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Keeping Your Eyes Healthy in the New Year (January 2018)

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Featuring

Gayatri Reilly

Dr. Gayatri S. Reilly

The Retina Group of Washington

The telephone discussion features Dr. Gayatri S. Reilly of The Retina Group of Washington, who has excelled in research, patient care, and educating other eye care professionals about treating diseases such as age-related macular degeneration (AMD).

  • BrightFocus Foundation
    Keeping Your Eyes Healthy in the New Year
    January 31, 2018
    Transcript of Teleconference with Dr. Gayatri S. Reilly
    1:00–2:00 pm EDT

    The information provided in this transcription is a public service of BrightFocus Foundation and is not intended to constitute medical advice. Please consult your physician for personalized medical, dietary, and/or exercise advice. Any medications or supplements should be taken only under medical supervision. BrightFocus Foundation does not endorse any medical products or therapies.

    Please note: This Chat has been edited for clarity and brevity.

    MICHAEL BUCKLEY: Hello, I am Michael Buckley from BrightFocus Foundation. Welcome to today’s BrightFocus Chat, “Keeping Your Eyes Healthy in the New Year.”

    If this is your first time on a BrightFocus Chat, welcome, and thanks for joining us. Let me take a moment to tell you about BrightFocus Foundation and what we will do today. BrightFocus funds some of the top researchers in the world. We support scientists who are trying to find cures for macular degeneration, glaucoma, and Alzheimer’s disease. We share the latest news from these scientists with families who are impacted by these diseases. We have a number of free publications and plenty of materials on our website, www.BrightFocus.org, that offer tips for living with such diseases as macular degeneration. Today’s BrightFocus Chat is another way of sharing this.

    Let’s turn to today’s topic and guest. The topic is “Keeping Your Eyes Healthy in the New Year,” and we are recording this on January 31, so most of us are still hanging on to some of our New Year’s resolutions. We are thinking that if one of your New Year’s resolutions was about health and how to stay healthy, it would be a great time to talk about how to keep your eyes healthy during the New Year.

    We have a great guest today who can help us with that: It’s Dr. Gayatri Reilly from The Retina Group of Washington. She will talk about macular degeneration and what we can all do to keep our eyes as healthy as they can be.

    Dr. Reilly, we’ve been fortunate to have you on BrightFocus Chats before, and you’ve been very helpful and informative. I would like to welcome you to the call. I was wondering if you could start off with a little bit about what you do at The Retina Group of Washington and what motivated you to get into this line of work.

    DR. REILLY: Thanks again for asking me back. I’ve always enjoyed these talks. I’ve been now with The Retina Group…this is starting my 5th year. Being involved in patients’ vision is ultimately what made me go into the field. There aren’t many things that we can value more than our sight and the ability to impact people and to be a part of their journey along the way. Hopefully, we can educate as many people as possible. It’s been something that is really important to me.

    Retina as a subspecialty in ophthalmology is actually fairly unique, in that it is also a surgical subspecialty, where you can very acutely save vision. Ultimately, that is what it has always been about—trying to help people and help their vision.

    MICHAEL BUCKLEY: That’s great. I appreciate that, and I really thank you for your commitment to what you do. It is something where our research and public education materials at BrightFocus are designed to really help people with healthy aging and let them know that while there are certainly challenges, there are a lot of things that people can do. I want to start off there, Dr. Reilly, with just a very basic question. What can someone do to keep their eyes as healthy as possible?

    DR. REILLY: You started off by saying that a lot of us have New Year’s resolutions on our mind. The first thing I usually recommend is, the first step, would be to get an eye exam. Too often, we are taking care of loved ones, we are taking care of parents, and our kids, and you start to not take care of yourself as much as you can. The first step would be just that—to see your optometrist or ophthalmologist and start with a basic eye exam to make sure that there are no early signs of things like cataracts, glaucoma, or macular degeneration, because with all of these conditions, early detection is truly key.

    A lot of the earliest signs of these diseases are asymptomatic, and you may not know that there is anything going on. Sometimes being able to take it upon yourself and take care of yourself by getting an eye exam would be the first starting point.

    MICHAEL BUCKLEY: Thank you. The first question we have today is from Jeanette from New York. She is wondering, “Is there a connection between too much iron in the blood and macular degeneration?”

    DR. REILLY: There are a lot of conditions in the body that are not completely proven to accelerate or cause macular degeneration. Too much iron has not been associated with macular degeneration, to my knowledge. In general, too much iron can cause other retinal problems. It’s generally something that your primary care physician wants to treat and manage. As far as macular degeneration specifically, it is not known to be a risk factor.

    MICHAEL BUCKLEY: Thanks for clarifying that. We have two similar questions. Marilyn from Oregon is wondering about some over-the-counter pain medications, such as ibuprofen, Tylenol, and other things that a lot of us take with some regularity. We also have a question wondering about Claritin, the allergy medicine. Could you comment about pain relievers and allergy medicines and if they have positive or negative impacts on vision health? What should we be concerned about or not concerned about?

    DR. REILLY: That’s a great question. All of these are over-the-counter medications. You want to make sure that you need to be taking these medications. Too often, we think that because they are available over the counter that they are safe and that you can take them just as prescribed, every 4 to 6 hours like it says on the bottle. Sometimes, you can have long-term effects from that. In general, ibuprofen, aspirin—these medications have been studied and don’t tend to cause any problems specifically with the eyes. Allergy medication can, though. The problem with allergy medications, particularly antihistamines, is that the way they work is to help to dry everything. Traditionally, we are tearing a lot, or sneezing, or having a lot of congestion. The idea with a lot of antihistamines is to decrease that. One of the side effects of that would be dry eye. Dry eye is one of the conditions that many patients suffer with. Something as simple as an over-the-counter medication can significantly worsen that.

    MICHAEL BUCKLEY: That’s interesting. I know that you and I, being in the Maryland/ Washington, DC, area, where the seasonal allergies can just be crushing—that is really good advice to let us know about the antihistamines.

    We have a question from Richard in Illinois. There are people in his family that have alcoholism. Is there any connection or any concerns that people with alcoholism should have regarding macular degeneration or other types of vision health?

    DR. REILLY: Excess alcohol can cause damage to the eye, specifically the optic nerve. It isn’t traditionally related to macular degeneration, but the optic nerve is the nerve that connects your eye to the brain. Basically, it is the power cord to the eye. It is extremely important for your ability to see. Excess alcohol or excess tobacco use can cause damage to the optic nerve.

    MICHAEL BUCKLEY: We have two very similar questions about the link between macular degeneration and glaucoma. Two callers are wondering, are glaucoma and macular degeneration related?

    DR. REILLY: The only true connection between the two is that they both are associated with increasing age. Otherwise, they are completely separate conditions. Having one does not cause you to have an increased risk in developing the other. Very frequently, all of these conditions—macular degeneration, glaucoma, cataracts—these are all things you hear about as you get older, and they are easily confused. Having glaucoma, for example, does not put you at increased risk for developing macular degeneration, or vice versa.

    MICHAEL BUCKLEY: I have two follow-up questions on that. Can someone have both glaucoma and macular degeneration at the same time?

    DR. REILLY: Absolutely. So glaucoma, traditionally, is damage to the optic nerve, like we talked about earlier. Macular degeneration is damage to the macula, the very central portion of your vision. There are definitely many patients who have both conditions, and both conditions need follow-up, evaluations, and treatment.

    MICHAEL BUCKLEY: What are some of the warning signs for glaucoma?

    DR. REILLY: Glaucoma is another one where screening and having yearly eye exams are so important because, unfortunately, glaucoma really doesn’t have symptoms until there has already been damage done. Traditionally, you don’t notice your peripheral visual field—which is what glaucoma ultimately damages—being affected until it is very late. Most patients have no idea, have no symptoms, are seeing well and doing well. They would not by symptomatic if their intraocular pressures are elevated. They would not be symptomatic if their visual fields are compromised until there had already been a significant amount of permanent damage.

    That’s another reason for getting an eye exam and having your eye physician and optometrist evaluate and check your eye pressure and look at your optic nerve to make sure you don’t have any risk factors or any signs of it already.

    MICHAEL BUCKLEY: I have one more question about people who may have more than one age-related disease. As you know, Dr. Reilly, at BrightFocus we work a lot on Alzheimer’s disease and funding research around the world on that and sharing information. Do you have any advice if someone is showing some form of cognitive decline? Some form of dementia? What happens to their vision? How can a family member help that person who may be heading into dementia continue to keep their eyes healthy? It would seem like a very daunting situation. I was wondering your advice as a clinician for families that may have that.

    DR. REILLY: Yes. I would recommend to not overlook the eyes. Actually, it has been seen very commonly that having advanced cataracts actually accelerates dementia because the patient isn’t seeing very well. Taking away that ability to see well actually influences their mental health, and something as simple as cataract surgery can be life changing in these patients. A lot of times we are focused, understandably, on one problem. I definitely think it is important not to overlook the bigger picture and to make sure that there isn’t anything that might be able to help their quality of life.

    MICHAEL BUCKLEY: Great. Any advice for families that may bring a person with dementia in for a comprehensive eye exam? Any suggestions on how to make that go as smoothly as possible?

    DR. REILLY: I do. I usually recommend—for most patients, there is usually a time in the day that is best for them. It may not be the 8:00 appointment in the morning. It may not be at the end of the day. There is usually a period in the day when that patient is at their best. I highly recommend bringing the patient in during that time. It is hard on the family. It is also hard on the patient, because sometimes these visits can be a little bit long. Keeping them in the window, the time that they seem to process things and be most involved, is really important. Not infrequently, I have patients reschedule their appointment for a different time—not because of anything that they did, but just because it’s a better time for them to be participating in the exam and understanding what is happening.

    MICHAEL BUCKLEY: That is good advice. I think that applies to a lot of people, to try to schedule something at the optimal time. Dr. Reilly, I want to turn to some lifestyle issues, such as diet and exercise, starting first with exercise. We all can think about weight, blood pressure, and cardiovascular health. Does exercise benefit vision health?

    DR. REILLY: Exercise is definitely helpful. Besides all of the mental benefits you have from exercise, on a physical level, being obese or overweight is very inflammatory on the body. Inflammation in the eyes is also affected, as well. When we look at things like macular degeneration, these are certainly less studied than traditional risk factors, but we know that obesity, hypertension, and cardiovascular risk factors all play a role in macular degeneration. All of these things are inflammatory to the body, which in turn is inflammatory to the eye.

    MICHAEL BUCKLEY: In terms of exercise, is there a distinction between the vigor? The aerobic nature of it, such as walking versus something more aerobic? Does that have an impact on vision health?

    DR. REILLY: Not traditionally. I really encourage patients to do what they can do. As they get older, joints are more affected; you may not be able to run a mile, but you certainly can walk a block or two. There are no studies or anything supporting that you have to make this a very high-impact or aerobic workout in order to improve the body. A lot of things as simple as yoga and stretching, lower-impact steady-state exercise, is just as helpful. In some ways, it might be even more beneficial in the sense of it being less harsh on the body overall.

    MICHAEL BUCKLEY: That is good advice for all ages to do the best they can. Related to exercise is diet. You and others on BrightFocus Chats have talked about the strong connection between diet and vision health. We often get questions—we have a number of them today—about specific types of food. Somebody wrote in asking about spinach. Can you give a sense of what type of diet and what type of foods are best for vision health?

    DR. REILLY: Sure. For overall vision, particularly the macula, green leafy vegetables are really key. Spinach is great. Kale is great. Basically, if it is green, it is good for your eyes. We know that it’s not just in cartoons, but the carotenoids in carrots are also very beneficial for the eyes as well. If we are able to improve our diet and have these green leafy vegetables and incorporate seafood in our diet, all of these things play a big role for eye health. In fact, all of the supplements that we recommend for patients—if they are having it in their diet, they traditionally probably don’t need these supplements. Unfortunately, most of us don’t have as many vegetables and things as we would like to.

    MICHAEL BUCKLEY: Understandable. Dr. Reilly, I know you’ve talked in the past about something called AREDS, A-R-E-D-S. Could you tell us a little bit about that and how it is good for peoples’ vision?

    DR. REILLY: Sure. The AREDS vitamins stem from a clinical trial that started back in 2000 looking at supplements; vitamins C, E, and A; zinc; et cetera, to see if this could help decrease the risk of developing more advanced forms of macular degeneration. Even more recently a second clinical trial, the AREDS 2 trial, looked at that even further. Basically, it found that having vitamins C and E and some antioxidants, like lutein, zeaxanthin, and zinc, were really key and decreased the risk of progression to wet macular degeneration—a more severe form of macular degeneration—by about 25 percent. This was really key because for a lot of patients who have dry macular degeneration, one of the questions I get most often is, “What can I do?” That is the first thing I mention: diet and thinking about taking these vitamins.

    MICHAEL BUCKLEY: Great. You mentioned that AREDS 2 came out of clinical trials; I want to turn to that briefly. We have Dotty from Pennsylvania, who has a question about how one finds a clinical trial. And in answering Dotty’s question, could you elaborate a little more about what a clinical trial is, why it’s important, and what people should know about or ask their physician about in terms of clinical trials?

    DR. REILLY: I really support clinical trials. I think clinical trials, in general, are a great way of answering a question and changing treatment for the future. The most important thing I would first ask, though, is where are you hearing about this clinical trial? If your physician is talking to you about the trial, that is really important. You want to have some questions ready for physician as to why they are recommending this clinical trial. What benefit would they potentially have in the clinical trial?

    The hard part is that there are different phases of clinical trials, and it is important for a patient to understand how far along in the process this particular clinical trial is. Has the safety been determined? Is it safe for the patient? Is there any preliminary data in terms of whether it is beneficial? Knowing the previous trials results and being involved along the way is really important.

    I don’t know if you had heard, but last year, unfortunately, there was a problem in Florida where patients had learned about a trial from the internet. They were blinded by a treatment that was unproven, not truly a clinical trial. That’s why I said that starting off and trying to figure out where you are getting the information from is really important.

    MICHAEL BUCKLEY: I appreciate that. I think it is both encouraging to see the value of trials and the caution. The BrightFocus website also has trial-finders that only include ones that are officially deemed to be safe and appropriate.

    Dr. Reilly, we’ve had a few questions about eye drops—someone wrote in about PRP eye drops. I was wondering what you think of that as far as macular degeneration and keeping your eyes healthy.

    DR. REILLY: PRP stands for platelet-rich plasma eye drops. That’s meant to be for dry eyes. I don’t use it as a retina specialist. There are many patients who benefit from basically having platelet-rich plasma for dry eye, but it isn’t used for macular degeneration.

    MICHAEL BUCKLEY: A few minutes ago, you mentioned the concern that dry age-related macular degeneration (AMD) could become wet AMD. I was wondering if you could give our listeners some sense of what to look out for if one’s vision is moving in that direction. Are there ways that you can monitor that yourself? How does one keep a close watch on that?
     
    DR. REILLY: Definitely. Hopefully, your eye care physician has given you an Amsler grid, which is a small grid that is like a graph paper of straight lines that should always remain straight. We’ve had this for decades, and it’s time-tested and proven to try to detect any abnormalities where the straight lines appear wavy, distorted, or, dark with testing. I tell my patients just to keep a grid on their refrigerator and the next time that they’re going toward the refrigerator they should test each eye and make sure there are no changes. If there are any signs of distortion, waviness, or darkness, they should contact their physician right away.

    The second thing that is more recent is called the ForeseeHome monitoring device. This is a little bit more time consuming. It takes about 3 minutes to do per eye. It is a test that tries to assess whether there are any changes to your macula, even before something that you would detect, which is really terrific. This home monitoring device was able to detect a change toward wet macular degeneration before patients were even symptomatic. Those two things are really important, and just generalized awareness that a lot of times—I find that patients say “I’ve had this symptom for a while. I just thought it would go away.” I really encourage patients that, if you’re noticing a change, at least call the office and try to talk it through with somebody to see if this is something that they should be concerned about.

    MICHAEL BUCKLEY: That’s great. I appreciate it. The ForeseeHome monitor sounds really interesting and like a great step forward. Do you know if something like that is covered by Medicare?

    DR. REILLY: It is now covered by Medicare, which was a lot of work and a lot of time. It ends up making so much sense for Medicare to want to be part of it, because what it does is it detects wet macular degeneration early. We know, clinically, that the earlier you detect macular degeneration, the more vision you preserve and the less treatment you need. It is truly vision-saving. For the past maybe 2 years or so, Medicare has been very supportive and reimburses for the home monitoring device.

    MICHAEL BUCKLEY: That is good to know. Dr. Reilly, we have about 5 minutes left, and we have a few more questions before we wrap up. We have a few callers today who are interested in learning more about family history or genetics. For example—I guess it’s a two-part question—is AMD hereditary? Also, is there a hereditary connection where families with high blood pressure are at higher risk for macular degeneration? Is AMD itself something that is genetic?

    DR. REILLY: Yes, AMD is highly genetic. That is something we are learning more and more about because, in terms of generalized medicine, gene therapy and understanding the genetics for all of major diseases has really changed over the past 5 years or so. We have identified the major genes implicated in macular degeneration. There are even genetic tests available for patients. The key is going to be knowing your own family, too. Sometimes we don’t ask these questions because we just don’t know. They may not have a known diagnosis, but sometimes the great grandmother might have been blind. So, you’d want to figure out why or ask some questions as to why she lost her vision when she was 90. Things like that. It’s really important to know.

    I also counsel my patients that when they do have a diagnosis of macular degeneration, to involve their children. It doesn’t mean that they will develop it, but it does increase their risk, so they should increase their screening and be aware of it. That’s really important.

    The second part of the question about hypertension and AMD goes back to the earlier talk of how hypertension can affect a lot of different organs in the body, but it won’t specifically be a direct cause for macular degeneration.

    MICHAEL BUCKLEY: Thank you. A couple final questions—they are a little disparate. Can you talk about sunglasses, particularly driving in the winter? Depending on where you live, it seems like the sun can be low in the sky and there can be glares from snow and ice. Any tips? I assume that you should wear sunglasses, but more specifically, are there any types of sunglasses that would help during this time of year?

    DR. REILLY: You want to make sure that your sunglasses block UV-A and UV-B rays. Those are the harmful rays that the sun emits year-round. Even if it’s a cloudy day, I still encourage patients to wear sunglasses because the sun can still have UV-A and UV-B rays. In general, you don’t have to spend a lot of money to find these types of sunglasses. They don’t have to be polarized or anything, you just have to block the UV-A and UV-B light.

    MICHAEL BUCKLEY: The last question before we start wrapping up with final thoughts. Keeping with the New Year’s resolution theme, a lot of us probably had a ton of sweets over the holidays and are probably trying to have fewer sweets now in the New Year. Is there a connection between sugar and vision health?

    DR. REILLY: Definitely—particularly if you are diabetic, you are more sensitive to having larger swings in blood sugar. For most of us who are not diabetic, our body is able to regulate our blood sugar levels to not have huge spikes in either direction, too high or too low. In diabetics, their regulation is more dependent on medications and insulin. It is harder for them to keep their blood sugar consistent throughout the day. We know that if you have high spikes of blood sugar into the 300s or 400s, it definitely causes you to have decreased vision. The lens inside the eye actually physically gets swollen, and you aren’t able to see as well because of that.

    MICHAEL BUCKLEY: Good to know as we try to keep the sweets a little more manageable than over the holidays.

    Dr. Reilly, I really appreciate your generosity. You’ve been amazingly helpful and particularly clear and easy to follow. I think you’ve given a lot of us some helpful advice to have a healthier 2018.

    I want to conclude—do you have any big-picture advice from your perspective as a physician? Is there a recurring myth or misperception that you’d like to clear up about macular degeneration and vision health? I’m wondering your final thoughts about all of this.

    DR. REILLY: Sure. Again, thank you for having me. I think with macular degeneration, so much has changed—fortunately for the better—over the past 15 years. Back in 2000, we didn’t have any good treatments for wet macular degeneration. A lot of times, patients still think back that maybe their mom went blind because of macular degeneration. That is really not the norm anymore.

    Now we have very good treatments, and we are able to maintain and actually improve vision in many patients. Being afraid of a diagnosis, such as macular degeneration, is understandable, but between the research and clinical trials, we have really strong treatment that can preserve vision. I have many, many patients who are still 20/25 or 20/30 with excellent vision. They are very functional, are driving and independent, and that is because of early detection. I highly recommend yearly eye exams, and ask questions. It doesn’t hurt to just ask, “I am concerned. Do I have any signs of X, Y, or Z?”

    MICHAEL BUCKLEY: I really appreciate that. It’s great advice, and it keeps us informed and inspired through 2018 to do the best we can with our vision health.

    To our listeners, I want to thank you very much for joining us today. We hope that this Chat was helpful, and I would encourage you to contact BrightFocus if there is anything we can do to be of assistance.

    Dr. Reilly, thank you very much for returning to a BrightFocus Chat. We hope that you can come back and we can have a similar conversation in the future. Again, thank you very much.

    DR. REILLY: Thank you.

    MICHAEL BUCKLEY: On behalf of the BrightFocus Foundation, this concludes today’s BrightFocus Chat. Thank you very much for joining us.

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