Blogs

This week’s blog on ‘Bell’s palsy’ has been contributed by Dr Osama Giledi, Consultant Ophthalmologist, Specialist in Cataract, Cornea and Refractive Vision Correction Surgery

What is Bell’s palsy?

Bell’s paralysis known as Bell’s palsy is a temporary weakness or lack of movement affecting one side of the face. It is the most well-known type of facial paralysis

Symptoms

Bell’s palsy affects the function of facial muscles, as well as tears, saliva, taste and the middle ear. It appears as droopiness on one side of the face from weakness or total paralysis of the facial muscles and it develops within two days.

The symptoms of Bell’s palsy include:

• Sudden limitation or loss of motion on one side of the face
• Drooping eyelid or corner of the mouth
• Difficulty smiling or shutting the eyelid
• Ear pain
• Drooling
• Dryness in the eye and mouth
• Ringing in the ear or sensitivity to sound
• Impaired speech or taste
• Reduced tear production.

If you have any symptoms of Bell’s palsy, it is advised to consult your physician early.
However, if facial weakness is a symptom in a person who cannot lift up both arms and keep them there or have difficulty speaking (speech may be slurred or garbled) you need to go to emergency department as these can be signs of a more serious condition, like a stroke. In contrast to Bell’s palsy, the symptoms of a stroke are sudden.

Treatment

Bell’s palsy is usually treated by a General practitioner. Symptoms generally begin to diminish within two weeks of starting treatment, with complete recovery within half a year
Treatments for Bell’s palsy include:

• A Short 10-day course of Oral steroid (medication should be within 3 days of the symptoms starting to speed the recovery of bell’s palsy)
• Eye drops and eye ointment to protect the eye and to stop the affected eye from drying out
• Surgical tape to keep the eye shut at bedtime

Bell’s palsy is rare in kids, and most kids who are affected make a full recovery without treatment.

How long the Bell’s palsy lasts

Most patients recover fully within 6 months, but sometime it can take longer. In a small number of cases, the facial weakness can be permanent which can be treated by surgery.

Causes and Risk Factors

Bell’s palsy is caused by inflammation or compression of the facial nerve (Seventh cranial nerve), which controls face muscles. Infection by a virus is believed to cause inflammation and swelling of the nerve. Various viruses from the herpesvirus family are related with Bell’s palsy. Other Non-Viral causes such as: Headaches, chronic ear infection, tumors, diabetes and injury to the face.

You can’t prevent Bell’s palsy

Because it’s probably caused by an infection of several types of viruses, Bell’s palsy cannot be prevented.
You’ll normally just get Bell’s paralysis once, yet it can once in a while return. This is more probable in the event that you have a family history of the condition.

Retinoblastoma is an eye cancer that occurs most commonly in childhood under the age of 5. . Two thirds of children are diagnosed before the age of two and almost 95% by the age of 5.
It is estimated that 5000-8000 children develop retinoblastoma worldwide every year. The incidence rate of retinoblastoma in United States and Europe is approximately 1:15000 live births. However, the rate appears to be higher in Africa and India.

Its present in two forms, bilateral (hereditary) form (25% of all cases) and unilateral (75% of all cases, 90% of which are non-hereditary).
The most common presentation is leucocoria which is an abnormal white reflection in the eye (60%) and 20% as squint, the misaligned position of the eye).
The best approach to manage this condition is based on early detection and early diagnosis.
It involves Paediatric Ophthalmologist, Ophthalmic Oncologist and Paediatric Oncologist. The aim of the treatment is primarily to preserve the life of the child. Secondly, to preserve vision and finally, to preserve the eye. It is highly curable if identified in early stages; more than 90% of children survive in high income countries and up to 40% in less privileged countries. Treatment includes radiotherapy, chemotherapy and sometimes enucleation of the eye with tumor. Children with bilateral disease and gene mutation are at higher risk for secondary cancers. This increases with radiation therapy.
It is very important to for parents, Pediatricians, Ophthalmologists and other healthcare professional involved in childcare to detect abnormal white reflection (absence of red reflex) during routine checkups of the children.
Leucocoria can be seen in the eye with the tumor due to the reflection of the white flash light from abnormal white retina in the back of the eye.
In the modern phone cameras, a red eye reduction feature is included so that the red reflex is prevented in the photos. There are few iPhone applications (apps) which are designed to detect the white reflex. However, there are certain limitations with these apps.
A thorough eye examination by a Paediatric Ophthalmologist is essential to detect the tumor in its early stages when concerns arise by parents with these apps or iPhone photos.

Why is it important for children to wear sunglasses? 

As children are in a dynamic active state of growth, it is estimated that 50% of total sun exposure occurs in the first 18 years of age, since children are more active outdoor during this age. Another important factor is the deletion of the ozone layer, a protective filter layer of atmosphere, leading to increased exposure to UV radiation which can negatively affect children’s skin and eyes.

UVA rays may cause harm to the central vision, causing damage to the macula, a central part of the retina at the back of the child’s eye. UVB may cause harm to the front part of the eye (cornea and lens), which absorb UVB rays. The other well-known side effects of UV radiation include: cataract (clouding of lens), macular degeneration, pterygium (benign growth on the white of the eye) and corneal sunburn which is painful and might cause temporary vision loss. Additionally, blue rays may cause digital eye strain due to the high energy light that is emitted by computer and mobile phone screens. Another important fact is that children’s eyes are more susceptible to the harm caused by excessive exposure to UV rays than adults because the young clear lens inside the eye is less capable of filtration of these harmful rays.

To put things in perspective, normal light is between 400 nm (on the blue end of the spectrum) to 760 nm (on the red side). However, the sun emits other electromagnetic waves in addition to light. The sun emits two types of ultraviolet rays (UV) radiation, UVA (ranges between 320-400 nm) and UVB (ranges between 290-320 nm). UVA accounts for about 95% of the UV radiation that reaches the skin and eyes. UVA rays are considered to be more harmful than UVB since they penetrate farther into skin and eyes than UVB. Also UVA rays penetrate glass while UVB rays do not. Both UV rays are reflected from sand, water and snow (80% of UVB rays reflect from snow).

In conclusion, it would be very wise for parents to ensure that their children wear protective tinted sunglasses outdoors, especially in snowfields, sandy beaches and near pools and sea. The color of sunglasses is not correlated with the level of UV protection, thus special tinted glasses with certification that will block up to 100% of the sun’s UV radiations is needed. However, before buying these sunglasses, it is advisable to arrange an eye examination with Paediatric Eye Doctor for a thorough eye examination and to provide a prescription for the glasses, if needed.

This blog on Minimally Invasive Glaucoma Surgery (MIGS) was authored by Dr. Salman Waqar, Consultant Ophthalmologist in Cataract and Glaucoma Surgery.

What is MIGS?

Minimally Invasive Glaucoma Surgery, or MIGS, has shown formidable results in mild or moderate glaucoma. MIGS is designed to improve the safety of surgical intervention for glaucoma cure.

While coined minimally invasive, micro is a more appropriate term, truly differentiates these microscopic ophthalmic procedures from other minimally invasive surgical procedures (i.e., general surgery). MIGS can be considered as an alternative to medical therapy in an effort to address adherence challenges, adverse events, and quality-of-life (QOL) issues with topical medications.

The iStent

The iStent is the smallest implantable device approved by the FDA to be used on the human body. The iStent can reduce the need for daily use of glaucoma eye drops. A small (1mm) titanium drainage stent is inserted into the eye’s natural drainage channel to lower intraocular pressure.

The iStent is not visible in the eye, and shows no physical evidence of its presence. Nor does it appear in the vision of the person with the stent.

XEN Glaucoma Implant

The implant is a soft, collagen derived, gelatin that is known to be non-inflammatory. The Xen Gel Stent aims to reduce intraocular pressure by inserting a small drainage tube into the eye. The stent allows fluid to drain from the anterior chamber into a reservoir (bleb) under the conjunctiva. The goal of implantation is to create an aqueous humor outflow path from the anterior chamber to the subconjunctival space.

Similar to the iStent, the implant also has no physical appearance. However, occasionally a shallow bleb can be seen in extremes of gaze, where the eye is looking very far down and outwards.

The Surgery

Successful MIGS surgery takes much less time than many other types of Glaucoma surgery, typically lasting 30 minutes at the most. At Moorfields Eye Hospital Dubai/Abu Dhabi, MIGS implantation is usually performed under local anaesthesia, although general anaesthesia is also possible under certain circumstances.

Typically a drug called Mitomycin C (anti-scarring medication) is also used at the time of surgery if indicated to suppress healing.

It is extremely rare for complications to occur at the time of the surgery. When the complications do occur, they occur usually within 2 weeks of the surgery.

Postoperative Period

The blurring is usually worst for the first 1 to 2 weeks after surgery, and improving slowly afterwards. It takes about 1 month for the eye to feel completely normal though vision would stabilise much earlier.

Eye drops and tablets to lower the eye pressure are not normally required for the operated eye during the first night after surgery. The following day, the postoperative eye drops are usually started after removal of the eye patch and cleaning of the eye. The postoperative eye drops will usually consist of an antibiotic and anti-inflammatory steroid eye drops to use for the first month after surgery.

The patient will require two follow up visits two weeks apart, after the operation in order for a follow up.

Following surgery you are able to read and watch television as normal as these activities will not harm your eye. It is however important to avoid strenuous activity during the first few weeks after surgery.

Here is a table with the dos and don’ts:

With showing 80-90% success rates in most studies, MIGS is slowly becoming a well requested form of glaucoma correction, especially since it only takes around 1 month for the eye to feel completely normal in most cases.

This week’s blog on Are all LASIK procedures the same? Which one is the best? has been contributed by Dr Osama Giledi, Consultant Ophthalmologist, Specialist in Cataract, Cornea and Refractive Vision Correction Surgery
If you have been thinking about laser vision correction surgery and reading up on it, you may have come across many different procedure names. Some may say that it is very confusing to understand and compare them to one another, especially as there are different packages and prices offered for such procedures.

The two main types of refractive laser procedures are the LASIK procedure and the surface laser procedure.
The LASIK procedure is one in which the thin layer of the cornea (located in the front part of the eye) is created, called a flap. The flap is then lifted to allow for the application of excimer laser energy beneath it. The laser then reshapes the cornea for vision correction outcomes. After the laser treatment is completed, the protective flap is replaced back to its original place in order for it to heal.
With traditional LASIK, a mechanical instrument called a Microkeratome uses a moving blade to create a thin corneal flap. Traditional LASIK may cause complications such as torn flaps and free flaps which in some cases can unfortunately cause permanent reduced vision. It is also known as Ultra LASIK, SupraLASIK or Thin LASIK.
An alternate new method of creating a LASIK flap is through the use of a femtosecond laser, also known as “IntraLase,” “blade-free” or “all-laser LASIK.” This technology represents an innovative and highly sophisticated laser technique used to prepare the cornea for laser vision correction surgery. This allows extra safety for the laser procedure. Using laser technology to create the corneal flap, which is most important step in LASIK procedure, has made the procedure much precise, effective, eliminates serious flap creation risks and is arguably the safest LASIK technique to undergo. Femtosecond lasik allows the surgeon to choose a excellent centration of the flap, create precise diameter and thickness and edge design of the flap, so it improves both the quality and the accuracy of the procedure.
A result, this reduces the risk of surgical flap formation complication to almost risk free, also reducing the risk of post-surgery flap wrinkles and weaker cornea, and also reduces the risk of dry eye after the procedure.
LASIK was originally approved by the FDA in 1995. The first FDA-approved bladeless flap-making system in the United States was in 2007, so it is not a new procedure, but as technology has advanced over the years, it is now extremely precise, safer and easy to perform with predictable outcomes.
In conclusion, not all LASIK procedures are equal; if you are considering LASIK, ask your surgeon whether they will perform the blade or Femto laser LASIK flap. If price is a major concern for you, the blade procedure may provide an option, however you should also consider the safety and raised potential complication rates and risks associated with this. Using the femto laser flap technique, your risk of complications and outcomes are much better guaranteed to be in your favor and also remember that some facilities offer different packages and financing options.
The choice is yours, just make sure to ask your surgeon, and the facility you are seeking treatment from, enough questions, especially how the Lasik flap is created in order for you to make an informed decision.

This week’s blog on Smoking and the eyes has been contributed by Dr Ammar Safar, Medical Director, Consultant Ophthalmologist and Vitreoretinal Surgeon.
Most people are very aware that smoking in all shapes can cause cancer, lung and heart disease, as well as many other health problems but people are always surprised when I tell them that smoking can seriously affect the health of their eyes too.

Here are some of the more important eye conditions affected by smoking:

• Dry eyes: This is a very common condition especially in the gulf area and it can be severely aggravated by smoking. Patients will feel burning sensation, scratchy eyes, redness, sandy sensation and severe irritation.
• Macular degeneration: this is a vision threatening condition that affects people over age 55 and can cause severe distortion or loss of central vision. Smokers are 4 times more likely to get this condition than non-smokers and people who live with smokers are 2 times as likely to get it too. Recent medical improvements have introduced a treatment for the severe form of AMD in the form of injections in the eye to restore vision loss. Research has proven that smokers are much less likely to respond to these injections than non-smokers.
• Cataract: This is clouding of the natural lens of the eye that obstructs vision. People who smoke are 2 times more likely to get cataract than those who do not.
• Diabetic retinopathy: People who are diabetic and smoke have much more risk of developing problems in the retina called diabetic retinopathy. This can be a serious condition and lead to blindness.
• Smoking while pregnant: If you smoke while being pregnant you could increase your child’s risk of bacterial meningitis by 5 folds. This condition causes swelling around the tissue of the brain and can seriously affect the eyes and the optic nerve. In addition to that, smoking during pregnancy increases the risk of early delivery. This can have direct effect on the eyes and especially on the retina. This condition is called Retinopathy of Prematurity (ROP) which is a serious condition, if left untreated can lead to permanent vision loss.

Patients are advised to engage in programs that lead to quitting this dangerous habit. Studies have shown that patients who quit smoking reduce their risks to pre smoking levels after 5 years of quitting.

This week’s blog on Blue light has a dark side has been contributed by Dr Osama Giledi, Consultant Ophthalmologist, Specialist in Cataract, Cornea and Refractive Vision Correction Surgery
Blue light has a dark side

What is blue light? The effect blue light has on your sleep and your health

Visible light is a lot more complicated than people may think.
Phones, tablets, televisions, electronic devices, LED lighting, streetlights, and even energy efficient light bulbs in your home; almost everything we interact with during the day emits blue light – including the sun shining above us.

We’re exposed to a broad spectrum of different kinds of visible (and sometimes invisible) light that can have a range of effects on your health. From retinal damage to a potential loss of vision, blue light is a risk to our health and should be considered.
Blue light is the portion of the visible light spectrum with the shortest wavelengths and highest energy ranging from 380 to 500nm. The sky looks blue because of blue light wavelengths from the sun.
The sun’s blue light regulates our body’s natural wakefulness and sleep cycle, called the circadian rhythm. Blue light affects melatonin production, the hormone that controls the circadian rhythm.
When the sun comes up in the morning, melatonin production comes to a natural halt and when it sets production starts back up again, telling the body to prepare for sleep and restoration, so we can refuel for the day ahead.
When we look at our electronic devices late at night, our melatonin production is reduced as a result. This is because blue light signal your pineal gland to stop producing melatonin. To your brain, blue light registers similarly to natural daylight, “tricking” your body to become more awake and alert which may cause sleepless nights and daytime fatigue.
Our circadian rhythms are naturally designed to synchronize with the rising and setting of the sun meaning that when the sun is out, our mind and bodies are alert and awake.
But circadian rhythm controls more than your sleep. This body rhythm regulates dozens of bodily functions like hormones, cellular health, blood sugar levels and metabolism and possibly even more functions we aren’t aware of yet.
Melatonin suppression has been linked with sleep disorders, increased diabetes, obesity, heart disease and even some forms of cancer.
When we aren’t in tune with our biological clock, our system begins to wear down, leaving us vulnerable to disease.
As technology improves, the amount of digital consumption through personal devices increases. The ease at which users are able to watch a movie on their phone or tablet, holding the screens in such close proximity to their eyes could mean potential long term damage to their eyes.
The eye is not very good at blocking blue light, especially in children. With age our lenses absorb some of the blue light and reduce the amount of blue light that reaches the retina.
Some blue light exposure can also be good for your health. Studies have shown that blue light exposure can boost your bodies alertness, help memory and even lift your mood. Light therapy has even been used to help with the treatment of depression.
Blue light can also contribute to digital eye strain, because short-wavelength, high energy blue light scatters more easily than other visible light, which means it isn’t as focused.
When you look at your television or laptop screen, your eyes are looking at unfocused visual “noise”.
These unfocused wavelengths are stressful on the eyes because they must constantly focus and re-focus on these flickering waves in our visual field. This creates glare or fuzziness in your vision, which is a common cause of headaches, fatigue, and eyestrain.

How can we combat the negative effects of prolonged exposure to screens?

Blue light blocking glasses and lenses have been developed to combat the effects of prolonged exposure to blue light. However, studies have shown that these lenses may increase contrast significantly. For a more comfortable experience when looking at a digital device for extended periods of time, yellow tinted lenses can be used to reduce strain on your eyes.
Researchers suggest that prolonged exposure to blue light could cause progressive destruction of retinal cells in the eyes therefore contributing to age-related macular degeneration, which is one of the leading causes of blindness.
Alternatively, nearly all visible blue light reaches the retina through the cornea and lens. For people who have cataracts and are about to have surgery, you can have an intraocular lens (IOL) surgically implanted with in-built blue light protection.

What about prolonged phone use?

If you are using your phone a lot, a convenient way to reduce your blue light exposure is to use a blue light filter. The blue light filter function is featured in some devices’ display settings and available to download from the relevant app stores. This filter limits the amount of blue light reaching your eyes without affecting the quality of the resolution and display. These are available for most modern digital devices including smartphones, tablets and computers and help to reduce the amount of blue light produced reaching your eyes.
Even better, stop using digital devices for a while before going to sleep.
Look for bulbs with opaque coatings to reduce bright light emissions. Or better yet, find a dimmable or colour-changing bulb that allows for softer light in the evening.
You can also use a dimmer on your tech screens. The mobile operating system activates blue light filtering at night. (Images: Apple Inc.)
Also, you can use some applications such as fl.ux for computers and laptops to reduce the light emitted from your devices and adjust it for the time of the day.
Computer users and those who work night shift can protect themselves by wearing blue light blocking glasses.
A Harvard study found evidence that blue-light blocking goggles are effective against the melatonin suppression response of blue light. Night shift workers are especially encouraged to invest in blue-light blocking goggles

https://www.health.harvard.edu/staying-healthy/blue-light-has-a-dark-side

This week’s blog on Reasons Why You Shouldn’t Rub Your Eyes has been contributed by Dr Luisa Sastre, Specialist Ophthalmologist in Medical Retina
5 Reasons Why Rubbing/Touching Your Eyes Is Not A Good Idea
Many of us tend to rub or touch our eyes frequently (consciously or not) during the course of every day. But did you know that every time we do this, we are taking serious risks?

Here is a list of eye diseases that have a connection with touching or rubbing your eyes:

• INFECTIOUS CONJUNCTIVITIS – Adenoviral conjunctivitis is the most common cause of ‘red eye’ in the world and is very easily transmitted by someone who is infected. The virus moves around through direct contact with eye and nasal secretions or by indirect contact with contaminated surfaces (door handles, elevator buttons…). You can even get the virus from someone who has no symptoms but is incubating the disease, days before the symptoms appear. This is one of the reasons why touching your eyes is not a good idea.
• KERATOCONUS – Keratoconus is an eye condition which results in a deformed and progressive thinning of the cornea, at the front of the eye. Keratoconus can cause severe loss of vision and surgery might be needed to stop it progressing. Rubbing your eyes is a known risk factor in the development of keratoconus and can make the condition worse.
• ALLERGIC CONJUNCTIVITIS – Allergic / atopic conjunctivitis is caused by allergens (irritants such as dust, pollen, pollution) in the environment or in the foods we eat. It causes itching which can sometimes be severe and our natural reaction is to rub our eyes. However, this rubbing action also stimulates the release of histamine, which causes even more itching and the desire to keep rubbing. The process can result in even more allergens and irritants, including bacteria, fungus and viruses, getting into to the eye.
• CORNEAL ULCERS – Dry eye syndrome is uncomfortable and feels like you have something in your eye and leads to rubbing. Rubbing can help produce tears that will soothe the irritation temporarily. However if left untreated, dry eye syndrome can eventually cause small wounds in the surface of your eye (keratitis) and rubbing can turn a mild keratitis into a corneal ulcer. Furthermore, rubbing your eye to remove something entered into it, can cause corneal ulcers and worsening of the condition (e.g. small metal splinters from grinding or cutting machines lodged on the cornea or conjunctiva are one of the most common emergencies seen by ophthalmologists). Finally, ‘fighting with a contact lens that won’t come out’ or that you think is ‘lost in your eye’, can cause significant irritation and corneal ulcers.
• AFTER SURGERY – No matter how much you would like to rub your eyes, rubbing them after eye surgery is extremely dangerous. Rubbing your eyes can open surgical incisions causing leakage and transmission of bacteria and viruses, weeks or months after surgery. It can also move or dislodge a flap after LASIK surgery or an intraocular lens.

What are the alternatives to rubbing?
No matter how much pleasure and relief you find in rubbing, compressing or touching your eyes, it can be dangerous.
Although we know that rubbing the eyes creates tears that moisturise the eyes, it is always much safer to use artificial teardrops, whenever you have the desire to rub. There is no limit to the use of artificial teardrops and you can use them hourly or even every 15- 30 minutes, if you have significant discomfort. Preservative-free artificial teardrops are the best option. And of course, visit your ophthalmologist if the itchiness or the need to rub continues, as it can be a symptom of a condition that might need treatment.

A child’s education, development, future job, self-esteem, and confidence are all linked to good vision. 80% of a child’s learning takes place visually, and 1 in 5 of them has a vision issue that interferes with their ability to learn, according to the American Optometric Association.

Following are some learning impairments linked to eyesight issues:

• spoken language – delays in speech development and speech disorders.
• written language – the ability to read, write, and spell.
• mathematics – the ability to reason.

When diagnosed and treated in the early stages of development, notably between the ages of 2 and 5, as well as up to the age of 7, the majority of visual impairments that affect young children’s learning can be successfully treated.

Parents, teachers and paediatricians should focus on the early detection and identification of the signs that a child might have a visual problem. These early signs include:

• holding a book close to face to be able to read
• covering one eye to focus more clearly
• tilting the head to see more clearly
• seeing double images
• rubbing the eye or blinking a lot
• an eye that turns in or out
• regular headaches
• struggling with hand writing
• avoiding reading
• poor performance in school
• short attention span
• difficulty in remembering things
• emotional and developmental immaturity
• high levels of frustration and irritability

If the child displays or complains about any of these symptoms, please take your child to a paediatric ophthalmologist (children’s eye doctor) for an assessment and appropriate treatment.

This week’s blog on Eyelid Twitching has been contributed by Dr. Qaseim Nasser, Consultant Ophthalmic Surgeon, Specialist in Oculoplastic Surgery, Cataract and Refractive Vision Correction Surgery
The muscles around the eyelid can be affected by a wide range of movement problems such as twitching. The most common disorders are ‘Benign Essential Blepharospasm’ and ‘Hemifacial Spasms’. So, let’s take a look at these in more detail.
Benign Essential Blepharospasm is an involuntary closing of the eyes. It can present itself in different forms, such as rapid and frequent blinking, the need to force the eyelids to close or an inability to initiate opening of the eyelids.

It can often be a combination of these different manifestations of the condition.
It can become a disabling condition and may go on to affect other facial muscles. In fact, 30% of patients with Benign Essential Blepharospasm also experience involuntary tongue, mouth and neck movements (Hemifacial Spasm).

Some of the known causes of eyelid twitches include:

• Fatigue or lack of sleep
• Stress
• Eye irritation or dry eyes
• Medications
• Alcohol or caffeine
• Physical exertion
• Allergies
• Eye strain (such as the eye strain associated with the prolonged use of digital devices)
• Poor diet and nutrition

Eyelid twitching will usually resolve itself within a couple of days or weeks but if it continues, then you should try to find the cause in order to help resolve the problem faster.
If you think about when the spasms are happening, what you are doing and how you feel at that time (time of day, food intake, stress levels, exhaustion) you may be able to make some lifestyle changes that will reduce or prevent eye twitching.
You could think about going to bed a little earlier, cutting out caffeine or finding ways to reduce or manage your stress. You can also try using lubricating eye drops to add moisture to your eyes.
Treatment for severe eye twitching may include Botox injections to paralyse the eye muscles, medications to relax the muscles, or surgery to remove the eye muscles causing the problem.

This week’s blog on The Importance of Nutrition to Your Eyes has been contributed by Dr Luisa Sastre, Specialist Ophthalmologist in Medical Retina
When faced with a diagnosis such as macular degeneration or diabetic retinopathy, many of my patients ask me: “Doctor, is there anything else, apart from the conventional treatments that I can do to stop the progression of my eye disease or to prevent it in my other eye?”
Almost every other day, I hear questions such as: “Doctor, I have heard that goji berries have a huge amount of zeaxanthin which can be very good for my macula; should I start eating them?”

Well, macular degeneration is the leading cause of  blindness in men and women over the age of 60, in Europe and the US. And unfortunately (but not surprisingly) diabetic retinopathy is the leading cause of the loss of vision among the populations in the GCC countries. So, whatever we can add to the medical and surgical classical approaches to help reduce this problem will be more than welcome.
Although there is some confusion about the relationship between nutrition, lifestyle and eye care (and more high quality research is required), we do have some good evidence available to help guide us on our lifestyle choices.
The main risk factor for macular degeneration is aging (for good reason the full name of the disease is ´age-related macular degeneration´ – AMD). However, we know that a healthy diet could play a significant role in the development of the disease, especially in people who are genetically predisposed to it. There is evidence that certain nutrients protect our body from damaging substances called oxidants. These nutrients are called antioxidants. The antioxidant vitamins that play a role in the health of your retina are:

• Carotenoids (Lutein and Zeaxanthin) are a natural sunblock for the macula (the central area of the retina), absorbing the damaging blue wavelengths of light. They are pigments present in some yellow plants (zeaxanthin can be found in orange, sweetcorn and orange peppers while kale, red pepper, spinach or lettuce, are rich in lutein). These foods containing antioxidant vitamins need to be consumed in our diet, as the human body does not produce them naturally. They should be very lightly cooked because over-cooking them may destroy the pigments. Zeaxanthin is present in eggs and is thought to be more easily absorbed by the body thanks to the fat in the egg.

• Vitamins (C and E) – Many of the nutrients mentioned above are also rich in vitamins C and E. Vitamin C is a powerful antioxidant present not only in citrus fruits but also in strawberries and brussels sprouts which, along with grapefruit, are among the top sources of vitamin C. Vitamin E can be found in seeds, nuts, and wheat germ oil.

Other nutrients important for your macula are:

• Omega 3 fatty acids (DHA and EPA) – They have a powerful anti-inflammatory effect that will help your heart and brain stay healthy, as well as your retina. The recommendation is to eat at least two servings of cold-water fish per week. Salmon, sardines, and herring are top sources of omega-3s; halibut and tuna are also good sources.
• Minerals like zinc (which is present in oysters and meat – beef, turkey, veal, pork, lamb) and copper (found in organic meats, nuts and seeds, chocolate and shellfish) are essential for important biochemical functions in the body and could play a role in maintaining a healthy retina.

Several studies (AREDS1 and AREDS2 studies), suggest that certain nutritional supplements can slow down the progression of AMD by about 25%. Many ophthalmologists may recommend taking these supplements, if you are diagnosed with dry AMD with medium size or large drusen, or wet AMD.  However, it is also widely agreed that if you eat a healthy diet including at least five portions of fruit and vegetables a day, you should not need a supplement.
I want to emphasise 3 important points:
Firstly, that no supplement is going to ‘cure’ macular degeneration. Supplements are just complementary to the main treatment, which in the case of wet AMD is the injection of certain medications into the eye.
Secondly, that supplements should not be used as a substitute for a healthy and varied diet.
Thirdly, taking antioxidant vitamin C, E or beta-carotene (vitamin A) supplements will not prevent the onset of AMD in people who do not have symptoms of the condition. There is no evidence for the benefit of other supplements, such as lutein and zeaxanthin.
Other measures to be considered in AMD are:

• Quit smoking: Smoking increases the production of damaging free radicals (oxidants) and people who smoke are up to four times more likely to develop AMD than those who don’t, regardless of genetic risk. By the way, if you are a smoker or you have recently quit, you should not take supplements with beta carotene (vitamin A), as this type of supplement is related to an increase in the incidence of lung cancer in smokers. None of the latest versions of supplements (based on the latest study AREDS 2) come with vitamin A.
• Wear sunglasses: Just as you need to protect your skin from UV exposure, you also need to protect your eyes. Excessive UV exposure can damage your cornea, your retina and can cause cataracts. Choose sunglasses with 100% protection against both UVA and UVB or glasses with 100% protection against UV 400. It is also important for children to get used to wearing sunglasses early in life, as it is the cumulative damage over a lifetime that puts you at risk of developing sight-threatening eye disease.

• Join a Support group: Support groups offer the opportunity to talk to other people suffering the same frustrations and concerns. They can help in finding solutions to your vision-related problems.

And lastly, when it comes to diabetic retinopathy, nutrition and lifestyle are simply one of the basic pillars of the treatment. Diet and exercise are mandatory in order to maintain good control of sugar levels and this will help prevent serious complications such as macular edema or retinal bleedings. Your endocrinologist or primary care doctor should definitely guide you in this journey.
Live a healthy life!
 It is more important to promote health positively rather than to prevent disease.

This week’s blog on The Risks Involved in Permanently Changing the Eyes Colour has been contributed by Dr Osama Giledi, Consultant Ophthalmologist, Specialist in Cataract, Cornea and Refractive Vision Correction Surgery

Eyesight or eye colour?

Artificial iris anterior chamber implants were originally developed for therapeutic purposes but have been used more recently for the cosmetic alteration of eye colour.

Initially this was done in Panama in Central America but now they are also inserted in some African and Asian countries. However, there is now growing evidence about the risks and associated problems of using these implants for cosmetic effect.
Cosmetic intraocular implant is when a colour implant is placed in the anterior (front) chamber of the eye to change the appearance of the iris for cosmetic reasons. The iris is the part of the eye responsible for controlling the diameter and size of the pupil and so how much light reaches the retina at the back of the eye. The iris is coated with the pigment melanin and this is what determines the colour of the eye.
Ophthalmologists use clinically proven functional colour implants for patients with iris abnormalities as a form of treatment to improve the vision and appearance of the patient. Cosmetic implants are used purely to change the colour of the healthy iris just to suit the preference of the patient. People who do want to alter their eye colour for some reason should use daily coloured contact lenses (but with care) and should not put themselves at risk from these cosmetic anterior chamber implants.
In addition to the normal risks of any eye procedure, such as infection or inflammation, these cosmetic colour implants inserted in healthy eyes must be positioned in front of the natural iris and lens, which tends to raise the intra-ocular pressure in the eye (glaucoma), and corneal damage and lens opacity (cataract). There is also the risk of iris atrophy, irregular pupil and inflammation of the eye (uveitis).
The risks are real and I have personally seen some cases in which patients had undergone the procedure in the region and then had a problem with them, leading to some loss of vision and the need to have the implant removed through another surgical procedure. Some patients may suffer permanent damage to the eye with these implants and a poor cosmetic appearance, which was the initial reason for the procedure.
There are now many reports around the world about serious problems from using these implants and almost all the major ophthalmic societies – for example, The American Society of Cataract and Refractive Surgery (ASCRS), The European Society of Cataract and Refractive Surgeons (ESCRS), The Asia-Pacific Association of Cataract & Refractive Surgeons (APACRS) – and other professional bodies advise against the use of this cosmetic iris implant in a healthy eye. The procedure is not licenced in the USA or Europe. There are no professional clinical trials underway to study the safety or efficacy of these implants for cosmetic use and medical publications only describe their potentially devastating complications.
There is no question about the use of approved functional colour implants for patients who need them for medical reasons but with cosmetic implants, there is the risk of potentially severe and irreversible complications and even the loss of vision. These complications develop slowly over months and even years after the cosmetic iris implantation, so a patient may not feel any change or be aware of any damage to the eye, until it is too late.
As a health professional, I believe it is essential to educate patients on the risks and dangers associated with these unapproved cosmetic implants and strongly discourage their use.

Statement from the American Academy of Ophthalmology (October 2014):
Following recent media reports about a cosmetic iris implant surgery to change eye color, the American Academy of Ophthalmology, the world’s largest association of eye physicians and surgeons, is warning consumers not to undergo the procedure, which has the capacity to cause serious eye damage, vision loss and blindness. Cosmetic iris implants have not been evaluated by any U.S. regulatory agency or tested for safety in clinical trials. While the implants are not approved by the U.S. Food and Drug Administration, it has been reported in the media this month that the surgery is being performed overseas.