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Nutrition and the Eye

Brad Emde OD
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Description

Keeping in mind that nutrition affects so many aspects of our overall health, this presentation will address how nutrition specifically affects the health of our eyes. Several eye conditions and their pathophysiology will be covered. This course is not only beneficial to eye doctors, but also to all health providers.


Objectives:

1. Increase knowledge and competency in understanding of the etiology, pathophysiology, diagnosis, and treatment of common eye diseases.

2. Describe how nutrition affects macular degeneration and be able to make beneficial recommendations to their patients based on what is presented.

3. Describe how nutrition affects other eye diseases such as cataract development, glaucoma, and dry eye syndrome and be able to make beneficial recommendations to their patients based on what is presented.

Presenter

Brad Emde OD

Optometrist practicing and Owner of East View Eye Care in Greeneville, TN

Conference

Recorded

  • October 27, 2017
    2:00 PM
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The Holy Father we thank you for your many blessings and we thank you for the opportunity to be here we thank you for the wonderful amazing and the architect that you are in just looking at that we know that. You are a gun of detail and we appreciate our vision and. As I tell my patients I can't wait till you come backs on out of a job and everyone can see as you designed us to see and so we asked now that you be with me as I speak about your creation and glorify you and help us to learn and keep our minds clear and sharp and learn practical things that we can use for our patients and I pray man so I like this logo this this year and a man or you willing and that can are you willing to do what and I care it's a little bit. It's a little bit like other areas in health care have been in the last twenty or thirty years and that is are you willing to go there with nutrition with your patients. That's a little bit different and I care than it has been in other other professions through the years and we're going to talk a little bit about that I have no financial incentives in any specific product or company I mention and so I wanted to make sure that that was clear here learning objectives number one we want to increase the knowledge of competency and understanding that aetiology pathophysiology diagnosis and treatment of common eye diseases that's our first half of the lecture the second half is describing how nutrition specifically affects macular degeneration cataract and dry eyes and so we're going to spend a lot on that top top one just learning a little bit about that and this is the bottom line so for those of you that like to look at the bottom figure this is it so this is the slide in the conclusion of the whole matter is what is good for your heart your blood your circulation your brain your nervous system your longs your respiratory system your G.I. tract your joints your and inflammation your skin immune system is good for your eyes and so the Bible in Matthew six says the lamp of the body is the I If therefore your eye is good your whole body will be full of light but if your eye is bad your whole body will be full of darkness. So let's go through these a little bit real quick here and when we look at the eye in the internal structures we realize that the central retinal artery and vein fan out in the back of the eye when we're sitting. Over here and we look through. This is something that we can see they are basically because the tissue in front is transparent and so you can actually see these it's the only place in your body that you can see blood vessels bare there and of course on the conjunctiva. So we look in and and we look under the slit microscope or the binocular indirect up down the scope or fundus photography and I'm wondering if we can pin these lights or not be able to. Then you can see in there and so you can see in this particular patient right here this abnormal wedge of blood right there that's good thank you and even a chordal me of us right there but this is a branch retinal vein occlusion where the blood the vein actually got clogged with a clot and so the veins of course drain the blood out of the retina and so the blood is backing up behind that clot and that luckily off to the edge like that this is the macular of course down here and that's where your central vision is and so this patient would be asymptomatic and not even know that was in there and to demonstrate this and most of you the do routine eye exams every day have cases just like this this is a case that I saw in two thousand and seven of a forty three year old white male forty three year old OK So this guy is probably barely If not he's probably not even in the bifocals yet and not expecting anything wrong with his eyes on a routine I am and twenty twenty both eyes and nose blood pressure was all high as one thirty over ninety eight and he was non diabetic but I don't know if you can see these but these blood haemorrhages are scattered around a little bit not terrible. Another one up there. But. You know. First question you ask Are you diabetic know and when the second question is when was your bloodwork done and if they say oh twenty three years ago I'm like oh let's get your blood work done but. Then I looked over you know into this view and this does not look good this is a very congested optic nerve and that is an impending central retinal vein occlusion. In his blood vessels here a little bit in gorged and a little bit torturous So when you see that in a retina that's a red flag of you know high blood pressure something venous congestion they are going on that. Is not good and so what I did is I sent him to the internist to that he went to and wrote a letter and recommended some different blood work and sure enough. Well if you let this go it can turn into that and that is a center where no vein occlusion so we didn't want that to happen and so we sent him for blood work and sure enough he has primary. Syndrome not from lupus this is often called hue syndrome and it is a hypo coagula two blood disorder that is the reason that his eyes looked like that so they put him on and he had high I.G.M. antibodies in his particular case and so they put him on coumadin and he has been on coumadin ever sence and so this is seven years later and his optic nerve you know you tell looks a lot better and he is. No longer at risk for death from a stroke and so very appreciative in the that was caught on a routine i example shocked him completely is will of me and so. But we see these things and these are not unusual findings that we see so. Now that it's seven years later and I have. Really About one year of Amen training where I would listen I had would listen to a man lectures and quite a bit of several years before I started attending this is my third year at a man and. I said I need to go there with this guy and here's why because a year after this photo was taken I started seeing some congestion again now he's already on coumadin and I it was almost like he was having a impending C.R.V. Oh center on a vein occlusion again and so. I needed to go so tell me about your overall diet Tell me about your health what you know this is not a. Healthy looking I and if the bottom line is remember that first live if it's healthy for the rest if you're seeing it in these blood vessels you're seeing it he's he's got the same problem all over his body OK It's just that his internist and his other Medicare or medical providers don't know it and so I went there and I asked him about his diet and I said What do you eat what your typical launch on lunch break and he said white blue sandwich white bread bologna sandwich and a Mountain Dew I'm like time out if you do that like once a month or something and he said and how it is that I do that every day that's my that's my lunch. And so on and I said what about vegetables what about you know anything green in the greens and things like that he's a no no no I can't I can't eat grains among whom and. He says I was told to avoid them you know like playing I said let's think about this so the tell you why he's a yak is going to mess up is going to thin my blood unless it mess it up and all that I said why don't you. Follow my line of thinking for just a moment. So why don't you. Plan on eating the same amount of spinach or whatever it is every day and have your pizza and P.T.T. checked and all that and get get. Your Coumadin adjusted according to your diet not adjust your diet according to your medicine and. You can just kind of see what I never thought of that and so here is. His. And my next step was I give my forks over Knives and this is three years ago and I sent him to my retina specialist to use the group here and. City and so. Luckily I get the letter back from the retina specialist and sure enough he's also recommending high diet or diet high in green leafy vegetables and fish and less caffeine and yes that was the retina specialist that actually said that which I was very proud of and yes and so we've got we're blessed in East Tennessee to have some really good. Support they are even from the minister that are up to date. And so. I saw him two months ago I saw him in August and now it's been ten years over ten years since this first happened I said How you doing what are you eating now and and he says you know what he says I cut out most all bread he says I don't eat processed meat any more and he added more vegetables do is diet and cut out all the caffeine in his blood pressure was now one twenty eight over eighty three with no meds and his vision still twenty twenty and now is fifty four year old fifty four years old and of course now in bifocals. And I can still still see him so of course we. We can get him. Seeing better and everything with glasses and that's what a lot we do but we do obviously much more than that so the other Here's another example of how we're going to talk about this in the next hour how things that affect your blood vessels also affect your retina that's our topic right here in this is course diabetic retinopathy and this would be pretty prolific of. You see a lot of lip exudate leakage there and blood in leaking through the capillaries into the retina. And then this interesting case here too so you know we know about bleeding in the eye and we see that quite often I have never. Heard this complaint. This lady came in and she said last night I bled onto my pillow. I looked at her mark Is it bleeding now and she's like No no I was just last night I woke up and there was blood on my pillow in my head you know you didn't have a nose bleed or something like that she was not all the blood was in my eye and it was pooling in my eye and you know you always think of subconscious level images when that happens but no no no here I was white and looked in and everything looks totally fine and so the eyelids flip eyelids you're not seeing the whole life so flip the eyelids and sure enough there was a contact I will up or people will come in genome up there would spontaneously bleed so decenter off to the surgeon get ever moved and she's fine ever since and spontaneous never had anybody come in and they've been in a been in practice now twenty years and that's still the only one but what's good for your eyes good for your heart your blood circulation your heart and now let's move on brain and nervous system again in the eye when we look at of course the optic nerve is direct extension of. Brain Tissue again the only place in your body that you can view brain tissue directly with no skin over it it's just the cornea and the vitreous in the lens which will clear all transparent. So you go again our view when we look in this is the optic nerve with normal amount of cupping to the optic nerve and if you. Remember the CD ratios up to disgrace shows and all that and so when you get damage or death of these neurological neurological tissue here. In the disease that is now classified as a neurological disorder and degeneration neurological degeneration that is glaucoma and. It is a brain neuron problem and that's the other eye and in this is a more advanced case this is. Actually only one or two times a year when we check this over the past. Fifteen years have we ever caught this pressure ever being high this is a example of the normal tense of. A patient. Well it's not normal to answer because it's been higher than twenty one at least one or two times but. So technically it's primary opening the. Same patient with visual field so when you have vision when you have no Ronal loss like that the optic nerve you're going to have visual field defects here. And these are these aren't just a depression of the hill of vision in visual fields these are zeroes that means there's no vision there you know these other areas here have vision it's just that these spots when shown if you've ever had a visual field had to be extra bright compared to the normal database but the these areas are are where there is no visual function sensing the light this is the other eye so very moderate Glock. If not the moderate to severe in the other eyes definitely severe. And so when we look at this of course we're going to be looking at the the. Tissue the tissue that comes through the optic nerve here and fans out to the photoreceptors and that passes of course through the retina fiber layer and so when we're looking at the regular fiber layer right there if these neurons die then the thickness out here will decrease and so the whole idea of ocular coherence technology in cities and spectral domain and all that of cities it's measuring Now this area here to a normative database and giving us an evaluation of that right over fiber layer and so when you look at this regular fiber layer thickness the. Solid line is the right on the dotted lines the left in these should be up in the green which they are and then that does its analyses here to the three hundred patients that are in the Carl Zeiss Metta tech database and your seeing any deviation from the norm and sure enough it's catching what we call a wedge defect right there in the retinal or fiber layer and but you can see this pretty good color up in here in the thickness map and that's so that's not bad just some very trace Renel if I really are thinning that spirit nasal quadrant right there this is a different story so what I want to show you first is I want you to look at the the nice color that the first thing you should look at when you when you evaluate one of these is these color maps up here and good good retina fiber layer coming off that optic nerve you see the difference this is this is your first hint that. There's some serious regular fiber layer loss right there so when you see that and you see these printouts and then you look down here and it's saying OK these are all areas that are super thin and sure enough to the normative database especially this area right here that's definite last superiorly. And. This in by the way when the areas that are thinning like this these technologies are being used because this is a neurological disorder these. Studies are being used to try to detect other neurological diseases like Parkinson's and multiple sclerosis and dimension Alzheimer's and whatnot because of of the potential correlation there so they're doing studies the other more recent thing that we've been doing for the about the last year or so is when we order the retina fiber layer we also order this gangly and cell analysis of the macula And so one of the other first thing is that starts to happen is this this is the same patient by the way so it was the left eye over here that was definitely abnormal abnormal coloring up here and if you look at the macula right here they gain billion cells there that the retinal layer axons you know to their dying and so you've got so in block coma you don't ever want to base a diagnosis on one test or anything you look at the whole the risk factor if you look at the visual field you look at the. Optic Nerve looks you look at pressure you look at it the other data that you can get from these more sensitive tests and then you say does this correlate does this make sense and you're trying to predict the future based on any trend that you can find. And of course this is the visual field in this is that same I we think oh well that's down here of course at superior. This appear your defect right there is going to affect what part of the visual field. Inferior So there's your start of the maybe a little R Q At last right there and so if this is a repeatable visual field. Then you'll know that this could definitely be glaucoma and glaucoma is defined as progressive optic atrophy though if it's not progressing and it's stable for ten years and looks just like this is it glaucoma know all right so you have to know that glaucoma is progressive and these patients are going to go blind tomorrow and even in two months luckily glaucoma is a disease of several years but it is definitely something that. We want to. Pay attention to the seats up here too. And this is the other eye in the other eye if you remember was pretty borderline and that's why the visual field is not affected there. So let's talk about this little bit lifestyle activities that raises. Pressure interocular pressure I.O.P. lifestyle activities you may or may not know the playing high wind instruments such as the oboe can increase the pressure more than double in approximately proximately twenty seconds but it comes right back down to baseline when you stop playing. And so if you are a very delicate fragile. In Stage glaucoma patient you might want to give up the oboe. Drinking coffee is much is the media and everybody wants to say Coffee is a very healthy for you it does cause a wonder for millimeter rise and P. that last for at least ninety minutes. And drinking five or more cups of coffee per day which sounds like a lot but if you talk to your patients really. Patients on five cups a day and that causes a one point six fold increase of glaucoma and of course caffeine is very vague constrictive So you have less blood flow to the optic nerve and that has something to do with the most likely. I'd say that not many people are doing yoga but inversion tables and moon boots when you go upside down. That causes your pressure to increase by two fold as well and it comes back down to normal again in five minutes but if you're in a very delicate stage glaucoma patient. You would not want to be doing these things either. In wearing neckties. This did change my wardrobe I will tell you when I saw this study several years ago when it came out I went up a half inch on my neck so I still wear ties every day but they are loose and just. Make sure you're more comfortable and I can turn. And lifting weights also can increase a little bit now what lowers that exercise actually lowers magine that and you can decrease it as much as four to five points and physically fit if you people that are more physically fit have lower pressure in general. But the hypertensive effects last only for a few weeks in physical fit individuals and if they stop goes away so it's not a fix but can sure help in so. So the only proven effective treatment for currently available that is lowering the pressure however if you saw this last year I was shocked to see this and this is the first time I've ever seen a nutritional study on glaucoma to this scale and this was cames out of code. Came out of the Nurses' Health Study. And those nurses who ate the most green leafy vegetables decreased their risk of glaucoma by twenty one percent. For the primary opening of a coma and forty four percent lower risk for glaucoma that was associated with impaired blood flow. Compared to those nurses who ate the least. Green leafy vegetables so isn't that amazing So if you you know for years I was always asked What about nutrition and glaucoma I didn't really have an answer except that I had ever seen that was that was to this scale. And I just said let's use common sense what's healthy for your optic nerve in other tissues and we know exercise is good for your body it's good for most everything it's probably good for your optic nerve and let's also use common sense on diet you know what's good for your rest of your body is going to be good for your optic nerve as well in this my classmate Ben Gatty. This just came out this month so go back home dig that out of your trash can this was in the optometry times and it says the role of nitric oxide in glaucoma. And guess where you find a lot of nitrates processed meat but not direct acid oxide is also in green leafy vegetables as far as healthy for you because in this. This this cracks me up a little bit here so instead of recommending eating more spinach they're actually. Coming out with this new drug for glaucoma this is in phase three studies right now and it's. L B N And what this is is is a pro drug in when it's metabolized it turns into a process which is Ayelet and the number one drug in America for glaucoma or the generic is and. A nitric oxide molecule which relaxes the smooth muscle in the tractor meshwork and also available dilates. So it helps the optic nerve blood perfusion And so the lowering of this this or the expanding of this work where the aqueous in the front of the eye the fluid drains out if you open the drain up it's going to bring that pressure down and it's been shown to be more effective than temple and Tanner Prost So that's huge in where we like to try to get about a thirty percent reduction interval coma patients they're getting depending on if you're a human or a mouse about thirty five to forty. Four thirty five to forty percent reduction with one drop which is good. So what's good for your eyes the nutrition that affects those neurological tissues are now even in other diseases A.L.'s or Lou Gehrig's disease. In just less than a year ago so the conclusions and toxins carotenes fruits and vegetables are associated with high higher a less function at baseline. And so the. Those responsible for nutritional care of patients with should consider promoting fruit and vegetable intake sense they are high in antioxidants and carotenes So again to me it's just common sense but JAMA neurological or neurology journal that's what it's showing in we'll move on here lungs and respiratory system how this affects the eye this is. Presumed ocular histoplasmosis syndrome where it you get a fungus that we see quite a bit in Tennessee and Alabama in the higher River Valley it's really only in the Ohio River Valley United States and it's a fungus that is in the air it's a lot of chicken manure and you breathe this fungus and it gets in your lungs which then gets into your bloodstream and goes to your retina and causes scarring like this and it can be bad and the the one patient that sticks out in my mind is this eighteen year old that just graduated from high school first time patient to me she walks in and says I lost one eye to the histo back a few years ago and now my other I am seeing some changes I looked in and she ended up losing her vision came legally blind that week after she graduated high school which is tragic very very sad so long as the rest are about the G.I. tract. Went to Mongolia with it is written this summer and one of the most common problems over there is constipation from their diet high high in meat they have a very short growing season and so they have less fiber and less less fruits grains lots of vegetables and lots of constipation so you're going to get this with that increased about sell the pressure a lot of times you'll probably us on a sub conscious base there. In the talk so plus most of it which is from you get your you get this is a baby you're born your mom was too close to the cat litter and somehow touched that guy. In just of the cysts from the cat feces or under cooked meat and then. Gets into the baby's. Retina and about fifty eight percent of the time goes to the macula which is sad so. Joints inflammation this is the pupil that's dilated but this part didn't dilate because it is stuck to the anterior surface of the lens right there and that's. In this can be caused when you see something like that the first thing that comes to mind is chronic I write this for chronic inflammation in the. Which you can get from that and and then we're going to talk a little bit later too about this dry ice and drawn this is foreseen staining on the cornea and you shouldn't be able to see the cornea but when you do then you know something's wrong with it usually and that's the. Superficial point to keratitis. So joints inflammation and dry eyes and inflammatory disease and that skin and of course this is another Croyle need right there just like in the viscera mole that you would have on your hand if you're dilating your patients which I hope you are you'll be seeing these multiple times a day. Very common this is my wife's. One of them and she's got two in each eye and so once a year I take photos and compare and make sure they're stable and one in one thousand of these will turn into melanoma and the closer they are to the optic nerve the more the more US they are and the other thing you want to do if you have an O.C. team machine and you have these are anywhere close where you can get a no C.T. scan on these the reason you want to do that on every one of them every year is you're wanting to look for a several fluid because that can be an ominous sign as well when you start seeing that this also is an ominous sign this is a Iris and Eavis it's not an iris melanoma even though it looks like it if you can see the picture a little bit better that's a peek pupil right there any time you see a peak people were it's not not circular but kind of like a a little notch in that pointing to the cancer then you know it's a red flag and so this was not though thankfully for that patient. In your immune system so one last thing here we this herpes simplex keratitis is. A painful red eye so just as a clinical Pearl those of you that it there are not eye doctors and don't have salute lamps where you can see this when you have a patient with a red eye or a pink eye and you think I'll just contract will just conduct a bias what's going to hurt to throw on a antibiotic and nothing. Pretty inflamed the second day what's it going to hurt to throw on a steroids this is what it. Would hurt and you will blind that patient in twenty four hours if you do that so no no provider except an optometrist or ophthalmologist should ever be using a steroid on a painful red eye that's your differential So a painful red is not normal conjunct divide us does not hurt it's a little bit sore but if painful red eye something else is going on get that to an eye care provider. So that patient of course was in a lot of pain put them on by rhotic this is back before the days of Dan which I absolutely love the rhotic every two hours up to nine times a day and that's Day four and you can see how much those dendrites are much much better and it when I say herpes is not type two genital herpes this is the colds or type one. And this is day seven much much better no dent rights whatsoever and doing great. And so what's good for all of these is good for your eye All right so end of Part one so let's talk about these three right here what can the nutrition do specifically well for the last thirty years or so. Well first of all macular degeneration What is it so macular degeneration has has two types it's the dry and the wet and you don't want either but. If you're going to have to pick I suppose I pick the dry. To start with and but the normal the normal life looks like this again and this one is pretty normal too and there's not much there in the macular going on but on the other eye of the same patient you can see this right here and that's so you want the macula to be this nice smooth dark this is where the photoreceptors are tightly packed so it should be darker in appearance like that but it should be a smooth smooth color like that and then when you see any disruptions in the retinal pigment up with a layer right there these are changes and Dru's and that's not good so if you do a macular you can see that right I look pretty normal this is a normal good photo real pit right there and these layers are pretty nice and straight right here there's a little deliberate There you see that. On a little higher resolution one that's the run of this is the left eye and now you really see it. And so these are blips right behind so this right there in the very middle in that dip is your twenty twenty vision that your central vision and so if this gets worse and you will start to have this this change in in this the macula in your vision actually you start to see it and so there are some more changes in the macula there with dry some some Dru's in there and these are peach Ange is and so when you look at this Amsler grid that you've probably seen in the newspaper or hopefully heard about from somewhere. You'll start to get this many metamorph down here so you're looking at that central dot but now as you look at that central dot you see these lines are no longer straight and even like this and this is extremely sensitive about picking up macular degeneration changes so that's why you want to give these to your patients to take home and they should do this every day I give them like three or four Tom put a cross from their toilet put them on their mere put them on their refrigerator for them somewhere because literally they look at this with one eye and they say is is this is my vision the same as yesterday looking at that dot and then I and then they look at the other eye and they have to it independently because the other eye will fill in so takes literally two seconds Yup same as yesterday Yup same as yesterday they're good to go and that is as sensitive as having somebody look in at the macula every single day it's so simple to do so we use it for a lot of conditions including histo diabetes macular degeneration and other things. So dry or M.D. is not benign so some people may well have a good form of macular degeneration Well there is no such thing but it is the better form given that but what the problem is is this geographic atrophy so Geographic atrophy is where it just did Terry. It's slowly and. Then when you start doing this more quickly so the prevalence of this at age seventy in European and ancestry is about less than one percent. This now jumps in ten years when you're by the time you're eighty it's almost three percent and then by ninety it's over eleven percent. Which is sad and this is what it looks like so there's no bleeding here it's just general atrophy of this of the photoreceptors and. It's just too bad because it's a seventy year old or eighty year old or ninety year old film camera for those of you that are old enough to remember film a camera. And it just deteriorates same patient two years later so here this one is two years later it's now all the way up into here and this just tends to get bigger and bigger over time until they're whole so when they look at you they can't see a thing right here they have to look over here and use their side vision so if they talk to you or if you're in a nursing home or something and and they will look at you in the face it's because if they do they can't see you so let them look where they are looking in just know that they're looking at you using their side vision. And so this is a patient of mine that just made me so sad because here's this geographic atrophy. This was his other eye. And right here he was still able to see two thousand and twenty believe it or not because they had this little island of vision right there OK Now of course he had changes on the macular area the Amsler grid and all that but he could still read a book sinus checks he could still do things like that until two years later that island is gone. And it went. Downhill from there. And. Really sad so patient like that I just I just want Jesus to return that's that's the cure and we've got nothing else to offer them except that and so forty fifty percent of eyes with geographic atrophy with good vision at baseline will lose three or more lines of vision so they might be if they're twenty twenty when they start they might be twenty thirty twenty forty within two years and within four years one out of four of them will be. Twenty two hundred or worse that's that's bad and that's exactly where he ended up. So there's no no treatment for dry macular degeneration degeneration at the current time except nutrition now it doesn't cure it doesn't treat but what it does is it lowers the risk as you'll see in so this this area is interesting because for the past thirty years. We really didn't have it in medicine as a general rule you weren't getting the. Mainstream doctors talking about nutrition until really the last five ten years OK and it was almost taboo it was almost have a topic still very few medical schools treat nutrition in teaching nutrition and so. I doctors in the eye researchers they. Said Well maybe vitamins. Of course created their formula of preservation and wouldn't do any studies on it. Because they didn't want to lose their market share I think that's what I heard and so they finally the and I H.. The National I Institute under and I stepped in in from one thousand nine hundred two to two thousand and one they did a huge age related eye disease study a Reds. And. Nutrition has become the standard of care for dry macular degeneration so I don't have a cure I don't have a treatment but I am if I'm a mist if I don't talk nutrition with my patients when it comes to macular degeneration in fact in two thousand and six P. Q. R. I started that's physician quality Reporting Initiative and which then later became to physician quality reporting. System I believe and now it's MIPS which is the merit based incentive payment system and basically what that is in a nutshell is that they gave give certain doctors in different specialties and what not certain things that made you a better doctor. To differentiate yourself other over other colleagues in your area and this is one of them for macular degeneration It's Did you talk to your patient about that a Reds study and so you are supposed to mention this if you're doing a higher level of quality of care and you should be and there's other things we're going to talk about so what the. Study found over this nine years with over three thousand patients it showed that taking that vitamin right off the shelf decreased your chance of conversion if you had dry macular degeneration which all of them did in this study it decreased your chance of conversion to wet. And so that's worth it and so when you have a dry macular degeneration patient it's worth your effort and time to talk to them about this. This was the formula right here the old A red formula. And I had the vitamin C. vitamin E. rate carotene zinc copper. And so meanwhile as the study was going on there was other studies that were showing things about lutein So in one thousand nine hundred four so from Harvard showed that eating a lots of lutein led to a forty three D. percent decrease risk for macular degeneration where you can get six milligrams per day by eating this much you have Cup cook kale. And have cooked cooked spinach and so that was big news too about lutein. That's why you know. Silver with lutein now for your eyes. Then this came out. As Anthony So what are Latinas is and then there are two photo pigments that that are in the retina and you get these out of your food and so easy as Anthony may decrease this as well here's your food sources for lutein and see as anthem. And Z. as Anthon is really down in here which is the appropriate orange yellow color and the green lutein is up in here and interesting to me was cooked spinach has more lutein availability than raw spinach did but it's all good so then there are studies about omega three coming out in there was a study that followed again over thirty five hundred men and women that said there was a fifty nine percent lower risk of getting macular degeneration. In those patients who ate the most three. And then. So men who ate over two servings of fish weekly were forty five percent less likely to have macular degeneration of course fish oil may increase the risk of bleeding so do you go to be careful for your own blood found thinners more for. Such as were for him or even if you're on ask him yes. I don't know is for it so me personally I do not eat fish oil and or fish and so I get mine from the algae. Algae the omega three you can get. From. Chia flexi and things like that too. So meanwhile also during the same time there was bad findings about beta carotene in member that was one of the components and so what happened was the sense that was published it was actually increasing the risk of lung cancer among smokers and those who used to smoke so oh oh so now you've got to be really careful about recommending a Reds the first edition of a Reds to smoking patients and. Smokers of course are four times more likely to to have macular degeneration four hundred percent more likely. To this this was a follow up study that was went from two thousand and six to two thousand and eleven published in two thousand and thirteen followed over four thousand patients and they changed the formula based on some of these other studies. So like it scratched beta carotene out and they added omega three lutein in Zia's Anthon and what that supposed to be and so here is the new formula for a Reds two so this is the latest a Reds formula right there. And it also had omega three in it. Well it showed a ten twenty five percent reduction in risk of progression now what was this study is a little bit different though because this was. These were already patients who were well educated and already taking supplements many of them all right so this study did show though that this formula. Was even better than the original formula because it was an additional ten percent or so more reduction in risk of macular degeneration. And while that was going on this study about exercise came out and this was in the British Journal up from ology two thousand and six four thousand people they followed for fifteen years and if they walked two miles a day on an average of three times per week they were seventy percent less likely to develop macular degeneration so was last time you you saw that this this is kind of a hidden it's there it's out there but you're not hearing exercise exercise you know you're hearing all about the supplements and vitamins and things like that to recommend. And then sense then this is about zinc this just came out this summer just a few months ago and zinc. To say this in a nutshell it's it's been a major controversy because and I H it with the National I used to says no zinc you don't have to worry about this but but C.M.S. OK Centers for Medicare services recently reviewed all of the available data and concluded that genetic testing was helpful in determining which patients should be taking the a Reds formula containing zinc because both formulas have the zinc in it and which patients are zinc sensitive and should be taking a formula without zinc and so because what it was is there was about thirteen in one thousand percent are zinc sensitive. And it actually caused them to advance their macular degeneration more frequently if they were taking this IS think so you don't want to do harm to your patients either yes. Yeah. That that I've seen this this is the first time I had seen this and so this is not standard of care in fact there was a lawsuit about this which they settled because they couldn't they were lost in court because this is not standard of care yet and so but this may become standard of care is genetic testing then is is more is done more of our colleagues and things so. Be aware of this and those that want to do this can do this and I'm not sure you know if they have testing they obviously have testing available for it because C.M.S. now covers it so Medicare is a covered service for them also since this came out was in. About aspirin. So what happened here was the people taking aspirin had a two and a half times higher risk of macular degeneration and it was dosed dependent. And so be aware of that and. So I don't know I'm not sure why that is and I'm not sure if they they. Knew it. Same thing here or. Dilators or beta blockers I mean. You want good blood flow to the choroid which is behind the retina you know. So I'm not exactly sure why but these had a greater risk in developing macular degeneration to dilators such as like a lot of ten and a wrestling had a seventy two percent greater risk of developing macular degeneration Lopressor had a seventy one percent risk of wet. There's a lot we don't know there's a lot we know and one is don't smoke period goes without saying but that's HUGE have more omega three even though they reds two by the way did not say that that helped there was other studies that said that it did in so the thinking is that it does help because these are already. Probably taking the supplements so any extra wasn't really helping them as is the thought less fat in omega six form so fried foods cheese things like that stay away from Eat more omega three omega three S. anti-inflammatory omega six S. inflammatory is pro-inflammatory eat greens that has the lutein and it eat the orange yellow vegetables that has the disease Anthony in it Angela makes a very good raw kale salad so if you're going to take a picture. OK. Here take a picture take a picture of the next one here that has the recipe because that this is one of my favorite salads that she makes right here and it's a raw kale salad it stones terrible when I first heard about it but it is just wonderful and I love it and she doesn't make enough in my opinion and so. So that's good it gets it gets a make a three is in there with your walnuts and get your greens and does have a little bit of. Maple syrup in there for a little bit of sweetener you don't have to use of course but really makes a good and I mean when I take this to lunch to my office and I sit around the lunch table with my staff and everything before you know I'll have them. Try this you know try this and they look what is it I'm like a raw kale salad and they just don't listen I mean that they just don't believe me but they will try it and they're like so good and so you can make you know you shouldn't die because of lack of knowledge on how to cook right so the other thing is in my opinion is the best intake of nutrients is not in a bottle it's actually by the way God designed it. This is not always realistic and the average American only gets two milligrams of lutein instead of the net needed ten and of course the leading source of antioxidants for Americans is coffee which is so sad and the number one vegetable in America are french fries in fact that's twenty five percent of all the take in the United States a french fry honestly but anyhow so then you know if you're not and so I tell my patients look God knew what he was doing and so he so eat the food it's the food you know you've heard that saying and but if you don't and you're not in you're going to eat the SAD diet the standard American diet you don't get sad diseases stand American diseases and you have a sad death standard American death so it's sad all the way around is what I tell him and if it's sad all the way around make yourself happy eat better if you don't if you're going to stay with your SAD diet then at least take the vitamins and decrease your risk a little bit so I doctors kind of got the idea you know these pill pushers vitamin pushers and things like that over the last thirty years or whatever because of this data and so this course I think I got all the vitamins My doctor told me to get. So exercise that's another thing we don't emphasize enough good blood flow it washes that metabolic waste build up right out of the choroid in the R.P.. Be careful with some of the medicines that you take especially if you have dry because of the possibility of converting to wet and aspirin and then wear sunglasses protect you because they think it's U.V. damage that increases this and also that the high energy blue light that is is back there damaging the retina as well. So limit your time in front of these harmful blue light. Devices which also by the way in messes with your circadian rhythms and so now you're going to get a new L.E.D. T.V. in are going to stay up and watch that at night you're going to stay up chronically late are you going to get less sleep in and that's going to interfere with your blood phatic system which if you haven't heard the lymphatic system Google that that's relatively new where the C.S.F. start scrubbing the brain and we we know there was no it lymphatics in the brain but they have now found that the C.S.F. acts as its own lymphatic system and so they've coined the term Glen fabrics at the University of Rochester in New York and it's fantastic and I think it has a lot to do with glaucoma as well because a lack of sleep. And you miss in so staying up chronically later they found that you missed that prewash cycle to that that flow that fast flow that scrubs the brain out of the metabolic waste and you need to learn about that for that is fascinating and then there are new developments for dry macular degeneration and we're fast running out of time here but it turns wet when it bleeds in there and so that's what happens so it is a bad form the good thing about wet macular degeneration is that. There are new developments right here called anti veggie eft there are fees and so there are you know these injections into the eye that actually will help. Decrease the new blood vessel per proliferation and there's a brand new one that's in phase three trials right now what's nice about this instead of having an injection every month it's every three months so the last twelve weeks after loading dose and so there's other things and. This is in Costa Rica here that talks about cataracts and I'm just going to in cataract or call a cataract because they look like waterfalls. And there's different. Cataracts but I want to jump to this study right here this followed twenty seven thousand patients OK for fifteen years two thousand and eleven huge study the Guinn's have forty percent less cataract vegetarians thirty percent less risk fish only twenty one. In the went up so this makes common sense the more anti-oxidants you consume the less oxidation you're going to have in that protein in the lens is just common sense and so that's a huge huge study in these heavy meat eaters that they compared to only ate meat once a day. Once a day meat eaters so can you imagine my patients of the three times a day. And. Statens some studies show an increased risk of cataracts some studies show a decrease risk and this Staten reduce the risk though of glaucoma potentially So there's some research going on right there with that. And lastly dry eyes all of these factors right here affect dry eyes it's the number one reason that a person visits and I doctor in America the number one medical reason is dry ice and wrong and there are multiple reasons right here that cause this inflammation to dry eyes and so again. These are all inflammatory things this is these are my my Bohmian glands inside my eyelid and suffer from dry eyes for years and sure enough I've got some eyeball me in the last right there these my Bohmian glands secrete the oil into the tear film and so some of the things for dry eyes don't smoke drink water of void caffeine even though some studies are trying to make it show that it increases tear production by thirty percent which it could it is a very potent. Constrictor and his dehydrating in all keep you up at night and when you're kept up at night you have more inflammation All right keep staying up late than lack of sleep causes inflammation that's why red eye flights or red eye flights. You're going to get over to Europe and your eyes are going to read because you're inflamed because you got two hours of sleep instead of eight and so try to avoid sugar if you Arthritis Foundation website it's right there slash the sugar foods to avoid if you have arthritis and so Ellen White with her right hundred fifty years ago she would so. Limit computer time get a little hygiene get sleep. And so that's where we got. Just an F Y I the summary on this too is that these foods that are subsidized by our government you're going to have to you're going to have to kind of fight against and these farmers. These farmers are prohibited from growing fruits and vegetables on their base acres if they have any subsidy crops at all so it's almost maddening because if they want to switch over some of those acres they can't because it's being subsidized and they have to only grow corn wheat soy beans cotton or rice on it so I don't know if you knew that and skepticism I want to touch on this really quick and I'm going in to my next lecture but I just want to touch this. If somebody comes in and they profess faith in the Bible and how you can test this is I just say one quick thing I just say. I don't know if you have any faith in the Bible or if you believe in the Bible or anything like that and I wait and I just looked at him. In a there you go or they go No they have another head yesterday or someone so absolutely if they had say absolutely you just open the door wide open for a lecture. A biblical reason to eat healthy because they just told me they believed in the Bible so I'm going to say so so you know the story about Daniel then and you know the story oh you know the story that hundreds of years before there was ever a Jew God made a differentiation of Noah's Ark about the queen unclean animals you know. They're like what hundreds of years before there was a Jew They know their Bible hopefully and I'm planting seeds is what I'm doing. And then if and I don't mean to bore you but then I go in and they're like you know what I want to hear more or something like that and I'll go there that's your entering wedge and you can do that as an eye doctor very very very easily when it comes to nutrition and so I use certain phrases like this and of course we want our patients to see well but we want them to see a vision. Of Christ that's our goal all right yes we want to see twenty twenty one game of vision of the love of God and we want that for all of our patients so with that let's say a prayer. There only Father we thank you for the time that we've had here and we just ask that you be with each person here we ask that you. Teach us to depend on you not only for. Our spiritual needs but for to learn that our physical needs in this nutrition and these things that we're trying to improve on our own lives. The power that we get to change our hearts comes from you anonymous selves so help us learn this lesson and teach that to a person's will. This media was brought to you by Adil verse a website dedicated to spreading God's word through free sermon audio and much more if you would like to know more about audio verse if you would like to listen to more sermons leave a Visit W W W. Or.

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