply worried about the possibility of going blind. The dry form of macular degeneration is more common than the wet one, where there is bleeding underneath the retina. However, dry macular degeneration can, over time, rob one’s sight or convert to the wet kind. Mrs Jones has several risk factors for macular degeneration—family history, high blood pressure, high cholesterol and a history of smoking.

For the general population, to help reduce the risk of developing macular degeneration, it is wise to enhance one's diet by:
* Increasing food rich in nutrients like lutein and zeaxanthin. These can be found in dark, green leafy vegetables like spinach, mustard greens, beet greens, kale, collard greens and Swiss chard, tomatoes and carrots.
* Increasing food rich in antioxidants like fruits (especially blueberries and blackberries), and spices like turmeric and fennel.
* Decreasing food rich in pro-oxidants and “unhealthy” omega-6 fatty acids like red meat, fatty or processed food.
* Food supplements (nutraceuticals) that might help you in these goals include flaxseed oil and fish oil.

For women with risk factors such as high blood pressure, smoking and high cholesterol, I also recommend taking supplemental vitamins—folic acid (2.5mg/day), vitamin B6 (50mg/day), and vitamin B12 (1mg/day). These were shown in a women’s health study to slow the progression of dry to wet macular degeneration. Keeping blood pressure under control is also important in this context.

Patients with macular degeneration must get their retina examined at least once a year. Patients can also “self-test” their vision once every week or two with an Amsler grid (either on paper or online) and pick up early signs of progression.

Case 2: Ms Patel, 48, has increasing eye irritation, burning, stinging and feeling of dryness. While her vision is good most of the time, she does report fluctuations in her vision, especially when working on a computer.

Dry eye is a very common problem, affecting more women than men, and is often associated with hormonal changes such as menopause. Excessive time spent on computer, phone, TV or iPad is a major risk factor as people tend to stare and forget to blink. Dry eye is often associated with a condition known as blepharitis, which is inflammation of the eyelids, and can lead to blockages of some of the glands responsible for producing tears.

Warm compresses—a hot towel or washcloth soaked in hot water, or special eye masks—three to four times a day for five minutes at a time are very helpful for both dry eye and blepharitis. By increasing circulation to the eyelids and helping open up pores, they promote healthy tear production.

For patients with dry eyes and blepharitis, it is helpful to enhance the diet by:
* Adding food high in omega-3 fatty acids (docosahexaenoic acid and eicosapentaenoic acid) like avocado, salmon, guacamole, walnuts, flaxseed, chia seed, almonds, organic eggs, fish oil, extra virgin olive oil, DHA-supplemented milk, canola oil or rapeseed oil.
* Adding food high in gamma-linolenic acid (GLA) like evening primrose oil, borage seed oil, black currant seed oil, hemp oil or GLA-enriched safflower oil.
* Cutting back on food that are high in trans fat or omega 6/9 fatty acids like processed food, donuts and pastries, deep-fried items and red meat.
* Cutting back on alcohol, caffeinated tea and coffee.

Diet will not cure these conditions, but eating healthy food can help improve your immune activity. Begin by choosing a variety of dark green and other vegetables such as spinach, kale, broccoli, corn and carrots to provide a healthy variety of nutrients. Fruits like strawberries, cantaloupe, bananas and oranges also offer healthy choices for many different vitamins and minerals. Develop a balanced diet by choosing dairy products such as skim milk and low-fat yoghurt and select healthy grains including quinoa, bulgur, brown rice and whole wheat pasta.

With our busy schedules, it is all too easy to neglect sleep and exercise. Adjusting your schedule to prioritise good, consistent and enough sleep, and finding about 20-30 minutes a day to do physical activities that you enjoy, whether it be jogging, swimming, weight-training or even just going for a brisk walk are all useful in helping reduce inflammation around the eyes.

Having a humidifier at home or office, wearing wrap-around sunglasses or 'shooter' or motorcycle glasses outside and wearing goggles if one is exposed to fumes or gases can be helpful. Taking breaks every hour or so from computer work to reduce strain on the eyes and improve blinking. Artificial tears or gels are often very helpful. Avoid drops that promise “to get the red out”. Avoiding polluted air, indoor as well as outdoor, and using air purifiers can be very helpful.

Some patients with dry eye, especially if they also have dry mouth and/or joint pains, may have an autoimmune condition known as Sjögren’s syndrome, which can be detected via a simple test such as the Sjö test. There are some eyedrops and oral medications that can help treat blepharitis. Placement of tear duct plugs into the lower eyelid can help retain one’s own tears in the eye rather than losing them into the nose. Some patients may also benefit from the BlephEx eyelid polishing procedure as well as Cliradex tea tree oil eyelid scrubs.

Case 3: Mr Reddy, a 58-year-old executive, feels he is slowly losing his peripheral vision, which is affecting his driving. His eye pressure is high at 28, and he has high blood pressure and snores at night.

This gentleman likely has glaucoma, in which high pressure inside the eye damages the optic nerve that carries the vision from the eye to the brain. High blood pressure is a risk factor, and should be controlled medically as well as with diet. However, low blood pressure at night when we are sleeping flat can also damage the optic nerve. Hence, I recommend to my glaucoma patients who take blood pressure medication that they consider taking it in the morning to avoid nocturnal hypotension (abnormally low blood pressure). Early removal of cataract can help in lowering pressure inside the eye. Wearing a tie too tightly and sleep apnoea, where snoring can cause collapse of the breathing passage, can make glaucoma worse as well. So I tell such patients to loosen their tie and to see a sleep specialist for evaluation and treatment of possible sleep apnoea, which could include weight loss, nasal strips, Provent, different pillows or beds, or assisted night ventilation with a continuous positive airway pressure machine. Other recent findings of note are that early life exposure to ultraviolet rays (snow or water sports), or bad oral hygiene can increase damage.
The views expressed are strictly those of the author and the university takes no position on these.

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