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Cataracts

Steroid Eye Drops Can Cause Cataracts

WHAT IS A CATARACT?

A cataract is a clouding of the lens of the eye. To understand what a cataract is, it's helpful to know that the lens is a clear, oval structure with three layers: nucleus, cortex and capsule. The analogy of a peach can be used to describe these layers. The nucleus or center of the lens is the pit of the peach, the cortex is the flesh surrounding the pit, and the capsule or elastic covering is the skin of the peach. The lens is supported inside the eye by tiny ligaments (zonules) that support the lens capsule.

        
      Eye with no cataract.     Eye with cataract.     

In a young person, the lens is crystal clear and allows light to pass through and focus on the retina. As the lens ages, the nucleus turns yellow and loses its ability to accommodate (focus for close work) although the lens usually remains clear. As the lens continues aging, the nucleus turns from yellow to amber and ultimately to brown. Aging changes do not necessarily result in a cataract unless the nucleus becomes opaque, or opacities that block or scatter light develop in the cortex or under the capsule.


Now you see it.                   Now you don't.

December 29th - Steroids, the legal kinds, such as Prednisone and Cortisone, are strong anti-inflammatory drugs that are helpful to people who suffer from serious diseases such as asthma, emphysema, arthritis, ulcerative colitis, eczema, lupus and multiple sclerosis. Whether taken orally, topically (for eyes) or via an inhaler, these are potent drugs that can reduce inflammation, control disease flare-ups, and sometimes even prevent death. But used too frequently and/or for long periods, they can lead to side effects in a variety of organs, including the eye.

WEIGHING THE BENEFITS AND THE RISKS

To limit side effects, oral, inhaled or topical ophthalmological steroids are often prescribed for a very short period of time. However, for many serious conditions, they must be used for longer periods of time. Chronic use of steroids can cause many well-known side effects, including weakened bones, fluid retention, high blood pressure, mood swings and confusion. Less well known is that they can also cause eye problems such as cataracts and glaucoma, notes David F. Chang, MD, a clinical professor of ophthalmology at the University of California, San Francisco and coauthor of Cataracts: A Patient's Guide to Treatment. The good news is that cataracts are very treatable, as is glaucoma when detected early. Before prescribing steroids, Dr. Chang points out that doctors always try to make sure that the benefits of treatment outweigh the risks and disadvantages, and generally will limit their use to as short a time as possible.

Ophthalmologists themselves use steroid eye drops to treat a variety of potentially serious eye conditions, such as severe inflammation and to prevent rejection of corneal transplants. Other physicians may prescribe them for other reasons, for instance to reduce the severe itching caused by hay fever and allergies. However, because of the potential for cataracts and glaucoma, patients should be under an ophthalmologist's care and supervision in these situations.

Finally, even steroid inhalers commonly prescribed for asthma and emphysema, such as Flovent and Advair, have the potential to cause cataracts and glaucoma. That these low-dose, frequently used steroid inhalers could potentially cause eye problems may come as a surprise to many people.

USE STEROIDS SAFELY

Here are some guidelines for safe usage:

Patients taking steroid pills or inhalers for chronic conditions should have a yearly eye exam. This is the best way to diagnose treatable problems such as cataracts and glaucoma, Dr. Chang emphasizes. For example, glaucoma has no early symptoms, so people may not realize it is developing -- or that early treatment with eye drops may be necessary to prevent permanent vision loss.

If you require chronic steroid medication, ask your prescribing doctor what side effects you should watch for. If you already have glaucoma, notify your ophthalmologist if you end up needing steroids in the form of an inhaler or pills for a prolonged period of time.

If you are using steroid inhalers or pills, carefully follow your prescribing doctor's instructions. He/she will generally want you to take the lowest effective dose for the shortest possible time. It is particularly important not to self-medicate with steroids, including eye drops containing steroids. These should always be used under the supervision of your doctor.

Do not abruptly stop taking oral steroids or using inhalers on your own. Withdrawal usually must be phased gradually, and stopping them too quickly may lead to serious medical problems. If you are experiencing side effects, discuss this with your prescribing physician rather than deciding on your own to stop them or reduce the dose.

Follow an anti-inflammatory diet. To fight inflammation, eat more nutrient-rich fresh fruits and vegetables (deeply colored blueberries and cranberries, dark green leafy chard and mustard greens, for instance). Cold-water fish such as salmon and tuna is rich in inflammation-fighting omega-3 fatty acids. Cut back on simple sugars and carbohydrates from processed foods (cookies, white bread, chips) and fast foods, which cause extreme fluctuations in blood glucose levels ... and fried foods (particularly those with trans fat such as French fries), which encourage inflammation.

Steroids -- whether as pills, inhalers or eye drops -- should be reserved for serious illnesses. The dramatic benefits can make them seem like wonder drugs, but your doctor must always weigh the benefits against the potential side effects.

Source(s):

David F. Chang, MD, clinical professor of ophthalmology, University of California, San Francisco, and coauthor of Cataracts: A Patient's Guide to Treatment (Addicus). Dr. Chang is chair of the Cataract Committee of the American Society of Cataract and Refractive Surgery

EYE DISEASES
PREVENTION CAN BE THE ANSWER
HERE'S WHAT YOU CAN DO TO STAY HEALTHIER

It has become clear in recent years that nutritional deficiencies are the root cause of many of our illnesses. The following is list of vitamins and supplements that are absent in many people's diets. It is in alphabetical order and not necessarily in the order of importance for you.

Essential Nutrient #1: Alpha-Lipoic Acid
2006 may as well have been the "Year of the Antioxidant." The latest research has discovered these substances, which prevent or impede cell oxidation (destruction) by free radicals, in everything from red wine to blueberries to chocolate.

Alpha-lipoic acid, ALA, has been called the "universal," "ideal," and "ultimate" antioxidant. According to the UC Berkeley Wellness Letter, "What makes ALA special as an antioxidant is its versatility - it helps deactivate an unusually wide array of cell-damaging free radicals in many bodily systems."

ALA also helps "recycle" vitamins C and E and other antioxidants, thus making them much more effective.

ALA is thought to be a powerful weapon in the fight against the oxidative stress we encounter as we age. The incidence of eye problems such as macular degeneration, cataracts and pterygium (a fleshy growth on the cornea that can impede vision) increase dramatically as we age due to free-radical damage from factors such as smoking, poor nutrition, and exposure to ultraviolet (UV) light.

Essential Nutrients #2 & #3: Bilberry and Bioflavonoids
Bilberry is thought to improve night vision. A close relative of the cranberry, bilberry is high in a certain type of bioflavonoid that speeds the regeneration of rhodopsin, the purple pigment used by the eyes' rods. British air force pilots in World War II ate bilberry jam to improve their night vision during evening sorties.

Bilberry fruits, found in the forest meadows of Europe, western Asia, and the northern Rocky Mountains, contain flavonoid compounds called anthocyanidins.

Flavonoids are plant pigments that have excellent antioxidant properties; they have been shown to help prevent a number of long-term illnesses such as heart disease, cancer, and macular degeneration, the leading cause of vision loss and legal blindness in Americans age 65 and older, according to the eye-health organization Prevent Blindness America.

Essential Nutrient #4: Chromium
Dr. Benjamin C. Lane, O.D., from the Nutritional Optometry Institute in New Jersey, says, “Americans are getting less chromium and much more of its major antagonist, vanadium (a trace element) because of recent dietary trends to large marine fish and poultry.”

In numerous tissue testing and diet assessment studies that Dr. Lane has performed over the past twenty years he has found that “low levels of chromium are a major risk factor for increased intraocular pressure.” Chromium plays a large role in muscle contraction which is why this occurs when deficiencies are present.

And yet another negative effect of near-point activities like computer use, Dr. Lane reports that “the set of muscles we use more than ever before, are those that help focus our eyes.” He has conducted several studies that have shown that straining to focus over a period of time, does in fact increase intraocular pressure. But with proper amounts of chromium in your diet, focusing may be easier and less stressful to your eyes.

The body does not make chromium naturally, so it must be obtained through your diet. The best sources of chromium are beef, liver, eggs, chicken, oysters, wheat germ, green peppers, apples, bananas, and spinach.

Essential Nutrient #5: Copper Gluconate
Copper is an essential trace element that is required for the proper formation of collagen, a component of the connective tissues. It is found in various foods, including organ meats (especially liver), seafood, beans, nuts, and whole grains.

Copper gluconate, a readily absorbable form of copper, is one of the most important blood antioxidants, helping to keep cell membranes healthy and aiding red blood cells to produce hemoglobin.

Since the function of the blood is to carry oxygen and other nutrients, poor circulation causes decreased oxygen delivery - and subsequent damage - to tissues in different parts of the body; some of the most sensitive tissues to decreased blood flow and oxygen delivery include the brain, the heart, the kidneys, and the eyes. Over time, vision loss can occur.

Essential Nutrient #6: Eyebright
Eyebright has been used for centuries to treat eye irritation. Its Greek name, Euphrasia, comes from Euphrosyne, one of the three Graces, who was distinguished for her joy and mirth. The name is thought to have been given the plant because of its valuable properties as an eye medicine that preserved eyesight and so brought gladness into the life of the sufferer.

Eyebright is an antioxidant herb. Its antibiotic and astringent properties tighten membranes and mucus surrounding the eyes, effectively strengthening and improving circulation. Rich in vitamins A and C, eyebright also contains tannins that are beneficial for reducing inflammation.

Essential Nutrient #7: Ginkgo Biloba
The ginkgo is the oldest living tree species, growing on earth for 150-200 million years. No surprise, then, that it's one of the most well-researched herbs in the world. Studies have confirmed that ginkgo, a powerful antioxidant:
* Increases blood flow to the retina.
* Can slow retinal deterioration which results in an increase of visual acuity.

Retinal damage has a number of potential causes, including diabetes and macular degeneration. Studies suggest that gingko may help preserve vision in those with macular degeneration.

Essential Nutrient #8: Glutathione
Glutathione is an amino acid that protects the tissues surrounding the lens of the eyes. According to Web MD, "It also has potentially widespread health benefits because it can be found in all types of cells, including the cells of the immune system, whose job is to fight disease."

Numerous studies link glutathione with the prevention of cataracts, glaucoma, retinal disease, and diabetic blindness. Foods that increase glutathione levels include sulfur-rich foods such as garlic, eggs, asparagus, and onions, and glutathione-rich foods such as watermelon, asparagus, and grapefruits.

Essential Nutrient #9: Lutein (containing Zeaxanthin)
Lutein, found in our retinas, is essential for healthy vision. Lutein and a related dietary carotenoid, zeaxanthin (see entry below), accumulate within the retina and imbue a yellow pigment that helps protect the eye.

It lowers the risk of cataracts and macular degeneration (low lutein intake is implicated as a risk factor in age-related macular degeneration), and may also help to prevent or slow down arteriosclerosis.

Lutein is found in the red, orange, and yellow pigments of fruits and vegetables; for example, tomatoes, carrots, and squash. Green leafy vegetables such as spinach also contain high amounts of lutein.

Clinical research has determined that lutein along with zeaxanthin are two naturally occurring carotenoids present in the macular segment of the retina.

The concentration of these two is so high in the macula (the retinal region responsible for fine visual activities), that the carotenoids are visible as a dark yellow spot, called the macular pigment, in normal, healthy retinas. They act like sunglass filters to protect the eye.

Research performed at Harvard Medical School has established that dietary zeaxanthin plays an essential role in protecting the retina of the eye from the damaging effects of light.

Epidemiologic studies have shown that people with higher lutein/zeaxanthin levels have reduced risk for advanced stages of macular degeneration.

Blue-eyed individuals need more lutein and zeaxanthin because they have less of these protective pigments in their retinas. Again, dark, leafy greens are the dietary winner here, along with corn, nectarines, oranges, papaya and squash.

Essential Nutrient #10: N-Acetyl Cysteine (NAC)
NAC is an amino acid similar in structure to cysteine, a building block of proteins. In our body, NAC helps stimulate the production of antioxidants by replenishing the body's levels of glutathione (see entry above).

NAC is thought to both stave off disease and play an important role in boosting the immune system.

Essential Nutrient #11: Quercetin
Quercetin is a powerful antioxidant, as well as a natural antihistamine and anti-inflammatory. It is a citrus bioflavonoid, a natural substance that helps protect capillaries, prevent bruising, and intensify the effect of vitamin C in the body - in fact, bioflavonoids are essential for total vitamin C effectiveness.

In a study of adults with symptoms of macular degeneration, moderate red wine consumption (a source of quercetin) offered some protection against the development and progression of the disease.

Dark berries, such as blueberries, blackberries, and cherries, are also high in flavonoids. Animal studies suggest that quercetin inhibits the activity of compounds that contribute to the development of cataracts.

Essential Nutrient #12: Rutin
Another bioflavonoid, rutin, is found in many plants, especially the buckwheat plant, the flour of which is used to make pancakes. Other rich dietary sources of rutin include black and green tea, and citrus fruits.

Rutin is considered to be an important nutritional supplement because of its ability to strengthen capillaries. The American Journal of Ophthalmology notes that rutin has been used with success to treat retinopathy in preliminary research.

Essential Nutrient #13: Selenium
Selenium is a trace mineral that our bodies need to boost immunity and fight off infections. It can also help prevent cataracts and macular degeneration by acting as an antioxidant that neutralizes free radicals that can damage the eye's lens and macula; studies have identified low selenium levels in cataract sufferers.

Selenium also helps your body to absorb vitamin E. Fish, shellfish, red meat, grains, eggs, chicken, liver, and garlic are all good sources of selenium, as well as brewer's yeast and wheat germ.

Essential Nutrient #14: Vitamin A
Known as the ultimate eye vitamin, Vitamin A is absolutely essential for eye and vision health. In our bodies, vitamin A is required by the retina for its proper functions - in fact, one of the two sources of dietary vitamin A goes by the name "retinoids."

The other source is carotenoids, obtained from fruits and vegetables containing yellow, orange, and dark green pigments, including that old standby, beta-carotene. When Mom told you to eat your carrots for good vision, she wasn't kidding!

Vitamin A is necessary for the production of rhodopsin, the visual pigment used in low light levels. One of the causes of night blindness is vitamin A deficiency; supplements of that vitamin are often recommended for those with poor night vision, along with a diet emphasizing Vitamin A-rich foods, such as sweet potatoes, carrots, mangoes, spinach, and cantaloupe.

Vitamin A also helps:
* Your eyes adjust to light changes
* Moistens the eyes, which can enhance visual acuity
* It has been shown to prevent the forming of cataracts
* It has been shown to help prevent blindness from macular degeneration.

Essential Nutrient #15: Vitamin C
Vitamin C's importance as an antioxidant cannot be overstated. Some sources call this eye vitamin the "Vision Superhero!"

Vitamin C has been linked to the prevention of cataracts - one study has shown that taking 300 to 600 mg supplemental vitamin C reduced cataract risk by 70 percent - the delay of macular degeneration, and eye pressure reduction in glaucoma patients.

It's an interesting fact that, while most animals produce their own vitamin C, we humans do not have that ability. In addition, we can't store this vitamin in our bodies for very long, so it needs to be constantly replenished to obtain its benefits.

Most of us think of orange juice as the quintessential source of vitamin C, but many vegetables are actually even richer sources: chili peppers, sweet peppers, kale, parsley, collard, and turnip greens are full of vitamin C, as are broccoli, Brussels sprouts, watercress, cauliflower, cabbage, and strawberries.

Essential Nutrient #16: Vitamin E
Because of its antioxidant action, vitamin E helps protect against cataracts and age-related macular degeneration. A clinical study has showed that taking vitamin E can cut the risk of developing cataracts in half. Another study also showed that the combination of vitamins C and E had a protective effect against UV rays.

Symptoms of vitamin E deficiency include muscle weakness, loss of muscle mass, abnormal eye movements, and impaired vision.

Uveitis, an inflammation of the middle layer (uvea) of the eye, is another disorder for which the antioxidant vitamins C and E may be helpful. The uvea contains many of the blood vessels that nourish the eye; inflammation of this area can affect the cornea, the retina, the sclera, and other important parts of the eye.

The richest source of vitamin E is wheat germ. Dark green leafy vegetables (such as spinach, kale, and collard greens), sweet potatoes, avocado, asparagus, and yams are also good sources of vitamin E.

Essential Nutrient #17: Zinc
Our eyes actually contain the greatest concentration of zinc in our body. This essential element is required for the conversion of beta-carotene into vitamin A. Oysters contain more zinc per serving than any other food, but red meat and poultry provide the majority of zinc in the American diet.

Experience simulated eye diseases.

Cataract simulator

Detached retina simulator

Diabetic retinopathy simulator

Glaucoma simulator

Macular degeneration simulator

 Now you know!

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  *Consultation with a health care professional should occur before applying adjustments or treatments to the body, consuming medications or nutritional supplements and before dieting, fasting or exercising. None of these activities are herein presented as substitutes for competent medical treatment. See Disclaimer.

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