Category Archives: Uncategorized

Vision & Vitamins: All about Vitamin A

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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: Eat Your Colors!

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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?

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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.

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.

Happy Birthday PRK!

By | Laser Eye Surgery, Laser vision correction, LASIK, PRK, Refractive Surgery, Uncategorized | No Comments

Photorefractive keratectomy (PRK) is the original laser vision correction surgery that was first performed in the US in the 1980’s and on June 12, 1990 at the Gimbel Eye Centre in Calgary Alberta Canada.  In the 25 years that followed PRK first gained in popularity over radial keratotomy (RK) in which incisions were made in the cornea to flatten the surface of the eye for treatment of nearsightedness.  PRK has the advantage of precision laser modification of the corneal curvature using the excimer laser.  The excimer laser was originally intended for industry and manufacturing but when a curious researchedr took some leftover Thanksgiving turkey back to to lab laser vision correction was born.

PRK quickly replaced RK as a more stable and precise way to eliminate the need for glasses or contact lenses.  As the search for improvements continued into the 1990’s the older technology of cutting a corneal flap was combined with the excimer laser reshaping in a treatment that was first called “FLAP & ZAP” and later laser in situ keratomileusis (LASIK).  LASIK quickly overtook PRK as the most popular laser vision correction method into the early years of this century due to the faster healing the flap allows.  Throughout this time PRK remained a trusted method and was considered safer than LASIK for thinner corneas and for athletes and people with occupations that might risk eye injury due to the risk of a LASIK flap shirt.

As the early 2000’s progressed a new and difficult to treat complication became recognized – corneal ectasia. Ectasia after LASIK is uncommon but can result in an unstable corneal surface that is analgous to a weak spot in a tire, which makes the surface of the eye bulge out and become irregular over time.  There has been a lot of debate about ectasia after LASIK, but many eye surgeons believe that PRK may be a lower risk for this specific problem due to the fact that the cornea is not disrupted as deeply as compared to LASIK.  The LASIK flap does not leave the eye but once it is cut it may no longer contribute as strongly to the corneal structure.  This weakening in addition to a number of other risk factors appears to play a role in post LASIK ectasia.  All the while PRK has continued to be offered as an option for laser vision correction in particular for people who might not qualify for LASIK.

In the past few years many surgeons around the world have moved “back to the surface” and choose not to cut corneal flaps in order to affect the smallest amount of corneal tissue needed to improve uncorrected vision.  Advances over the last quarter of a century since PRK was first done include significant advances in excimer laser technology including iris recognition, cyclotorsion adjustments, and the ability to do individually customized treatments using wavefront technology.  In addition, improved bandage contact lenses and medications have been developed to reduce post-operative discomfort and risk for haze following PRK.

PRK turns 25 this year in Canada and is still going strong!

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: Ginkgo Biloba, Glaucoma, and Macular Degeneration

By | Epi-lasik, Epilasik, Eye health, FDA, Food for thought, Ginkgo Biloba, glaucoma, Health Canada, Laser Eye Surgery, Laser vision correction, macular degeneration, Mayo Clinic, Ophthalmologist, Ophthalmology, Opthamologist, Optometry, Pubmed, Refractive Surgery, science, Uncategorized, Vision & Vitamins | No Comments

Vitamins and natural herbs have become more and more popular for alternative treatment as additional treatments for medical conditions.  Ginkgo Biloba has been used for centuries as a traditional treatment which may help blood flow to the brain and aid in treatment of dementia or Alzheimer’s disease.  It might help treat leg pain that results from blood vessel disease, and there is some suggestion that ginkgo biloba might also help PMS symptoms, depression, multiple sclerosis, and ADHD.  Ginkgo Biloba is extracted from the leaves of the Ginkgo Biloba tree.  As far as vision and eye health are concerned, it is possible that Gingko Biloba might be helpful to eye health but as with many natural products the scientific studies show some favorable and some unfavorable results.

There are some scientific studies that have been reported in the peer reviewed literature which is a data base of articles that have been reviewed by scientists with expertise in the particular field of study before the article is allowed to be published.  Peer review helps to make sure that studies are done in a way that will provide strong statistical evidence for or against a specific area of study.  The most powerful studies are randomized and double-blinded which means the researcher and the subject who is taking the supplement do not know if it is the actual supplement or a placebo being taken.  The “placebo” effect has been well studied and up to 30% of people taking a fake pill who are told it will have beneficial effects will report that it helps whether or not there is any measurable effects.  By double-blinding and using large and randomized numbers of subjects the results will show with more confidence that a particular supplement is helpful or not for a specific condition.  Because there are a lot of different conditions that are being studied, so far there are only a few published peer reviewed scientific studies that have been done to find out if Ginkgo Biloba is good for your eyes.

According to the Mayo Clinic there is some scientific evidence suggesting that Ginkgo Biloba may be helpful in preventing worsening in age related macular degeneration which can lead to central vision loss, but there is little evidence to suggest it might be helpful for treatment of glaucoma.  In the peer reviewed literature there are a few studies including this 2012 study by Cybulska-Heinrich, Mozafferieh and Flammer that suggests supplementation with Ginkgo Biloba might be helpful in addition to traditional medical treatment in cases that are not responding as well as needed to these traditional treatments.  They suggest that antioxidant effects along with a variety of other effects on blood flow might be responsible for the beneficial effects of supplementation with Ginkgo Biloba.  The American Academy of Ophthalmology reported there was a single small randomized trial that showed promise for using Gingko Biloba to slow macular degeneration.

A commonly reported dose of Ginkgo Biloba is a standardized extract, standardized to 24% flavone glycosides and 6% terpene lactones starting at 40 milligrams of that extract three times daily, but there does not seem to be enough evidence in the scientific studies to prove the most effective doses for a specific condition.  Risks and side effects of Ginkgo Biloba supplements include headaches and dizziness, bleeding, and other side effects.  If you are on a blood thinner or aspirin, or are on other medications you should talk to your pharmacist and/or doctor to make sure that there won’t be dangerous interactions.  There is also some question about the quality of the products in some cases and as with all supplements it is important to be sure you are getting a high quality product.  In Canada a DIN or NPH number can be found on products that have been reviewed by Health Canada.  In the US the FDA does not require approval of supplements before the product is marketed but does collect information on adverse events.  The other thing to consider is the cost of a product like Ginkgo Biloba versus the proof that it will be helpful for your health.

Whether you already had LASIK, Intralasik, EpiLasik, PRK, wear glasses or contacts, reading glasses or no glasses at all you should be sure to get regular checks with your eye care specialist (optometrist or ophthalmologist) in order to optimize your vision for the rest of your life.  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 carrots!

By | Eye health, Food for thought, Laser Eye Surgery, Laser vision correction, Ophthalmologist, Refractive Surgery, Uncategorized, Vision & Vitamins | No Comments

Is the old wives’ tales about eating carrots fact or fiction?  Carrots are high in beta-carotene which the body converts to vitamin A.   Carrots also provide vitamin C, iron, calcium and fiber.  Carrots and other foods rich in vitamins C and E, zinc, lutein, zeaxanthin, and omega-3 fatty acids DHA and EPA benefit eye health and general health, as hown by the the Age-Related Eye Diseases Study (AREDS), funded by the National Eye Institute. These nutrients are linked to lower risk for age related macular degeneration (AMD) and cataracts.

The myth that eating carrots can improve your vision seems to have been made popular during World War II when a propaganda campaign was run to convince the Germans that Royal Air Force pilots had superior night vision due to eating carrots.  This campaign was started to cover up the fact that the pilots were using a secret new radar technology that allowed them to strike under cover of darkness.  According to the Smithsonian Magazine and the World Carrot Museum (a virtual museum about all things carrot) RAF fighter pilots told newspaper reporters that carrots improved their night vision and it was picked up in the popular press of the time.

In reality carrots and other deeply colored fruits and vegetables do contain vitamins that are important for healthy eyes, but in most developed countries vitamin A deficiency is rare so eating carrots is not likely to result in a noticeable improvement in vision.  It is possible that in ancient societies there may have been improvements in vision from eating carrots in areas where vitamin A deficiency may have been common due to seasonal changes in diet.

Eating too many carrots will turn your skin orange but is not likely to harm you.  According to the USDA 1 cup of chopped carrots contains 0 fat, 0 cholesterol, 88mg sodium, 12gm carbohydrate (4gm dietary fiber, 6 gm sugar), 1 gm protein, 428% daily recommended Vitamin A, 13% daily recommended Vitamin C, 4% daily recommended calcium, and 2% daily recommended iron.  There are some reports that pesticides can build up in the skin so peeling carrots may be a healthier option.

In general it is good advice to –  eat a little bit of everything and not too much of any one thing.  As it turns out the stories about carrots are both fact and fiction!

 

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

 

Should you have laser eye surgery (PRK or LASIK)? Answer these three questions.

By | Laser vision correction, LASIK, Ophthalmologist, PRK, Refractive Surgery, Uncategorized | No Comments

1. Do the benefits outweigh the risks (low but not zero)?

The vast majority of people who have laser vision correction (PRK or LASIK) are satisfied with the outcome, and in a large FDA study of LASIK (PROWL 1&2) <1% of people experienced “a lot of” difficulties following surgery.  The most common side effects at 3 months in that study were dry eye and some increase in halo at night; these side effects may improve in some people beyond 3 months.  If this sounds like a reasonable risk versus benefit then read on; if you need a 100% guarantee of the outcome of PRK or LASIK then laser eye surgery may not be a good choice for you.  If you would like to have laser vision correction and are looking for the lowest risk then PRK may be your best choice.  This no-flap treatment avoids cutting into the cornea to create a LASIK flap.  Eliminating the need for a LASIK flap will avoid any complications that could happen when cutting the flap and also will eliminate the risk of a LASIK flap shift in the future if you suffer an eye injury even months or years after surgery.  For some people with high risk occupations PRK is a better choice.  Surface PRK also does not disturb the cornea as deeply and may be a better alternative in thinner corneas.  Surface PRK does involve a longer recovery (7-10 days) before returning to usual activities, but provides equally good results without the need to cut a corneal flap.

2. Do you have the right expectations?

The goal of laser vision correction is for you to function as well without glasses or contact lenses as you do now with your corrective lenses.  PRK or LASIK will not be expected to make your vision better than it is with your glasses or contacts.  If you already need reading glasses over contact lenses or a bifocal in your glasses, then laser eye surgery can correct for distance but you will still need reading glasses.  For people that have PRK or LASIK at a younger age, they will need reading glasses in their mid-forties as the focusing declines naturally with age.  This is called presbyopia and there is no treatment available for this natural age change that has been shown to be effective at this time.  In most people their night vision will be similar to what it was with glasses or contact lenses before surgery, but it does take longer (up to 6 months or longer for some people) to improve than vision during the day or in bright light.  For most people if they have dry eye with glasses and contact lenses this means their eyes will be dry after surgery.  Dry eye can also be worse for the first three to six months and generally returns to baseline – PRK and LASIK do not cure dry eye (some people think that if they can get rid of the contact lenses then the dry eye will be solved, but this is usually not the case).  There are a number of treatments for dry eye, so if this is a problem then working with your eye care provider to improve your comfort is recommended before considering PRK or LASIK.

3. How do you find out if you qualify for laser eye surgery?

There are some eye conditions and also systemic conditions that may disqualify you from PRK or LASIK.  An assessment with specialized corneal mapping and other testing is the next step if you answered yes to the first two questions.  During the assessment a medical history is also taken.  If your testing shows that you are a good candidate then there will be an opportunity to discuss any questions and to learn more about laser eye surgery.  At Western Laser Eye Associates Dr. Anderson Penno will examine your eyes at the assessment and answer any questions that you may have about laser eye surgery.  Once you have all the information you can make the choice that is right for 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.

 

What is up with that White&Gold (or is it Blue&Black) Dress?

By | Fashion, Food for thought, Ophthalmologist, Uncategorized | No Comments

Most people who spend even a little time on the internet will have seen this photograph of the striped dress that has created a firestorm of debate about the true colors.  This explanation from an article on the New York Times site is probably the most concise, however it is not completely understood even by eye specialists why there is such a difference in perceptions between different people viewing the same picture.  Interestingly there is still a difference when the picture is printed which means that the viewing angle when looking at an electronic display versus paper does not completely explain the effect.  Although not a scientific study, in a small sample size of ophthalmologists and engineers, the ophthalmologists all saw the dress as White and Gold and the engineers all saw Blue and Black.

There have been reports that the split is from 70% white and gold to 50/50 in on each side.  It is possible that there may be genetic tendency to view the dress as one color or the other due to either retinal differences (the retina lines the back of the eye like film in a camera and the center of the retina is responsible for color vision) or due to differences in the brain or both.  Another interesting fact is that for some people the dress changes from white and gold to blue and black which indicates some adaptation in the brain’s interpretation of the images that are formed on the retina.  How Your Eyes Trick Your Mind shows a number of different optical illusions and explains some of the science behind them.  In some cases MRI images will show the involvement of specific parts of the brain when people are viewing an optical illusion.  The White/Gold/Blue/Black dress is a bit different than classic optical illusions in that it involves color.

In many ways we ultimately do see with our brains.  For example it is well established that people can adapt to glasses that turn everything upside down.  This is called perceptual adaptation. Another well known phenomenon is inattention blindness. This is an effect where when attention is focused on a specific detail a person will not see things that may be right in front of them.  There is likely to be continued debate about why this particular photograph of what should be referred to simply as the “striped dress” for now creates such a large difference between viewers.  For now it is nice to know that these perceptual differences are a normal part of the visual system (and whether you see it Blue&Black or White&Gold you are not right or wrong – just different).

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