Nutritional supplements are plentiful in the local vitamin store and which one is best for you will vary depending on age, medical condition and dietary habits. Lutein is a water soluble carotenoid that possesses anti-oxidant properties. Age related macular degeneration (ARMD) patients are particularly helped by the intake of additional anti-oxidants like Lutein. It is ingested orally and reached the target organs like the retina via the blood stream. The immediate benefit of Lutein is seen in the increase of macular pigment optical density. This improves visual function.

In addition, Lutein aids in the absorption of high energy, short wavelength light that has been shown to act as a catalyst to Macular Degeneration and cataracts. Since both the retina and the crystalline lens are vulnerable to oxidative damage, Lutein an anti-oxidant, is of particular benefit in preserving these structures and thus maintaining better ocular health and vision. The two foods that have the highest quantity of Lutein in them are spinach and kale.

Individuals who have deficiencies in the amount of macular pigment are especially helped by Lutein supplements. Patients with poor dietary habits are likewise encouraged to take Lutein. Visual function is improved rapidly upon consumption depending on the blood level of Lutein. Furthermore, since filtering high energy blue light increases contrast sensitivity, one can also expect an improvement there with additional levels of Lutein.

In short, young healthy individuals who eat well will probably not see many benefits with Lutein supplements. Since it is water soluble excess amounts will be excreted so there is no harm to taking extra amount. In patients who suffer from ARMD, cataracts and other ocular conditions who are older and eat poorly, Lutein supplements are of particular benefit. As always, consult your physician when taking any medications and supplements.

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Contact lenses have been worn for many decades and have improved substantially over the years. Along with this change in lens technology has been a dramatic improvement testing and diagnostic capabilities. While many contact lens wearers do so with out incident, there are many perils that may inflict damage to the eyes that can result in devastating complications.

Proper contact lens fitting and follow ups should include not only the basic refraction, cornea readings and corneal health evaluation, but also corneal topography and endothelial cell count measurements. The topography examines the outer most layer of the cornea for irregularities, curves and pathology. The Endothelial cell count measures the actual cells in the inner most layer of the cornea. This layer is one cell layer thick and when damaged does NOT regenerate. Thus, proper care must be taken when considering both contact lens wear and any ocular surgery. The ECC evaluates the number of cells per unit area and the quality of the cells. In an otherwise healthy normal individual one would expect to see about 2400 cells per unit area and the actual cells should be uniform, regimented, equal in size and shape and similar in color. Any alteration in their appearance could indicate a negative change resulting in death to the cells and a gap in this cell layer. The endothelium has the responsibility of pumping water out of the cornea. Any damage to it will result in increased corneal swelling, thickness, glare and a decrease in correctable vision.

An ECC should be performed on all contact lens patients to make sure that this very important tissue component is functioning properly. Certain changes in the endothelium should result in major changes in contact lens wearing.

Polymegathism is a change in the cell size and appearance within the endothelial layer. Studies have suggested that Polymegathism demonstrates a compromise in the endothelial cell’s ability to pump water out of the cornea. This can, and often does result in corneal opacification (cloudy cornea). The etiology of the change is the increase of lactate in the cells, changes in PH, and an elevation in CO2. As a result, there is a decrease in cellular ATP and an increase in endothelial hypoxia.

The reason for these changes is often contact lens over wear, poor fitting contact lenses, and poor contact lens compliance. The resultant changes occur because the endothelium is over worked and breaks down under the stress. These cells appear as huge irregular cells and may number as few as several hundred per unit area in severe cases.

In patients with moderate to severe Polymegathism contact lens wear must either be completely terminated or substantially reduced to less then 10 hours per day. In addition, the only lens that would permit enough oxygen through to the cornea would be a high DK (allowing a good deal of oxygen) rigid gas permeable contact.

With regard to refractive surgery, this condition is a contra-indication. During the normal course of any corneal procedure there is a possibility of endothelial cell loss. Therefore, any corneal surgery that is not required must be avoided. In addition, future cataract surgery may pose a problem since there is always loss of endothelial cells during that procedure.

In summary, before wearing contact lenses a complete exam should be performed including an ECC to make sure that the entire cornea is healthy and that it is not being put at risk by wearing the lens. Of course the same rules apply prior to LASIK.

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Cataract surgery has come a long way over the years and the surgical results are dramatically better then in the past. However, there are still potential complications and careful presurgical evaluations can often predict post surgical complications. One such potential problem is corneal edema (swelling of the cornea).

With the development of Phacoemulsification which involves vibrations that break apart the cataractous lens, the likelihood of corneal swelling is much greater. In the hands of an experienced cataract surgeon, this side effect should be minimized, but there are certain ocular conditions that may still results in substantial post surgical corneal edema.

A very dense cataract will require a longer and more intense time period to break apart the lens; thus increasing the intraocular vibrations. This will in turn result in more swelling within the eye. Likewise a shallow anterior chamber (the area between the iris and the cornea) will result in more post surgical swelling. This decreased distance permits more of the shock waves from the phaco instrument to reach the endothelial layer (back layer) of the cornea resulting in more swelling. All pre-existing corneal disease will weaken the cornea and therefore result in more post surgical edema; the worse the disorder, the more the swelling. Finally, viscoelastic fluid from the surgery may clog up the drainage areas thus resulting in high post surgical intraocular pressures. This in turn will cause the cornea to become swollen.

In short, proper presurgical evaluations can often predict post surgical corneal swelling. While this should not be a contraindication for the surgery; expecting this side affect will make the follow up care better and permit more complete patient instructions. It will also allow the patient to have more accurate expectations post surgically.

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Alpha lipoic Acid (ALA) also known as thiotic acid is a naturally occurring compound made in the mitochondria of the cells, and is a cofactor that helps ATP. It also aids in the synthesis of glutathione and regenerates antioxidants thus helping Vitamin C, E and a coenzyme Q 10.

ALA is very important due to its ability to cross the blood brain barrier, thus helping neurological functions, and is involved in reducing small and large blood vessel complications in diabetes. Interestingly enough, while eating organ meats, spinach and broccoli that contain ALA, oral supplements of more then 50 mg are the best source to increase plasma levels of this important compound. It must be noted that the increased level is temporary and is not stored in the cells.

ALA helps the anterior segment of the eye by reducing cataract development and protecting the conjunctiva and cornea. In addition, when patients with open angle glaucoma ingested 150 mg of ALA 4 times per day for one month they demonstrated improved visual acuity. ALA also helped heal damage to the cornea and conjunctiva secondary to UV light radiation.

ALA also has positive effects on the retinal tissue. It reduced retinal capillary damage and thus improved the health of the retinal tissue and vision in diabetics. It also aided the functioning and survival of the cones in retinitis pigmentosa during the research. There does not appear to be a deficiency problem in humans which would indicate that we can manufacture ALA as needed. Excesses however did cause allergic dermatitis and gastrointestinal discomfort.

In summary, ALA is an important compound that helps our health and eyes, but should not be taken in excess and all drug interactions must be considered.

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