Vision & Vitamins: No clear evidence Coenzyme Q10 helps eye health

By | Calgary, Cataracts, LASIK, Mayo Clinic, Ophthalmologist, Refractive Surgery, Vision & Vitamins | No Comments

eyelabeledCoenzyme Q10 (CoQ10) has become a popular supplement which is said to help with a number of health issues including cataract and macular degeneration in the eye, but the Mayo Clinic gives it a “C” grade for its benefits in the eye (meaning the evidence is unclear to support its use).  CoQ10 is also called Q10, Vitamin Q10, ubiquinone, and ubidecarenone.  It acts as an antioxidant in the body and has a role in producing ATP which is a molecule which provides energy to cells.  CoQ10 deficiency has not been reported in the general population and it is estimated that a varied diet will provide up to 25% of the measured plasma CoQ10 and that the body naturally makes the remainder.  Primary CoQ10 deficiency is a rare inherited disorder that causes neurologic and muscular dysfunction.

For healthy individuals there is not strong evidence to show that CoQ10 supplements improve athletic performance or prolong life.  There may be some specific circumstance where CoQ10 supplementation may be helpful.  There is some scientific evidence to show that it may be helpful in chronic heart failure and in the treatment of high blood pressure but more studies are needed.  CoQ10 has also been thought to be helpful in specific cancer patients who are undergoing chemotherapy.  There are not enough studies to show that CoQ10 is helpful for eye conditions such as macular degeneration.  According to some sources CoQ10 should not be used for diabetes, hepatitis C, or Huntington’s disease.

There have been some studies that use CoQ10 eye drops for some specific conditions affecting the retina, cornea, and optic nerve.  While early studies are promising for specific diseases, more studies are needed.  More commonly studies have used a tablet or capsule, injection, or intravenous (IV) CoQ10.   There are some side effects including insomnia, elevated liver enzymes, rash, heartburn, and fatigue that have been reported when using CoQ10.  As with all supplements be sure to check with your doctor or pharmacist before starting to take CoQ10 as it may interact with other medications (in particular blood thinners).

Foods that contain higher amounts of CoQ10 include beef, herring, chicken, soybean, canola oil, rainbow trout, roasted peanuts, sesame seeds, pistachio nuts, broccoli, cauliflower, orange, strawberries, and eggs.  A varied diet is helpful in providing a wide variety of nutrients and since CoQ10 appears to act in concert with other vitamins such as vitamin E, having a dietary source of this vitamin may help provide CoQ10 along with other nutrients and co-factors that will aid in absorption and in action.  CoQ10 naturally declines with age so maintaining a healthy diet is increasingly important.  Given the scientific evidence to date it seems unlikely that CoQ10 supplementation is helpful for vision in healthy people.

If you have questions about laser vision correction or wish to book a complimentary evaluation with Dr. Anderson Penno, contact Western Laser Eye Associates.

 

 

 

Vision & Vitamins: Can supplements prevent/treat nearsightedness (myopia)?

By | Calgary, Eye health, Food for thought, Vision & Vitamins | No Comments

Beautiful young woman wearing glasses portrait.If you or your children wear glasses for nearsightedness (myopia) you have probably seen advertisements for vitamins and supplements that claim to prevent or reduce nearsightedness.  Approximately 1.6 billion people were nearsighted in 2000, and up to 2.5 billion worldwide are expected to be nearsighted by 2020.  The myopia boom in East Asia has resulted in an increase in myopia from 10-20% in China in the mid-twentieth century to up to 90% of teens and young adults with nearsightedness today.  According to a recent article in the journal Nature up to 96% of 19 year olds in Seoul are nearsighted.  While there is a genetic or hereditary cause for nearsightedness, this increase in myopia worldwide indicates that other factors may be important.

It has been a longstanding theory that prolonged near work including reading and screen time may lead to an increase in nearsightedness.  A newer finding is that light levels and time spent outdoors in natural light may be protective in preventing myopia progression – and in some countries public health posters tell children to “Keep Myopia Away, Go Outside And Play!”  There does seem to be a positive effect of natural light (and not just that playing outside does not involve reading or near work) since some animal studies confirm this finding.

Can vitamins prevent increasing nearsightedness?  There is little evidence to prove most of the various vitamins and supplements that are marketed to reduce myopia, except more recently for Vitamin D.  There may be a connection between the findings that more time in natural light seems to reduce increases in nearsightedness and the Vitamin D findings.  When UVB from sunlight shines on bare skin the body produces Vitamin D.  This vitamin can also be found in fortified milk, cereal, and other foods.  In spite of this many people may be deficient.  A blood test can determine your Vitamin D levels to find out if you are deficient.  Supplements can boost your Vitamin D levels, but too much can lead to dangerously high calcium levels – so as with all supplements and vitamins more isn’t always better.  It is advisable to work with a nutritionist or physician to determine the dose that is right for you.

While there is no strong studies to support taking other supplements to prevent increasing nearsightedness, it is a good idea to have a diet which includes colored fruits and veggies, fish, and nuts.

If you have questions about laser vision correction or wish to book a complimentary evaluation with Dr. Anderson Penno, contact Western Laser Eye Associates.

 

LASIK (flap) versus Surface PRK (no flap)

By | Calgary, Dry eye, Epi-lasik, Epilasik, Intra-LASIK, Laser Eye Surgery, Laser vision correction, LASIK, Ophthalmologist, Ophthalmology, Opthamologist, Photorefractive, PRK, Refractive Surgery, Surgeon, VISX | No Comments

STAR S4According to some reports over 28 million laser vision correction surgeries have been performed worldwide since the excimer laser was developed in the 1980s.  Both PRK surface laser and LASIK surgeries use the excimer laser to reshape the corneal surface.  The main difference between the two types of laser vision correction methods is the creation of a corneal flap with LASIK and treatment on the surface of the cornea after removing the thin layer of epithelial cells with PRK.  eyelabeled

 

Advances in both the excimer laser and in flap creation technology have resulted in a variety of names for laser vision correction surgeries.  Flap surgeries include LASIK and IntraLase and no flap treatments include PRK, LASEK, and Epi-LASIK.  With LASIK a small oscillating blade in a device called a microkeratome is used to cut the LASIK flap.  With IntraLase the femtosecond laser is used to create a corneal flap.  Originally called “flap and zap”, with LASIK and Intralase the flap is lifted and the excimer laser reshaping is done on the underlying corneal tissue.  With no flap treatments the excimer laser energy is applied directly to the surface of the cornea.

PRK surface laser vision correction gained in popularity from it’s introduction in the 1980s over the next decade.  LASIK was introduced in the 1990’s  and became the most popular laser vision correction by the early 2000’s due to faster recovery.  Within the past several years there has been a shift back towards surface treatments due to the improvements in post operative management and in excimer laser technology.  It has also been determined that for some people PRK surface treatments may be a better choice.  The reasons that PRK may be recommended include:

1. Risk of flap shift or trauma with job or sports activities.

2. Thin corneas that may be a risk for ectasia (unstable cornea with progressive thinning) with LASIK flap.

3. Very steep or very flat corneal curvatures that may increase LASIK flap complication risk.

4. Previous injury or eye or eyelid surgeries that may raise the risk of LASIK flap complications.

5. Moderate dry eye might be worsened by the deeper disruption of corneal nerves with LASIK flaps.

Both LASIK and PRK have be demonstrated to produce equally good results over 6 months or more.  In the short term of days to weeks LASIK patients will recover vision more quickly.  So taking a short term perspective it makes sense that people may choose a LASIK flap laser vision correction method.

Taking a long term approach there are advantages to forgeting the LASIK flap and choosing a no flap PRK surface treatment.  Advantages of a no flap PRK approach include:

1. no LASIK flap = no flap complictions such as incomplete flaps, buttonholed flaps, partial flaps

2. no LASIK flap eliminates the risk for flap dislocation in the future

3. no LASIK flap means there can not be complications like epithelial ingrowth, diffuse lamellar keratitis, interface debris, flap wrinkles,  or other LASIK flap related complications.

4. Less risk of a weak and unstable cornea called corneal ectasia due to the LASIK flap disrupting the cornea more deeply than surface PRK.

5. Possibly less risk of severe dry eye with surface PRK.

To make the choice that is right for you, first find out if you qualify for laser vision correction and then learn the pros and cons of the treatments available to you.  If you have questions about laser vision correction or wish to book a complimentary evaluation with Dr. Anderson Penno, contact Western Laser Eye Associates.

 

Vision & Vitamins: All about Vitamin A

By | Uncategorized | No Comments

Vitamin A.  This first to be discovered vitamin is found in a wide variety of fruits and veggies as well as eggs.  Vitamin A deficiency is rare in North America but worldwide the World Health Organization estimates that 250 000 to 500 000 vitamin A-deficient children become blind every year, half of them dying within 12 months of losing their sight.  The World Health Organization is working to supply Vitamin A supplements and foods rich in Vitamin A to needy countries around the world including in Asia, Africa and South America.

Vitamin A can also be harmful in high doses.  This can be a problem if large doses of supplements are taken over a long period of time and can damage the eye and other organs.   It is uncommon to overdose on Vitamin A with food but acute overdose can occur from eating polar bear liver or chronic overdose can happen over a long period of time from taking supplements like cod liver oil which will harm the liver, eye, and skin.  As with all supplements it is important to be aware of recommended dosages and keep in mind that more is not better as the body is a finely balanced system.  It is not possible to overdose on Vitamin A by eating fruits and vegetables since plant-based vitamin A precursors such as beta-carotene (in addition to other mixed carotenoids) are regulated by the body which prevents overdose.

Vitamin A  can be measured but it is too costly to be practical in third world countries.  In North America Vitamin A deficiency is uncommn so if Vitamin A deficiency is suspected then a secondary cause such as celiac disease may be investigated.  Most overdoses of Vitamin A are due to over supplementation and the treatment is to stop the supplementation.

Any time vision changes are noted it is a good idea to contact your optometrist or ophthalmologist to investigate possible causes.  While reduced night vision can be a symptom of Vitamin A deficiency, in North America it is more likely to be caused by other more common disorders such as cataracts. If you have questions about laser vision correction or wish to book a complimentary evaluation with Dr. Anderson Penno, contact Western Laser Eye Associates.

 

 

Vision & Vitamins: Food versus Supplements

By | Vision & Vitamins | No Comments

IMG_2327I am a fan of food.  The most powerful health advice is common sense – simple and straightforward.  Don’t smoke, exercise, get your blood pressure and blood sugar checked, and have regular screening exams both for eyes and general health.  Michael Pollan’s seven words – Eat Food, Mostly Plants, Not Too Much – are a beautiful example of this simple approach.  My other favorite is one I heard at a conference years ago – Eat a little bit of everything and not too much of any one thing.  Another favorite is – Eat around the outside of the grocery store.  The outside perimeter almost always contains the fresh vegetable, dairy, and fish/meats and the center has more of the processed foods. With whole foods (not processed) the ingredients are reliable and unknown additives will not be an issue.  Supplements are not regulated like prescription medications so some of them may not contain the listed ingredient and some have harmful additives that are not listed on the labels.  It is nearly impossible to harm yourself with food when eaten in usual amounts – “not too much” .  One exception to this is eating polar bear liver which can harm the eye due to overloading vitamin A.

By eating a wide variety of foods and not too much, most adults will be able to consume the nutrients needed for good eye health.  Foods also contain fiber and other micronutrients that are essential for good health.  It is also less likely that food will interfere with prescription medications, although there are exceptions to this.  Grapefruit is know to interact with a number of prescription medications and blood thinners may be more likely to be affected by certain foods like broccoli.  With mindful eating the eye healthy nutrients will be part of your diet including the colorful fruits and veggies, and in fish and nuts.

With that said, it your diet is poor or if you have early high risk macular degeneration then supplements may be helpful.  However, if you smoke then it is probably a waste of money to buy supplements unless you first quit smoking.    Other groups of people that may benefit from supplements include pregnant women and people with problems absorbing vitamins. There is no definite evidence to show that vitamins will prevent eye disease, but there is some scientific evidence to support taking AREDS 2 formula vitamins for people with early but high risk macular degeneration.  There is also some suggestion that certain fatty acids such as those found in flaxseed and fish oil may be helpful for treatment of dry eye.  The effects of vitamins and supplements is very hard to study in a scientifically rigorous way due to the need for very large number of people who will need to be included in the studies and the length of time, possibly years, needed to see statistically significant effects.  So the risks and benefits are sometimes not clear for decades.  There are also a lot of confounding factors like smoking, diabetes, or other chronic diseases that may impact health whether or not supplements are taken.  In fact in some cases long term studies show that supplements may be causing harm as in the case of vitamin E.  There has been some suggestion in the scientific literature that vitamin E supplementation might be associated with an increase in total mortality (death), heart failure, and stroke.

The best approach is mindful eating for everyone and mindful supplementation for select people.  At worst vitamins and supplements may harm you, and they may be a waste of money.  Regardless if you need glasses or contacts,  certain people are likely to benefit from select supplements, so do your homework and talk to your doctor and nutritionist to make sure you are making good choices with your health and nutrition.  Exercise and don’t smoke.  If you have questions about laser vision correction or wish to book a complimentary evaluation with Dr. Anderson Penno, contact Western Laser Eye Associates.

Vision & Vitamins: Eat Your Colors!

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IMG_2358

It turns out getting vitamins in your diet that are good for your eyes is a simple as looking for color.  Of course the old favorite is the bright orange carrot.  Beta-carotene which is responsible for the orange color in carrots, squash, and pumpkins that the body converts to vitamin A which is important to retinal function and good vision.  Leafy greens – spinach, kale, lettuce – contain zeaxanthin which are antioxidants that may reduce development of macular degeneration and cataracts.  Blue and red berries like blueberries, bilberries, strawberries, and raspberries have vitamin C and other compounds like anthocyanin that promote retinal health and healthy blood vessels.  The eye has one of the highest blood flow of all the body organs – so keeping your cardiovascular system healthy is a key to good vision.  Don’t forget about the importance of brown (nuts).  Sunflower seeds, almonds and other nuts are full of vitamin E which may also be helpful in preventing retinal problems like macular degeneration.  Finally think about eating colorful fish like salmon and the bright yellow of egg yolks when looking for eye healthy foods.

So next time you are shopping at your local grocery store or farmers’ market keep an eye out for colorful foods that will not only be pleasing to look at but also good for your eyes.

If you have questions about laser vision correction or wish to book a complimentary evaluation with Dr. Anderson Penno, contact Western Laser Eye Associates.

 

Vision & Vitamins: What is bilberry?

By | Uncategorized, Vision & Vitamins | No Comments

Bilberry is a shrub that produces berries that resemble blueberries.  It is found in Northern and Central Europe.  In Scandanavia wild bilberries are the most common.  Various medicinal effects have been attributed to this natural source of antioxidants.  The compounds that are responsible for the dark color are anthocyanins.  This berry has been reported to lower blood sugar and lipids, and to fight inflammation.  Bilberry has been classified as safe when consumed appropriately by the American Herbal Products Association.

Does Bilberry improve night vision?  According modern folklore the Royal Air Force used Bilberry during the second world war to improve night vision – although the same claim is made for carrots.  There have been some peer reviewed studies (peer reviewed means the studies are analyzed by other scientists prior to being accepted for publication) over the years to suggest that there may be some benefits to Bilberry, but the dose has not been determined and the most of the studies are somewhat small.  So the benefit of bilberry to eye health is not strongly supported by science and future studies will be needed to find out the true benefits.

Is Bilberry better for the eyes than other antioxidants?  There does not seem to be any evidence that Bilberry is better, but since deeply colored fruits and vegetables all contain a variety of beneficial nutrients including antioxidants it makes some sense to include Bilberry along with a variety of other eye healthy foods.  A professor of mine once told me, “Eat a little bit of everything and not too much of any one thing.”  It is uncommon but it is possible to harm your health with supplements.  Consumer reports published an article about twelve supplements you should avoid. It is less likely to harm yourself with real food, but it is wise to be cautious about the amounts of vitamins that are in your diet.  For example, vitamin A is necessary for vision but too much can lead to blindness.  It would be unlikely to ingest too much vitamin A unless you eat polar bear livers, but in general more vitamins are not necessarily better.  The stuctures and biochemistry in the eye (just like the rest of your body) is like a delicate fine tuned watch which require specific amounts of various nutrients for the best function.  Mega doses of vitamins are like trying to fix the delicate watch with a hammer.  Bilberry shows promise as part of well rounded eye healthy diet.

If you have questions about laser vision correction or wish to book a complimentary evaluation with Dr. Anderson Penno, contact Western Laser Eye Associates.

Vision & Vitamins: Can supplements prevent nearsightedness?

By | Cataracts, Diabetes, Laser Eye Surgery, Laser vision correction, Ophthalmologist, Ophthalmology, Opthamologist, Optometry, science, Vision & Vitamins | No Comments

Nearsightedness (also called myopia) affects from 20% to 50% of North Americans and up to >80% of some populations in Asian countries.  The need for nearsighted correction with glasses or contacts can run in families and is more likely to be present if both parents are myopic.  The natural course of nearsightedness is that it can start in childhood or young adulthood and continue to progress up to age 20 or in higher corrections into the 30’s.

There are some conditions that may be associated with nearsightedness so regular eye examinations are recommended even if the prescription has stopped changing.  Nearsighted people and parents of nearsighted children are of course interested in finding ways to slow or prevent the progression of myopia.  There has been conflicting scientific evidence to support the relationship between reading and near work and higher myopia, however there was no proven association between nearsightedness and computer work.  There has also been some evidence to suggest that more time spent in natural light (outdoors) can help to reduce the increase in prescription over time.

There have been a number of studies to try and find a link between nutrition and nearsightedness and to this date there has not been anything proven to prevent natural progression of myopia in children and adults.

It is important for anyone affected by nearsightedness to have regular eye examinations with and optometrist or ophthalmologist even if the prescription isn’t changing.  Sudden shifts in the degree of nearsightedness can indicate conditions like diabetes or cataracts if changes are happening at an older age.

Correcting nearsightedness is usually involves using glasses or contact lenses.  Laser vision correction can be considered after the prescription has stabilized for at least 2 years.

If you have questions about laser vision correction or wish to book a complimentary evaluation with Dr. Anderson Penno, contact Western Laser Eye Associates.

75 Mile Obstacle Course: AKA West Coast Trail 2015 (5 simple steps)

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“I don’t know how they can call this a trail.”  This was the comment from one of my trek-mates in the first leg of the West Coast Trail last week.  We started from the south end and did the first 13 K in 7 hours which is pretty good compared to some – the last 12 K took 3.5 hours which tells you the difference in difficulty from south to north.

If you are thinking about doing the West Coast Trail here are 5 simple steps:

1. Can you and do you want to do the West Coast Trail? If your answer is no then don’t do it.  The southern end is challenging even in a dry year like 2015. Five out of six of us fell at least once on the trek and fortunately had only minor scrapes and bruises.

2. Have the right gear:

– must have: waterproof boots (again even in this drought year 2015 your feet will get wet and wet feet breed blisters), extra socks because once wet nothing dries even if it isn’t raining), pack covers for protecting pack and contents from rain and overnight dew, and of course the usual food, fuel, and toilet paper (one role per person per week is a good rule of thumb). And of course a sense of humor and a sense of adventure.

– optional: Gaiters probably would be a good idea in a year with more rainfall and were helpful even in this dry year to keep sand and water from pouring in over the tops of our boots. Poles are favored by some and considered a nuisance by others – I used the one pole method to keep one hand open to grab onto branches, roots, and anything else to help with balance.  We broke one pole and bent another within the first day on the trail, so the down side was carrying the broken pole the rest of the trek. Camping pillows can help in getting a good night sleep.

– do not bring: Cell phone – contrary to reports we had no cell coverage anywhere including Port Renfrew, the entire trail, and all but the top of one hill in Bamfield so don’t bother bringing it.  Hammocks are not helpful as an alternative to tents due to campsites being on the beach and no suitable place to hang them for most sites. Avoid down sleeping bags or vests as once wet they are not usable.

3. plan your itinerary:

–  Our 5 night itinerary for West Coast Trail 2015 was: Campers Bay (7 hours from start and grueling), Walbran, Dare Beach, Tsusiat Falls, Michigan Creek

– plan to take more time then you think you will need in order to have some time to enjoy the scenery

– south to north worked well for our group in order to get the hardest part (first 2 days of the south end) out of the way and the packs didn’t get that much lighter by the end of the trek anyways.

– plan your water stops and if you have a bigger group be careful to plan for water stops so that the faster hikers do not leave the slower ones without water.  Have lunch at a creek and fill up your water bottles before heading off again.

4. Take your time and watch your step as every step is potentially slippery and as soon as you relax you will slip and fall.

5. Decide how much cash you want to spend at Chez Moniques and the Crab Shack at the Ninat Narrows.  Both have good food but pricey due to the location.  You may also need cash for a cab ride at either end depending on your transportation plans.

And of course have fun!

 

Western Laser Eye Associates Welcomes Dr. Deepak Khosla, Ophthalmology Associate

By | Blepharitis, Calgary, Cataracts, Dr. Khosla, Dry eye, Eye health, glaucoma, Laser Eye Surgery, Laser vision correction, macular degeneration, Ophthalmologist, Ophthalmology, Opthamologist, Optometry, Photorefractive, PRK, Refractive Surgery, Uncategorized, VISX | One Comment

Western Laser Eye Associates is excited to welcome Dr. Deepak Khosla as the newest member of our eye care team.  Dr. Khosla has a special interest in medical retina and general ophthalmology.  He speaks a number of languages including Hindi, Punjabi, Urdu, and Tamil and has a number of years of experience in ophthalmology.  Urgent eye care problems and new patients are welcome.

Dr. Khosla is a general ophthalmologist which differs from an optometrist in the training and scope of practice.  Ophthalmologists are “Eye MD”s with a medical degree and training in all systems in the human body.  An optometrist has specialized training in eye health and also may have more experience and training in the optics of prescribing glasses and contact lenses.  Western Laser Eye associates has a diverse team including 2 optometrists who specialize in eye health including dry eye, glasses and contact lens prescriptions, and eye muscle testing.  Dr. Khosla joins Dr. Anderson Penno as a second ophthalmologist and together they cover a wide array of eye health problems including screening for diabetic patients and treatment of many common eye diseases such as glaucoma and macular degeneration.  Dr. Khosla and Dr. Anderson Penno also care for urgent conditions including foreign body, eye infections, styes, and retinal tears.

Dr. Khosla offers Saturday appointments for select appointments.  To inquire about an eye health exam call 403.247.1477 or ask your medical doctor to fax a referral to 403.247.9774.

If you have questions about laser vision correction or wish to book a complimentary evaluation with Dr. Anderson Penno, contact Western Laser Eye Associates.