Good Sight Guide 2010

The WDDTYGood Sight

G u i d e

A comprehensive guide to keeping your eyes healthy

W H AT DOCTORS DON’T TELL YO U

A

P U B L I C AT I O N

Good Sight Guide 2010.qxd 30/3/10 11:07 Page 1

© Copyright 2010 WDDTY Publishing Ltd

First published in various editions of What Doctors Don’t Tell Yo u.

Editor and co-Publisher: Lynne McTaggart; Publisher: Bryan Hubbard

No part of this publication may be reproduced or transmitted in any form

or by any means, electronic or mechanical, including recording, photo-

c o p y, computerised or electronic storage or retrieval system, without

permission granted in writing from the publisher.

While every care is taken in preparing this material, the publisher can-

not accept any responsibility for any damage or harm caused by any

treatment, advice or information contained in this publication. Yo u

should consult a qualified practitioner before undertaking any treat-

m e n t .


Contents5

INTRODUCTION

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1 CHILDREN’S EYE PROBLEMS

Common ailments • Eye testing

Alternatives to glasses • How to cure squint

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2 MYOPIA AND FARSIGHTEDNESS

Radial keratotomy • Laser surgery • Contact lenses

Educational eye strain • Prevention • Alternative treatment

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3 CATARACTS

How they develop • Risks from surgery

Types of cataract • The UV connection • Prevention

Nutritional cures • The Evans treatment

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4 GLAUCOMA

What does it do? • Are you at risk? • Tests

Dangers of drug treatments • Surgical approaches

Drug-free approach • Exercise • Acupuncture

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5 AGE-RELATED MACULAR DEGENERATION (AMD)

Possible causes • The link with fats and minerals

The dangers of aspirin and other NSAIDs

Solutions from nature

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6 COMMON COMPLAINTS

Dry eyes • Floaters • Blepharitis

Herbs for the eyes

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7 THE BATES METHOD

Exercise your eyes back into shape

Techniques • Other vision programmes

Recommended reading


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I n t r o d u c t i o n

Perhaps more than any other part of the body, doctors act as thougheyes have a life of their own, disconnected from the rest of our

bodies. The medical profession tends to view eye problems as purelymechanical—a retina that somehow got detached, a globe that becamemisshapen or stubbornly refuses to stay straight or see correctly, a bad toss of the dice that has somehow, without our having anything to do withit, ‘just happened’.

Consequently, the prevailing medical approach is to surgically or chem-ically get those errant lenses or muscles back into line—an approach thatattempts to correct vision by treating the symptoms, not the underlyingcause.

In most cases, the underlying cause isn’t understood and certainly neverconnected to our diet or any drugs we may be taking.

What Doctors Don’t Tell You has amassed an increasing amount of evidence showing the pitfalls of the orthodox approach to vision prob-lems. This guide will show you why vision loss is not inevitable with age.Growing old no longer means going blind.

It also reveals how popular procedures for common problems such asstrabismus (squint) and myopia (nearsightedness) are ineffective and to be avoided at all costs.

Don’t assume that your vision will deteriorate with age, and don’tassume that there isn’t anything you can do about it. The worse thing youcan do is become accustomed to having poor eyesight. There are steps you can take now to prevent vision loss, and choices you can make abouttreatment.

A positive approach and perception is the first step to seeing throughthe fog of orthodox medicine for vision.

Our thanks go to the late British ophthalmologist Stanley Evans, whosenutritional approach to many eye problems, as well as his analyses of eye surgery, is covered throughout this booklet, and to Dr Harald Gaier,WDDTY’s resident naturopath for his advice on herbs for the eyes. The


● The WDDTY Good Sight Guide

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advice from Peter Mansfield (The Bates Method) and Dr Robert-MichaelKaplan (Seeing Without Glasses) is much in evidence within this booklet, as is, of course, that of the late W.H. Bates, MD.

Lynne McTaggart


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1Children’s Eye Problems

The eye suffers more unnecessary medical intervention than virtuallyany other part of the body—and this includes the wearing of glasses.

Far too many children wear spectacles for conditions that could be treatedby other means, such as nutrition and eye exercises; some ophthalmolo-gists, particularly those who follow the Bates Method, estimate that up to80 per cent of spectacle wearers have been prescribed them unnecessarily.

Another test, carried out in the US, revealed that seven out of 10 children wearing glasses need not do so, either because the spectacles wereinappropriately prescribed or because the eye deficiency was too slight tobenefit from wearing eyeglasses.

In addition, there is the overtreatment of minor eye illnesses, such asconjunctivitis or ‘pink eye’, which are often caused by an allergic reactionto food, the environment, chemicals and so on.

Common eye ailments◆ Cross-eyes or wall-eyes. These occur in very small babies, usually with-

in the first three months of life, when the eyes seem to operate indepen-dently of each other and before they begin to work in coordination.

◆ Sometimes the condition persists so that one eye wanders; this is calledalternating strabismus and will usually self-correct before the child isage five. Medical options include surgery—but such a decision shouldnot be taken lightly, and certainly not before the child has had a chanceto grow out of the condition.

◆ A more serious condition is known as amblyopia, when one eye ‘sits’ inthe corner. Usually, the child cannot see out of the ‘lazy eye’, and someintervention may be necessary to help it along. This can vary frompatching over the good eye, thereby forcing the lazy one to start work-



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ing, to eye exercises, eyeglasses or, in extreme cases only, surgery.Be sure, however, that you are dealing with amblyopia and not stra-

bismus, as even specialists have been known to confuse the two.◆ Styes are infections of the sebaceous glands lying along the edge of

the eyelid caused by staphylococcal bacteria. The first stage of a styefeels like a piece of grit in the eye, followed by painful irritation and redness. Finally, a pimple-like lesion forms at the edge of the eyelid.

This will go away on its own, although it can be helped along withthe application of hot compresses every 10–15 minutes. Boric acid andEpsom salts can also be used, though hot water often works just as well.

Eventually, a stye will either burst or get smaller and smaller; the latter kind is known as an ‘internal stye’.

◆ Conjunctivitis, also known as ‘pink eye’, refers to inflammation of theconjunctiva, the eye’s protective outer covering. In this common condi-tion, the eye becomes red, sore, feels gritty and may have a discharge.

Conjunctivitis can be due to an infection or allergy, a chemical ordrug, or exposure to ultraviolet radiation, therapeutic lamps or even the reflected glare from snow.

Allergic conjunctivitis is often triggered by hayfever, the dander of animals, mascara, contact lens-cleaning solutions or, very occasionally,food.

Infective conjunctivitis can arise from an infection picked up in aninadequately chlorinated swimming pool, or it may appear at the sametime as a cold or other infection such as measles. It is usually spread byhand-to-mouth contact (often in children), or by the viruses associatedwith colds, sore throats or an illness such as measles.

Conventional medicine usually treats infective conjunctivitis witheyedrops or an ointment containing an antibiotic drug. Chloramphen-icol (Chloromycetin, Sno Phenicol) is a commonly prescribed broad-spectrum antibacterial, and the drug of choice for most GPs for anysuperficial eye infection—bacterial or otherwise. It is applied topicallyas an ointment or as eyedrops.

Nevertheless, manufacturers of the drug have disclosed that, on rareoccasions, it can cause aplastic anaemia. Although the incidence of thishappening is supposedly rare, the disease is very serious indeed (there


● 1 Children’s Eye Problems

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is a significant reduction in red blood cell-producing marrow elements). In spite of this, GPs could be said to be somewhat cavalier about

prescribing the drug for simple infective conjunctivitis, especially asmany cases are caused by viruses that will not respond to it.

Simpler and safer treatments abound in alternative medicine.

First aid✔ For babies, the traditional folk-medicine approach is to bathe the eyes

in milk, preferably breastmilk if available (the second choice is goat’s milk)✔ Mixing one drop of the herb Euphrasia officinalis (eyebright) as an extract

with an eggcupful of cooled boiled water and applying it with an eye bathor a dropper will usually help adults. When treating children, dilute theextract and apply it with cottonwool

✔ Dr Alfred Vogel, in his book The Nature Doctor (Main Stream Publishing,1996) suggests applying the white of an egg to your eye (assuming you are not allergic to eggs)

✔ Take beta-carotene (4 mg per 30 cm of height) in divided doses thro u g h o u tthe day (J Nutr Environ Med, 1995; 5: 235–42)

✔ For rh i n o v i rus (nose) infection involving the conjunctiva, take zinc gluconate lozenges (containing 23 mg of elemental zinc) every two hourswhile awake (J Antimicrob Chemother, 1997; 40: 483–93) .

Homeopathy✔ Rhus tox 6CH twice daily—if your eyes are sensitive to light and there

is pustular inflammation✔ S t a p h y s a g r i a 3CH twice daily—for re c u r rent styes and if a pronounced heat is

felt in the eyeballs✔ Arsenicum alb 12CH twice daily—for acrid tearful discharge and oedema

a round the eyes✔ A c o n i t e 6CH twice daily—for grittiness and profuse watering of the eyes, ver-

tigo, and when the eyelids are swollen, hard and very re d✔ M e rc u r i u s 12CH twice daily—if you can see black ‘floaters’ after exposure to

ultraviolet light, and when there is a profuse, burning discharge with thick,swollen lids (Boericke W. Pocket Manual of Homeopathic Materia Medica, 9th edn. Boericke

& Tafel, 1927) .



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Western herbalism✔ Apply warm compresses using extract of Euphrasia rostkoviana (another

species of the eyebright plant) or Arctium lappa (burdock as a herb, notthe root), or use Calendula officinalis (marigold) as an eye lotion.

✔ Take immune-boosting herbs such as garlic or Echinacea (Planta Med, 1973;

23: 324).✔ Remember: never use straight herbal tinctures in the eye. ✔ Make sure you consult a qualified health professional if conjunctivitis

lasts for more than 48 hours, whenever there is a thick discharge, if vision isaffected or if light hurts the eyes.

Eye-testingMedicine’s intervention starts pretty early, usually with the eye test. Thefirst eye test is far from unnecessary, although nothing much of use can be gleaned before the age of four, as the eye is still developing.

Indeed, some argue that no eye test should take place before the child isfive years of age, when true seeing—when the eye and brain coord i n a t e — i sfirst established.

But having measured the quality of your child’s vision, the practice ofannual tests after that is generally a waste of everyone’s time. A sensibleinterval between eye tests is about four or five years. A child who took an eye test at the age of four need not have another until age nine. The only exception to this admittedly general rule would be if your child hascomplained of blurred vision or difficulty seeing in the meantime. Buteven in such cases, it is better to first suspect an infection or allergic reaction than a sudden overall deterioration of the eye.

If your child has taken a ‘bad’ eye test, and the ophthalmologist oroptometrist suggests spectacles to correct vision, it’s advisable to haveyour child take another test perhaps a month or so later, before immedi-ately succumbing to a spectacle-wearing existence for your child.

Everyone, specialists included, seems to view the eye as an unvarying,static organ whereas, of course, it is very much alive, with its own ‘off’days like any other part of the body. Some days, our joints are a little stiffor perhaps we have a headache, but nobody would dream of making uswear a splint or a head bandage for the rest of our lives. This is because



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we know that tomorrow, or soon after that, these minor symptoms will disappear.

Similarly, many things can affect our vision—stress, allergic reactions,illness, smoke and so on—so if your child is unlucky enough to have aneye test on an ‘off’ day, he could be condemned to eyeglasses for the restof his life.

Your child will not suffer any damage for waiting a little while longerbefore wearing spectacles; conversely, his eyes could be permanently dam-aged by wearing glasses that were not necessary.

‘Perfect’ eyesight, by the way, is popularly known as ‘20/20 vision’. It isso called because it is measured as a ratio of that which can be seen againstthat which should be seen. So someone who can see at 20 feet everythinghe should see at that distance is said to have 20/20 vision. Someone with20/60 vision would see at 20 feet what he should be able to see at 60 feet.

Although a child’s eyes are physically developed by the age of sixmonths to see with 20/20 vision, the interaction of the eye with the brainis still being established, which means that 20/20 vision cannot be mea-sured much before the age of five. So, a child of two will have about 20/70 vision, at three, 20/30 or 20/40 vision and, at four, 20/25.

Alternatives to spectaclesThe most common reasons why people wear eyeglasses are because theyhave myopia (short- or nearsightedness), hyperopia (farsightedness) orastigmatism.

The conventional wisdom has it that visual problems have a purelyphysical cause and are linked to the shape of the eyeball. A US study (JAMA, 1994; 271: 1323–6) found that the eyes of children whose parentsare myopic are not spherical, but more elongated than those of childrenwith non-myopic parents. Given that the children of myopic parents aremore likely to develop myopia (Clin Vis Sci, 1993; 8: 337–44; Acta Ophthalmol,

1968; 98 [suppl]: 1–172; Hum Hered, 1985; 35: 232–9), these findings offer hope that measuring axial length may provide a way to assess whether a childis in the process of becoming myopic.

Nearsightedness is due to the fact that the distance between the corneaand the retina is too great, forcing the eye to focus in front of the retina. If



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the distance between cornea and retina is too short, the eye has to focusbehind the retina, causing farsightedness. Astigmatism is when the corneaor the lens is bumpy or irregular.

Farsightedness can improve after the age of 21, as all ophthalmologistsagree, and myopia will also stabilise at around that age.

But several schools of thought have had considerable success in treatingthese common conditions without spectacles.

The Bates MethodThe first of these is the Bates Method (also see Chapter 7, page 87), namedafter a New York oculist, William Bates, who died in 1931. Bates’ champi-on was the writer Aldous Huxley, whose book The Art of Seeing introducedBates’ methods to many thousands of people. The Bates system considersseeing to be dynamic and also, in part, to be a function of memory.

People who have difficulty seeing, Bates observed, will stare or squint,which tenses the eye muscles. The healthy eye, in comparison, is relaxedand constantly moving, continually picking up bit-sized portions of theimage in front of it, thus building and rebuilding the entire picture.

The person with poor sight, in contrast, tries to ‘gulp’ in the whole picture without moving the eye and, of course, fails.

Spectacles, Bates argues, trap the eye in the state it happened to be inwhen it was tested. The analogy drawn by Huxley is like putting a brokenleg in a permanent cast; without use, the leg will wither and always bedependent on the cast.

We know, of course, that exercising the leg will make it strong again.This, in simple terms, is exactly what the Bates method tries to do for the eyes.

NutritionAnother school of thought maintains that nutrition can help cure orimprove most eye ailments. While many nutritionists will argue that ahealthy diet can cure some ailments such as conjunctivitis, others go fur-ther and maintain that even ‘permanent’ eye disorders can be successfullytreated with good nutrition.

The late Stanley Evans, a vision expert, based his research on the



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successful treatment of myopia, cataracts, glaucoma and other eye disor-ders with nutrition. He made many of his discoveries while working with malnourished people in Nigeria. Some cases of myopia, for example,were successfully treated by Mr Evans and his followers with the use ofglucose and various vitamins.

The precise nutritional diet depends, however, on the individual, and sogeneral guidelines would be useless, although vitamins A and C play animportant role. High doses of vitamin A can be toxic, and so it is advisableto take it as beta-carotene instead (see Chapter 3 on cataracts, page 37).

Autogenic trainingAs this involves visualisation and self-hypnosis, it may not suit all chil-dren. However, the remarkable success of one doctor, who restored hisown vision despite having his iris destroyed, is inspirational, and throwsmore light on what we call ‘seeing’.

Dr Kai Kermani had an incurable condition which leads to blindness.One of his eyes was already blind, and the other was almost so when hetook up autogenic training, which he combined with reflexology, spiritualhealing and massage.

Miraculously, the discipline had almost restored the sight to both hiseyes when he suffered a severe injury to one eye which tore his eyeball,destroying the iris. Nevertheless, within months, his eyesight returnedwhen he resumed the autogenic training.

The dangers of surgery for strabismusThe last 50 years have shown that most cases of strabismus, or squint(when eyes are not properly aligned), can be cured with nutritional ther-apy. However, many cases of squinting are still treated surgically and, inevery such case, serious damage is done to the eyes’ binocular function.

Over the past 30 years, Stanley Evans witnessed many cases of stra-bismus that were cured within a few weeks with his own brand of nutritional therapy. Compare this to the years it takes to cure the conditionthrough traditional methods, such as wearing a patch over the normal eye. The success rate of these traditional methods is very low, which is why the majority of cases are referred for surgery.



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When one eye deviates from its normal position, the usual surgicalmethod to straighten the eye is to cut one or more of the muscles attachedto the eye responsible for moving the eye in the direction of the deviation,and suturing it further back onto the surface of the eyeball so as to weak-en its pull.

Alternatively, the muscle or muscles responsible for moving the eye in the opposite direction may be cut and sutured further forward on thesurface of the eyeball so as to increase the pull and, thus, overcome thedeviation.

Frequently, both of these procedures are done, and it is very common for the good eye as well as the deviating eye to be operated on.

The operation thus destroys the normal function of all the horizontallyacting muscles. Not only is the delicate relationship between the photo-receptors in the retinas and the individual muscle fibres of all four eyemuscles disrupted, but the flexibility of all four muscles is seriouslyimpaired. The result is that normal eye movements are restricted in bothhorizontal directions.

Furthermore, it is very rare for a patient to undergo a single operation.Even when compound surgical procedures are adopted, these frequentlyhave to be repeated because the operation, by its very nature, has such ahigh potential for inaccuracy. Indeed, the first operation may reduce thedeviation or cause one in the opposite direction, so that another operationhas to be done to correct the error of the first one, or repeated several timesuntil the eye appears straight.

In performing such an operation, the surgeon is confronted with a mostdelicate task, and it is not possible to accurately forecast the result.

Often, the first operation is not expected to completely correct the devi-ation; the surgeon will deliberately operate in stages, rather than attemptto do it all at once.

This has to do with the scale of the surgery. The eyeball is a globe less than one inch in diameter. Changing the position of a muscle inser-tion by only one millimetre will change the position of the eye by approx-imately five degrees of arc. Most operations are performed to correct deviations this slight. Even when the most accurate apparatus possible isused with the highest level of skill and experience, the kind of accuracy



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called for is often too high to guarantee success. In addition to this, the healing process can completely upset even the

most superior surgery. The fact that the eyes may appear straight after the operation, or series of operations, does not mean that the two eyes areworking together correctly and giving normal binocular vision.

Every time an eye muscle is cut and sutured in a different position, thedelicate circuit connections feeding the group of muscle fibres that havebeen cut no longer remain in contact with the cells of the nuclei in the brainstem, with the photoreceptors in the retinas, or with the brain cells in the visual or motor cortex. This means that the delicate mechanismdesigned for providing eye balance and movement is irreparably disrupt-ed.

Over the past half-century, Mr Evans was consulted by a large number of patients who had been operated on for squint, and who had subse-quently experienced very serious trouble because they were unable tomove their eyes correctly or change fixation with comfort. Many patientsexperienced double-vision whenever they attempted to move their eyesfrom the straight-ahead position.

In every case of squint, the patient or parent should never consent tosurgery without first attempting a thorough trial of nutritional and exer-cise therapy. Such therapy never harms the eye functions but invariablyimproves them, whereas surgery always permanently destroys at leastpart of the delicate visual mechanism, and frequently causes far moretrouble than leaving the strabismus alone.

Often the parent is too anxious to straighten a squint in a child when he is young in the mistaken belief that nothing can be done later. Manycases of strabismus have been cured by the nutritional approach even after many years whereas, with surgery, the normal binocular vision isvery unlikely ever to be restored.


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2Myopia and Farsightedness

Laser eye operation—or photorefractive keratectomy (PRK)—to correctmyopia (shortsightedness) is the new darling in the operating room. It

was first introduced in the US in 1987 and in the UK two years later toreplace surgical correction that entailed making several cuts into the eye.

However, if you’re considering surgery to correct eyesight, you maywant to think again. Research is uncovering the dangers behind the twomost frequently performed correctional procedures—radial keratotomyand laser surgery. And 50 years of study has uncovered methods usingnutrition and exercise that can help your sight.

A close-up look at radial keratotomyMyopia is caused when the eye is a flattened sphere that is too long fromfront to back. As a result, the lens will focus images in front of the retinainstead of on it. The standard treatment to correct this is eyeglasses or con-tact lenses. However, patients can also opt for an elective procedure called‘radial keratotomy’ (RK).

During RK, several hairlike incisions are made in the cornea like thespokes of a wheel, avoiding the centre of the lens. During the healingprocess, the scars contract, causing the cornea to flatten and become lesspowerful.

When RK was first introduced some 30 years ago, it quickly became all the rage. However, subsequent research shed some doubt on the effica-cy of the procedure.

According to an article in the medical journal The Lancet (October 29,1994), a 10-year follow-up study found that RK is unpredictable as regardsboth the short- and long-term changes in eye refraction. The ProspectiveEvaluation of Radial Keratotomy study found that the operation could



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lead to a continuing hyperopic shift (a shift to farsightedness) during the10 years following the operation.

Radial keratotomy also increases the risk of infection and ulcerationlong after the procedure is done. In some serious cases, a therapeuticcorneal transplantation has been necessary (American Journal of Ophthalmology,

July 1994 and June 1995).

Laser eye surgery: a shortsighted solutionLaser eye surgery was supposed to be the great saviour for all glasses-wearers, and was science’s answer to most of the common sight problems.But, already, the hype and hope are giving way to growing concerns overthe safety and effectiveness of the various techniques, and patients areproving to be somewhat elusive just as the surgery is being offered onevery high street in the UK.

In the US, a growing number of consumers are questioning the proce-dure, and its popularity is apparently waning. At its peak in 2000, 1.42 million Americans underwent the surgery, but figures for the followingtwo years saw a significant drop to 1.31 million in 2001 and 1.15 million in 2002. Profits and share prices of the medical chains performing the oper-ation tumbled as a result (International Herald Tribune, 31 January 2003). In the UK,around 100,000 people undergo the procedure each year.

Nevertheless, patients’ concerns are well placed. Researchers at the New Jersey Medical School discovered that as many as one in five of thepatients in their study of 1306 patients needed to undergo retreatment torepair or enhance the first one (Ophthalmology, 2003; 110: 748–54).

One of the major concerns of ophthalmologists is the sudden loss of contrast sensitivity—the ability to distinguish objects in poor light—aftersurgery. This problem surfaced in 1996 when researchers at TübingenUniversity in Germany reported that three-quarters of the patients whohad undergone photorefractive keratectomy (PRK) surgery for myopiaover the previous 10 years had such poor contrast sensitivity that they had failed federal German night-vision standards (ASCRS [American Society of

Cataract and Refractive Surgery] Symposium, June 1996).The London Centre for Refractive Surgery has reported similar prob-

lems. After hearing of the German findings, the centre recalled all patients


● 2 Myopia and Farsightedness

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treated with an Excimer laser and found that 56 per cent (36 of 54 patients)also had greatly reduced contrast sensitivity (Lancet, 2003; 361: 1225–6).

This loss of sensitivity appears to be permanent and untreatable, says Dr William Jory, consultant ophthalmologist at the London Centre forRefractive Surgery.

These findings have been supported by a further German study (ESCRS

[European Society of Cataract and Redfractive Surgeons], Brussels, 2000) and one fromCanada (Can J Ophthalmol, 2000; 35: 192–203). The Canadian federal govern-ment in Ottawa has since advised all provincial governments to testpatients’ night vision after surgery before a driver’s licence is issued.

Advocates of laser eye surgery argue that many of these safety issuesrelate to the PRK technique, which has since been superseded by LASEK(laser subepithelial keratomileusis), a modification of PRK, and by LASIK(laser in situ keratomileusis), now probably the most popular form of laser eye surgery (Semin Ophthalmol, 2003; 18: 2–10).

With PRK, the surgeon applies the laser beam directly to the cornea (the transparent tissue covering the front of the eye), and ‘shaves’ andreshapes it. LASIK uses a special knife to lift a flap of tissue from the surface of the cornea to reveal the corneal bed (stroma). The laser works on this tissue, then the flap is replaced. The LASEK technique detaches theoutermost layer (epithelium) of the cornea, and reshapes the corneal sur-face with the laser. The epithelium is then returned to its normal position.

There has been a range of concerns about the PRK technique, but onethat is rarely aired is the possibility of postoperative infection. One studyreviewed the records of 12 PRK patients who developed infectious kera-titis, which can result in corneal ulceration. The researchers recommendedthat just-in-case antibiotics be given to all PRK patients before surgery(Ophthalmology, 2003; 110: 743–7).

Contrast sensitivity is also a major concern for PRK patients. Research-ers at Moorfields Eye Hospital in London reported that 30 per cent of itsPRK patients suffered a loss of contrast sensitivity within two years ofsurgery (Refractive Surgery Symposium, London 2001)—and the same symposiumheard that half of all LASIK patients suffered a similar loss, one year afterthe operation.

The LASIK technique can cause the cornea to weaken in up to 40 per



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cent of all cases (Lancet, 2003; 361: 1225–6) and, sometimes, the weakenedcornea resumes its original shape—so the myopia returns.

One study reported on a variety of complications following LASIKsurgery. Of the 24 cases, 13 of the complications occurred during the pro-cedure, and the rest afterwards. The technique, the researchers concluded,could result in serious complications that can lead to visual loss (Eur J

Ophthalmol, 2003; 13: 139–45).Patients may also have to go through a second, corrective operation.

In one study of 1306 LASIK patients, over 10 per cent had to undergo a second operation, a likelihood that increases with age, the degree of initialcorrection and the extent of astigmatism (Ophthalmology, 2003; 110: 748–54).

As with PRK, postoperative infection is also a concern for the LASIKpatient. One study found that keratitis could occur up to 450 days aftersurgery, and was serious enough to threaten vision (Ophthalmology, 2003; 110:

503–10).The US Food and Drug Administration (FDA) is equally unsure of the

LASIK technique. According to its website (www.fda.gov), LASIK is “anoption for risk takers”.

LASEK is a newer technique, so there are fewer studies into its efficacyand safety. However, one study from Japan urges caution. After studyingthe progress of 42 LASEK patients, the researchers reported postoperativecomplications such as pain, delayed recovery of visual sharpness andcorneal haze (Nippon Ganka Gakkai Zasshi, 2003; 107: 249–56).

Compared with PRK, LASEK may result in less discomfort in the earlypostoperative period, faster visual recovery and less haze, but these claims,made by LASEK proponents, need to be vindicated in long-term trials, sayresearchers at the University of Washington (Semin Ophthalmol, 2003; 18: 2–10).

In general, complications that can develop after any of these three pro-cedures have included:❖ Eye infections (Ophthalmology, 2003; 110: 743–7; J Cataract Refract Surg, 2002; 28:

722–4; J Cataract Refract Surg, 2001; 27: 471–3)❖ Dry eye with compromised tear function (Am J Ophthalmol, 2001; 132: 1–7)❖ Strabismus (‘cross-eyes’) (Yonsei Med J, 2000; 41: 404–6)❖ Detached retina (Am J Ophthalmol, 1999; 128: 588–94)❖ Macular damage (Am J Ophthalmol, 2001; 131: 666–7)



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❖ Vision disturbance due to optic nerve damage (Am J Ophthalmol, 2000; 129:

668–71)❖ Irregular astigmatism (a misshapen cornea, causing blurred or distorted vision)

caused by surgical complications (Rev Optom, May 1999)❖ Impaired night vision and loss of contrast sensitivity, making it hard to see

objects against a similarly coloured background (Med Post, 8 June 2000)❖ Long-term weakening and thinning of the cornea, leading to a risk of further

myopia (Ophthalmology, 2001; 108: 666–72).Corneal weakening and corneal distortion are ‘serious’ complications,according to Dr Jory. They cause myopia that, in some cases, becomes progressively worse. “No one knows the rate of risk or the timescale,” hesays.

With more and more ‘walk-in’ laser-surgery centres opening up, theemphasis is on the benefits; very few mention the possible risks either in their advertisements or during the face-to-face consultations before theoperation.

The Advertising Standards Authority, the UK’s advertising watchdog,has upheld complaints against misleading advertising for LASIK surgerywhich had been produced by Boots, Maxivision and Optimax, some of theleading players in this lucrative field.

Such a misleading approach was a major concern of the patients, according to a poll conducted by HealthWhich? earlier this year. Some complications that doctors deemed ‘minor’ can seriously affect people’slives and jobs. One patient complained she could no longer drive and nowfails to recognise people who are just 10 feet away. But because she can still read an eye chart, her problem is not considered significant, the pollsaid.

Some patients whose lives have been ruined by eye surgery have taken on the task of providing a health warning to potential patients, andalso to provide help to those already affected. The Surgical EyesFoundation (www.surgicaleyes.org) is a US-based support group for peo-ple with “longer-term complications from refractive surgery”. Their aim is“to restore quality of life to the thousands who suffer from complicationsof . . . refractive surgeries”.

Others are much more militant. In the UK, the Medical Defence Union,



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the biggest insurer of British doctors, said claims against surgeons per-forming laser eye operations are soaring—because the expectations of thepatients don’t match their results. The MDU says doctors needed to warnpatients of the possibility of an “imperfect result and other complications”before obtaining the appropriate consent for the procedure (The Guardian,

26 May 2003).Unrealistic expectations, or perhaps expectations that have been put in

the patient’s mind by advertisements or during the preoperative discus-sions, could be at the heart of the issue. Even if you are among those who suffer no reactions or complications after surgery, you are still likelyto need to wear glasses for some tasks, eye surgeon David Gartry told theBBC News (26 May 2003).

Quality of treatment can vary enormously from one clinic to another.Yet, this information is rarely, if ever, made available to patients choosingwhere to have their treatment.

Extraordinarily, any currently registered doctor can offer laser eyesurgery without the need for any special, formal qualifications. In themain, surgeons receive just two or three days of training at best—and thengo on to develop and perfect their skills on you, the patient. Britain’s RoyalCollege of Ophthalmologists recommends that refractive surgeons shouldbe fully trained ophthalmologists and should have undergone additionalspecialist training; they suggest that prospective patients should ask aboutthis when enquiring about surgery.

Laser eye surgery: what’s involvedLasers have been used in eye surgery for some time, but they have onlybeen in widespread use since the beginning of the 1990s. Before that time,the eye surgeon needed supreme skill and confidence with a scalpel.

When lasers are used to treat myopia, the shape of the cornea is finelysculpted to allow the eye to focus better. The central part of the cornea is flattened, which brings the focal point of the eye closer to the retina,allowing distance vision to be improved.

The surgery removes microscopic amounts of tissue from the outer surface with a cool, computer-controlled ultraviolet beam of light. Thebeam is so precise that it can cut notches in a strand of human hair



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without breaking it. Each pulse can remove 39 millionths of an inch of tissue in 12 billionths of a second.

All eye surgery is carried out under local anaesthetic, given as eyedrops.It is an outpatient procedure that takes just a few minutes to perform.Patients are typically able to return to their daily routines within one tothree days—if all goes according to plan.

Before the procedure begins, the patient’s eye is measured to determinethe degree of visual problem, and a map of the eye’s surface is construct-ed. The required corneal change is calculated based on this information,and is then entered into the laser’s computer.

Patients who elect for LASIK surgery rarely feel pain during the pro-cedure. The doctor will have you lie down, then make sure the eye isdirectly under the laser. (One eye is operated on at a time.) A kind of retain-er is placed over your eye to keep your eyelids open. This has a suctionring that keeps your eye pressurised, which is important in LASIK forallowing the surgeon to cut the corneal flap. The surgeon uses an ink marker to indicate where the flap should be. The cut is then made with the microkeratome. During the procedure, you won’t see the flap being cut as it is very thin.

The surgeon uses a computer to adjust the laser to your particular pres-cription. You will be asked to look at a target light for a short time whilehe/she watches your eye through a microscope and the laser sends pulsesof light to your cornea. With some lasers, it is critical that your eye remainsfixated on the target light to obtain the best results. Other lasers areequipped with a special tracking device that follows your eye even if itmoves.

The laser light-pulses will then painlessly remove tissue. You’ll hear asteady clicking sound when the laser is in operation. You’re also likely tosmell a mildly acrid odour from the tissue being removed.

The higher your prescription, the more time the operation takes. Thesurgeon has full control of the laser and can turn it off at any time.

When the procedure is finished, you will rest for a little while. If you’rehaving both eyes done on the same day, the surgeon will probably do theother eye after a short period of time. Some people choose to have theirsecond eye done a week later.



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The doctor may prescribe medication for any postoperative pain, butmany people feel no more than mild discomfort after LASIK, whereaspainkillers are often prescribed after a PRK procedure.

After the procedure, you will be advised to take proper rest. Whatoccurs after the surgery can affect your vision just as much as the opera-tion itself.

You may be able to go to work the next day, but many doctors advise a couple of days of rest instead. They also recommend no strenuous exer-cise for up to a week afterwards, as this can traumatise the eye and affecthealing. Avoid rubbing your eye as there is a chance of dislodging thecorneal flap.

Laser eye surgery is costly and, at present, not normally available on theUK’s National Health Service or under most health-insurance schemesin the US.

A straw poll of clinics revealed variable prices—most charging upwardsof £1200 per eye, or more in the small number of centres offering the moreadvanced wavefront technology (see below). In the US, the Los AngelesTimes reports a typical price of between $1500 and $2000 per eye. Potentialpatients need to check whether the prices include aftercare, and any nec-essary repair or retreatment in case of disappointing results.

The next waveIf at first you don’t succeed, then wavefront could be the new technologyin laser eye surgery to stifle the critics. One company promotes the treat-ment by saying in its press release that it takes most of the ‘guesswork’ outof predicting the results of surgery.

The technology is a byproduct of astronomy, which uses it to unscram-ble starlight from space.

A fine beam of light is shone into each eye and reflected back by the retina. The returning reflection is assessed over many diff e rent points on thepupil, and surgeons are now able to spot very slight imperfections and aberra-tions more accurately than before. This allows the subsequent treatment withthe laser to be ‘tailor-made’ for each patient in a more precise way, or so itsadvocates claim.

One overview of US trends in eye surgery reported their findings that the



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new forms of laser surgery “were minimally employed but appear poised to bethe wave of the future” (J Refract Surg, 2003, 1: 357–63) .

S c i e n c e magazine (14 March 2003) describes new developments in eye exam-ination that peer into the eye, rather than assessing the information that comesback from it. ‘Adaptive optics’ again uses space-honed technology on thehuman eye to examine single cells deep in the eye. The world’s first and onlyscanning laser ophthalmoscope can look at the retina at diff e rent depths, and “each layer of the retina tells its own story”, saysS c i e n c e. This has enormous potential for a range of eye diseases and conditions.

Presbyopia—diminished elasticity of the lens due to ageing—can some-times be treated with laser surgery using a treatment known as ‘mono-vision’. The laser is used to deliberately make one eye slightly shortsight-ed—the resulting imbalance aims to improve vision for close objects. It’susual to advise a prospective patient to first try contact lenses or spectaclesto see if this imbalance in the eyes works, as the surgery is not reversible.

So, does this new technology offer a safer way forward? It’s just tooearly to say. Watchful waiting has to be the best approach at the moment.

A suitable case for treatment?Not everyone can, or should, have laser eye surg e r y. Any reputable doctor orclinic will check your expectations and your medical situation very c a refully before agreeing to surg e r y. And, of course, you will undergo adetailed eye examination.

It also makes sense for you to ask questions, shop around, do your owns e a rches on the Internet and perhaps, if you can, think about waiting a whileb e f o re deciding on which form of treatment, if any, you want.

You might also wish to consider getting one eye done at a time to allow timeto check for any after- e ffects before deciding to have both eyes t reated.

The website www. s u rgicaleyes.com has a list of evidence-based contra-indi-cations to laser eye surg e r y. Some of the most common include: ❖ u n c o n t rolled diabetes❖ p re g n a n c y❖ vascular disease, such as lupus or rheumatoid arthritis, and autoimmune

d i s e a s e s



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❖ inability to wear contact lenses, particularly rigid gas permeables (if you devel -op any complications of eye surgery, these lenses may be the only ones you canwear to correct your vision)

❖ cataracts❖ tendency to dry eyes (exacerbated after surgery).

Contact lensesA common concern with contact lenses—particularly extended-wearlenses—is the risk of infection. All contact-lens wearers are at some suchrisk, as all types of contact lenses reduce the amount of oxygen that reach-es your cornea—the clear membrane over-lying the pupil and iris—andless oxygen can promote infection. However, studies show that the inci-dence of eye infections is higher among people who sleep in their lenses.

In the 1980s, when extended-wear lenses first came out, a four- to 15-fold increase in the risk of infection was seen when lenses were wornovernight, rather than just during the day (Br J Opthalmol, 2000; 84; 327-8).Users of extended-wear lenses who wore them overnight had a 10- to 15-times greater risk of ulcerative keratitis (inflammation and ulceration ofthe cornea) compared with those who didn't sleep in their lenses (N Engl J

Med, 1989; 321: 773-8). Ulcerative keratitis is considered the most seriousadverse effect of contact lenses as it can lead to scarring and blindness.

As a result of these findings, the US Food and Drug Administration(FDA) recommended that lenses approved for extended wear should beworn for no more than one week. And many worried eyecare physiciansdiscouraged patients from sleeping in their lenses.

Recently, however—thanks to highly permeable silicone hydrogel, or‘SiHy’—extended-wear lenses have made a comeback. Lenses made fromSiHy allow more oxygen to reach the eye than conventional soft lenses,making overnight wear safer than before. In fact, they deliver so muchoxygen to the cornea that some brands of SiHy lenses are approved for 30days of continuous wear.

CIBA Vision's Night and Day are among the 30-day lenses now on themarket. In more than 6000 people who wore these lenses for up to 30nights consecutively, the incidence of bacterial or fungal infection of theeye was low, around 18/10,000 users. Also, the rate of microbial infection



27

resulting in loss of visual acuity was only about 3.6/10,000 wearers (Oph-

thalmology, 2005; 112: 2172-9). However, these rates are still higher than with daily-wear lenses, and

SiHy lenses on a daily-wear basis have fewer adverse events than whenwearing them continuously (Eye Contact Lens, 2007; 33: 288-92). One study con-cluded that “extended wear with even these newer [SiHy lenses] is still arisk factor in the development of microbial keratitis [corneal inflamma-tion]” (Br J Ophthalmol, 2002; 86: 355-7).

Contact lens safety tipsDon't clean your contact lenses with tap water, and don't swim in swim-ming pools when you're wearing them. These two simple rules will helpreduce the risk of a special type of infection that can lead to blindness—and which standard contact lens solutions cannot kill.

Researchers have discovered that a high percentage of contact lenses arecontaminated with pathogenic amoebae known as Acanthamoeba, a com-mon protozoa found in soil and fresh water. The amoeba can cause infec-tions, and can lead to an eye infection called amoebic keratitis, which cancause blindness. Around 85 per cent of all cases occur in people who wearcontact lenses.

The amoeba is found in chlorinated swimming pools and domestic tapwater, and so contact lens wearers who either clean their lens in tap water,or who go swimming while wearing them, have a far greater risk of devel-oping the infection. In one study of 153 contact lens cases from users inTenerife, researchers discovered that 65.9 per cent were contaminated eventhough the wearers did not have any signs of infection. No strains werefound in daily lenses, although some were found in monthly and bi-monthly lenses. Those who wore the same lenses for more than two yearshad the greatest levels of infection (J Med Microbiol, 2008; 57: 1399-1404).

Other pointers:◆ Listen to your eyes: they should look well and feel comfortable, and vision

should be clear ◆ If you have a problem, immediately remove your lenses and contact your eye -

care professional



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◆ Never wear your lenses for longer than prescribed ◆ Always wash and rinse your hands thoroughly before handling them ◆ Wear good-fitting goggles if you go swimming with them◆ Avoid wearing them overnight if you are unwell◆ See your eyecare professional for regular checkups.

Taking a deeper lookDelaying the ageing process and preventing disease in the eye requiresg reater attention to nutrition, exercise and protection from harmful environmental influences.

Practitioners are beginning to come around to the idea that visual dis-turbances are symptoms of the first stage of the progressive, but pre-ventable, degeneration of the eye. For them, diseases such as cataracts andglaucoma are simply extreme forms of a common process.

This theory gains some credence from the fact that people with myopiaare known to be at a greater risk of developing eye diseases such as age-related macular degeneration (AMD), glaucoma and cataracts. In onestudy, intraocular pressure (most commonly associated with glaucoma)was associated with the development of myopia. The progression ofmyopia in 49 children, aged 9 to 12 years, was studied over a period of two years. What they discovered was that the rate of myopia in those children with high intraocular pressure (IOP) was nearly double that ofthose with a lower IOP (Doc Ophthalmol, 1992; 102: 249–55).

Although almost every child can recall being told that carrots are goodfor your eyes, nutrition to improve eyesight is not a subject which hasreceived much serious consideration in the medical journals. Vitamin A(found in, among other foods, carrots) is undoubtedly vital for healthyeyes. Carotene is metabolised in the intestinal mucosa into retinol, whichis then transported to the liver, where the vitamin is stored in the form of retinyl palmitate. This is why, in diseases which affect the liver, reducedvision and even blindness are commonly seen.

When diet is studied, it is usually in relation to serious conditions suchas macular degeneration (J Am Optom Assoc, 1996; 67: 30–49) and cataracts (Crit Rev Food Sci Nutr, 1995; 35: 111–29), rather than refractive errors such asmyopia. The damage which free radicals can do to the eye has also



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received some attention. Inflammation of the eye can occur when toxins such as free radicals build up in the body, including the eye (Nutrition, 1996; 12: 274–7). However, preventative measures, such as takingantioxidants, have been extensively shown to help prevent visual deterio-ration (Ann Epidemiol, 1996; 6: 60–6; Ann NY Acad Sci, 1980; 570: 372–82; Acta

Ophthalmol, 1993; 71: 214–8).One study did look specifically at the association between diet and

myopia. The nutritional profiles of 24 children between seven and 10 years of age who developed myopia were compared with the nutritionaldata of 68 10-year-old subjects with perfect eyesight (Optom Vis Sci, 1996;

73: 638–43). The results showed that those children who developed myopiahad a generally lower intake of many essential nutrients compared withthose whose vision remained good. In particular, there were statistically significant differences in total energy intake, protein, fat, vitamins B1, B2and C, phosphorus, cholesterol and iron from the diet.

This demonstrates the importance of the role of metabolism in eyehealth. If the blood pH (acid-to-alkaline balance) becomes acidic, muscletone increases, turning the eyes inward, while an alkaline pH will interferewith normal muscle tone, leaving eyes posturing outward and generallyfatigued. Blindness and cataracts are linked to diabetes, and reduced nightvision is often linked to impaired liver function. Gastrointestinal disorders,such as Candida overgrowth and parasitic infestation, can also contribute to poor vision by interfering with the normal assimilation of essential proteins, vitamins and other nutrients.

Educational eye strainThe role of the environment is also important. Other reviews have con-cluded that the increasing prevalence of myopia among children andyoung people is related to the stress—both physiological and psychologi-cal—placed on them by the educational system. Long hours of close work force the eye to strain unnaturally when focusing on objects fartheraway (Tidsskr Nor Laegeforen, 1991; 73: 3635–7; Gig Sanit, 1996; 24: 19–22). OneJapanese study found that there was also a strong relationship betweenfailing eyesight and the sitting posture adopted by young students duringstudy. It concluded that myopia is strongly associated with a short view-



30

ing distance and increased neck flexion (Nippon Ganka Gakkai Zasshi, 1997;

101: 393–9). These data are, of course, also relevant for adults who work or study under similarly unfavourable conditions.

What has received less research attention is the subject of electromag-netic fields (EMFs) and eye damage. Ann Silk is a retired optician andmember of the Royal Society of Medicine who has made a special study ofthe effects of EMFs on eye function. Her findings were published in a two-part series in the Journal of Electromagnetic Hazard and Therapy (1998, 8: 10–11;

1998; 9: 8–9).Ms Silk confirms through her research that EMFs can cause eye damage

both directly and indirectly. For instance, low-level microwaves—such asthose found in everyday communications equipment—have been shownto cause direct damage to the retina, iris and macula. She also reports thatdopamine loss, which can be triggered by external electrical fields, can leadto blurred vision. Dopamine is a hormone essential for the developmentand maintenance of the health of the eye.

According to conventional wisdom, reduced night vision comes withage, or with wearing certain types of corrective lenses. However, accordingto Ms Silk, “Reduced night vision, or night myopia, can have a nutritionalcause, usually a zinc deficiency. But it can also be caused by sitting in amagnetic field all day.”

Research into indirect causes of eye damage has proved more challeng-ing to obtain. But researchers in Tokyo have investigated the growth ofboth Escherichia coli and Bacillus subtilis bacterial species in a stronger-than-normal magnetic field. Their findings indicated that not only was bacteri-al growth gre a t e r, but also the bacterial cell death rate was inhibited. Research at the University of California at Los Angeles inthe US has also shown that fungi proliferate in electromagnetic fields.

The polymers used in the manufacture of contact lenses can also beaffected by emissions from VDUs such as computer screens. Ongoingstudies quoted by Ms Silk have shown that lenses can develop minuteholes which can irritate and affect the health of the eye.

Now is the time to sit back and watch as many of those who have hadlaser eye surgery within the last 10 years approach the point when long-term adverse effects may begin to reveal themselves.



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Perhaps the point is to address the underlying causes of eye problems,such as nutrition, before leaping to cover up the symptoms.

Preventing myopia◆ Myopia may be linked to an increased intake of refined carbohydrates,

according to a study carried out on hunter–gatherer societies and onrecently Westernised hunter–gatherer groups (Acta Ophthalmol Scand, 2002;

80: 125–35). The researchers speculate that, when hunter–gatherer soci-eties change their lifestyles, and introduce grains and carbohydratesinto their diet, they rapidly develop nearsightedness rates that equal orexceed those seen in Western societies.

◆ Children who develop myopia by the age of 10 have a diet that is lowerin energy intake, protein, fat, vitamins B1, B2 and C, phosphorus, ironand cholesterol (Optom Vis Sci, 1996; 73: 638–43).

◆ A further hypothesis linking diet to the development of myopia comesf rom ophthalmologist William Jory (b m j . c o m / c g i / e l e t t e r s / 3 2 4 / 7 3 4 7 /

1195#22422). He bases his work on his own studies done in North WestBritish Columbia on teenagers, contrasting both their high prevalence of myopia and greater height with their better-sighted, stockier parents.He suggests that this increase in long-bone measurement happenedalong with an increase in the axial length of the eye, causing myopia,and both were due to a sudden change of diet from high-protein meat and fish to a high-carbohydrate Western-style diet in a single generation. It was noteworthy, he says, that the further these tribes livedfrom a Western-style fast-food outlet, the lower the incidence of near-sightedness.

◆ Wearing rigid, gas-permeable contact lenses may slow the developmentof myopia. Several studies have indicated that children given this typeof contact lens benefit from a slowing of the expected progression ofshortsightedness. However, a major three-year trial, the CLAMP study,carried out by scientists at Ohio State University College of Optometryshowed that, although myopia progressed more slowly, their results didnot indicate that rigid gas-permeable lenses should be prescribed solelyfor myopia control (Arch Ophthalmol, 2004; 122: 1760–6).

◆ There are claims that eye exercises—and there are a number of different



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types—can improve nearsightedness, but there are no clinical trialsshowing any clear benefit. Perhaps the most famous of these is the Batesmethod, developed in the 1920s by American oculist William Bates andbrought to the public by writer Aldous Huxley in his much-reprinted1942 book on the Bates method, The Art of Seeing (Flamingo ModernClassics, 1994; see also Chapter 7, page 87).

◆ There is a growing interest in the impact of nutritional and lifestyle factors on eye health in general. The US Age-Related Eye Disease Study(AREDS) is an important ongoing study that may teach us a lot aboutways of preventing and treating the progression of eyesight problems inolder people. So far, significant benefits have been seen in the field ofage-related macular degeneration (AMD), which leads to a progressiveloss of sight. Nutrients included the antioxidant vitamins E, C and beta-carotene, and zinc with copper. In the AMD trial groups, those at highrisk of developing advanced AMD lowered their risk by about 25 percent when treated with megadoses of antioxidants combined with min-erals (Can J Ophthalmol, 2003; 38: 27–32; Arch Ophthalmol, 2001; 119: 1417–36;

Insight, 2002; 27: 5–7; see also Chapter 5, page 73).

Preventing farsightedness in the ageing eyeThere are two types of farsightedness: hyperopia and presbyopia. Hyperopia,where the eye is shorter than usual, is a condition you’re born with, but whichgets worse over time. Presbyopia is where eye muscles become rigid and theeye lens is less able to focus. This is usually noticeable around age 40, whenmany people find they are unable to focus sharply on close objects.

Medicine has no prevention or treatment for presbyopia other than varioustypes of corrective lenses. As the condition progresses, many end up with twosets of glasses—one for up-close work and one for seeing farther away.

However, a technique called ‘conductive keratoplasty’ (CK) uses radio-waves to create a constricting band of collagen around the eye to increasecorneal curvature, bringing near-vision back into focus. Known as ‘mono-vision’, it is only done on one eye, so the other eye can focus on the distance.Optometry can do the same thing with different fixed lenses, but it’s a com-promise, not a cure.

There are various things you can do to slow the progression of presbyopia



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and perhaps even improve vision.◆ Eat well. A diet that includes green leafy vegetables and grains will lower

your likelihood of eye diseases such as AMD and cataracts. Adequate pro-tein is also important as the eyes require all the essential amino acids.

◆ Take regular aerobic exercise, which encourages circulation and, thus, thetransport of nutrients to your eyes.

◆ Avoid long hours focused on a computer screen. Take frequent breaks toallow your eyes to focus naturally on faraway objects, and work under adequate, but not glaring, light.

◆ Clean eyes twice a day with cool, clean water.◆ Try Shiatsu or acupressure, and learn which acupoints can help to maintain

good vision and eye health. ◆ Avoid environmental toxins, like pesticides, which can damage the eye

(Invest Ophthalmol Vis Sci, 1981; 21: 700–13). Likewise, take care when using sham-poos and hair dyes, which can harm delicate eye tissues (Am J Optom Physiol Opt,

1982; 59: 1002–4). ◆ Manage chronic stress, linked to eye diseases like glaucoma, with biofeed-

back, meditation, yoga or tai chi. ◆ Avoid corrective lenses if you don’t need them as they may worsen vision

over time (Ophthalmic Physiol Opt, 2003; 23: 13–20).◆ Wear sunglasses as excessive exposure to heat and light can prematurely

age the eye (Dev Ophthalmol, 2002; 35: 40–59).◆ Do eye exercises. Visit www.visionworksusa.com for free general eye exer-

cises; or try the Bates method (Bates WH. Better Eye-sight Without Glasses,NY: Owl Books, 1981; www.seeing.org).

◆ Supplement with antioxidants (vitamins A, C and E) and 20 mg of luteinplus 1 mg of zeaxanthin daily, free-radical scavengers in the retina. Vin-pocetine (periwinkle) 5–10 mg/day improves blood circulation to the eye.

Improving your sight◆ Increase antioxidants. Increasing your nutritional supplementation is

important for good vision (Prog Food Nutri Sci, 1987; 10: 39–55). Aim forexcellent supplements that include vitamins A as well as B1, B2, B6 andB12, vitamin C (up to 3 g), high doses of vitamin D2, vitamin E and selenium, nicotinic acid, folic acid, para-aminobenzoic acid, calcium,



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choline and inositol, magnesium and potassium. ◆ Change your diet. The late ophthalmologist Stanley Evans recommend-

ed a high-protein diet with a minimum daily intake of 70–80 g of good-quality protein in the form of milk, eggs and other high-protein foods(Evans SC. Help for Progressive Myopes. Teecoll Publications, 1990). While carrotsare a useful source of beta-carotene, green vegetables may provide even more protection. In one study, a high intake of green vegetablesreduced the risk of AMD (JAMA, 1994; 272: 1413–20). This has been con-firmed by research which found that the foods richest in lutein andzeaxanthin, vital vision-saving substances, include kiwi, seedlessgrapes, celery, cucumber, pumpkin, spinach, butternut squash, cour-gettes, yellow squash, orange and green peppers, egg yolk, honeydewmelon and corn (Br J Ophthalmol, 1998; 82: 907–10).

◆ Avoid aspartame. While research is thin on the ground, some believethat a high consumption of aspartame-sweetened foods can contributeto eye problems. The sweetener’s reported eyesight-related side-effectsinclude decreased vision, blurring, bright flashes, tunnel-vision, blackspots, double-vision, pain, dry eyes and even retinal detachment. (Formore information, read Aspartame (NutraSweet): Is It Safe? [Philadelphia:Charles Press, 1990] or Sweet’ner Dearest: Bittersweet Vignettes AboutAspartame (NutraSweet) [Florida: Sunshine Sentinel Press, 1992] by H.J.Roberts).

◆ Herbs. A single dose (200 mg) of Vaccinium myrtillus extract (VME),from bilberry or European blueberry, was shown to bring about mea-surable improvements (via electro retinography) in patients withmyopia and glaucoma.

Another study with VME at 400 mg/day with 20 mg/day of beta-carotene found improved adaptation to light and night vision as well asenlargement of the visual field (Ann Oftalmol Clin Ocul, 1965; 91: 371–86).

Other studies show that VME combined with vitamin E can improvemyopia (Klin Monatsbl Augenheilkd, 1977; 171: 616–9).

◆ Pycnogenols (PCG), which contain vitamin C-like bioflavonoid nutri-ents, is made from the leaves of the hazelnut bush, the bract of the limetree and the bark of the maritime pine tree or grape seed (Vitis vinifera).PCG at 150–300 mg/day can significantly improve vision in the dark



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and after glare (J Fr Ophthalmol, 1988; 11: 452–60; Bull Soc Ophthalmol Fr, 1988;

88: 173–4, 177–9). In another small study, 85.7 per cent of myopic patients taking Vitis

vinifera grape seed experienced significant improvement—and 40 percent showed remarkable improvement—as determined by retinal mea-surements (Ann Aft Clin Ocul, 1988; 114: 85–93).

◆ Rule out chemicals and other toxins. Heavy-metal poisoning may contribute to visual problems, as can household toxins and pollutants.The link between chemicals and eyesight was publicised in the medicalpress in the 1990s when the fashion for ‘foam parties’ led to several eye-sight problems (N Engl J Med, 1996; 334: 474). The foam used was alkalineand probably not far removed from the kind of chemicals and deter-gents used in the average home.


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3Cataracts

The conventional wisdom among ophthalmologists tells us that, ifyou live long enough, you will get cataracts. Eye doctors believethat this clouding of the lens is an inevitable part of ageing, and that

surgical removal of the lens is the only solution for regaining your sight. If your cataract is at such an advanced stage that it obstructs your

vision and significantly impacts on your quality of life, cataract surgerymay be the only solution. However, what many doctors don’t tell you isthat it is possible to prevent early developing cataracts from getting worseand, if caught soon enough, it can even be reversed.

What are cataracts?Cataracts are described according to the site of the opacity. A ‘nuclear’cataract, commonly associated with ageing, affects the centre of the lensand causes a gradual loss in distance vision. A ‘cortical’ cataract developsfrom the cortex, or outside, of the lens towards the centre. These have little initial effect on vision but, as they grow towards the centre of the lens, light may be seen surrounding objects, especially shiny ones.‘Posterior subcapsular’ cataracts typically start near the centre of the lensand tend to advance rapidly, causing major vision loss within months.

What doctors tell youUp to some 15 years ago, cataract surgery involved making a small (11–12mm) cut into the lens to remove the cloudy nucleus. A clear artificial lens—an intraocular lens (IOL)—was then inserted and the incision sutured.

This has now been replaced by phacoemulsification, in which a specialprobe uses high-frequency ultrasonic waves to break up the lens into frag-ments, which are simultaneously vacuumed away through the hollow



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probe. This technique involves a much smaller incision (2–3 mm) and nostitches are required. Healing is also much faster, with patients regainingclear vision after only a day or two.

Given these technological advances, cataract surgery is now thought tohave low complication rates and better outcomes. This has led to manypatients being operated on earlier than before, as there is no longer anyneed to wait for the cataract to ‘ripen’ as they would have done in the past.

What doctors don’t tell youNevertheless, no matter how much the technology moves on, there is stillroom for error. Although the new-generation phaco systems can improvethe outcome of cataract surgery, high levels of skill and concentration arerequired to use these tools. And surgeons, being only human, can stillsometimes make mistakes.

“Phaco surgery is an unforgiving procedure because each step relies onthe success of the previous one,” says David Spalton, a consultant ophthalmologist at St Thomas’ Hospital in London. One badly performedincision at the start of the operation, for example, can make the whole procedure much more difficult and, indeed, jeopardise the whole opera-tion, he continued (Optometry Today, 2001, Sept 7: 28–33).

Among the various complications that can arise during cataract surgery,one of the most serious is ‘posterior capsular rupture’ (PCR), whereby thebag-like capsule that surrounds the lens is inadvertently torn. Althoughthe incidence of PCR is considered to be a “low” 3–4 per cent, the con-sequences can be serious. Patients who sustain a capsular tear duringsurgery are more likely to go on to suffer further complications such asretinal detachment, significant macular oedema, increased pressure withinthe eye and difficulties in positioning (centring) the artifical lens (Ophthalmic

Surg Lasers Imaging, 2004; 35: 219–24).These problems, in turn, can lead to a marked reduction in eyesight.

According to a study by a team of ophthalmologists at London’s Moor-fields Eye Hospital, eyes that suffered PCR were nearly four times morelikely to be below average in visual acuity (Br J Ophthalmol, 2001; 85: 222–4).

Another complication seen with phacoemulsification—especially whenolder-generation machines are used—is burns wounds to the cornea. The


● 3 Cataracts

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high-frequency ultrasound beam has to be concentrated to break up thecataract, but the downside of this is that the energy generates a lot of heatand, if the surgeon is not careful, this heat can cause thermal injury to thecornea, resulting in visual distortions, or astigmatism.

Another well-known postoperative complication is ‘posterior capsularopacification’ (PCO), also known as a ‘secondary cataract’. This happens in approximately 20 per cent of patients within the first five years follow-ing cataract surgery. PCO is caused by cells accumulating on the backsideof the lens capsule, which then becomes increasingly cloudy and begins tointerfere with eyesight in the same way as the original cataract did.

To get rid of this secondary cataract requires laser eye surgery, a pro-cedure that, in itself, opens up a gateway to yet another set of problems.

Types of cataractAccording to the late Stanley Evans, an ophthalmologist who cured many eye problems such as glaucoma and cataracts using a nutritional approach, of the number of different types of cataract, the one most commonly seenin the US is known as senile cataract. This usually begins after the age of 50, and is usually regarded as a normal consequence of ageing (com-parable to having gray hair).

Other forms of cataract are caused by metabolic disorders such as diabetes, or by outside influences such as toxins, trauma, radiation, pres-cription and over-the-counter medications, alcohol and tobacco. Sometypes of cataract are caused by orthodox methods of treating eye disorders.For example, pilocarpine drops, which are used for glaucoma, can causecataracts. This has been known for many years. Also, a study in the BritishMedical Journal (July 2, 1994), reported a case of steroid-induced glaucomaand cataracts (with irreversible visual loss) following prolonged, unsuper-vised use of topical steroid eyedrops.

The modern use of laser beams for different eye disorders is anotherhazard which can cause changes in the lens cells and precipitate cataractdevelopment, rendering the eye virtually useless.

Congenital cataract is rare in developed countries, but common in thedeveloping countries. It is present at birth, and is caused by either mal-nutrition and/or drugs, alcohol and smoking during pre g n a n c y.



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Nevertheless, the senile cataract of the developed countries is indistin-guishable from the majority of cataracts caused by malnutrition and nutri-tional deficiency in developing countries.

The exceptions demonstrate that, although age may be a factor in theonset of cataract, it is evidently not the root cause. Many people at 90 arefree of these eye disorders.

Exposure to ultraviolet raysOur daily exposure to ultraviolet (UV) radiation from the sun appears tobe a cause of cataract. Studies conducted with animals have shown thatprolonged exposure to UV light can damage the lens and retina of the eye(Shulman J. Cataracts: The Complete Guide—From Diagnosis to Recovery for Patients and

Families. Simon & Schuster, 1984). Other studies show that people with thegreatest exposure to UV rays, those who live in sunny areas or who workoutdoors, have a greatest risk of developing cataract (Executive Health’s Good

Health Report, May 1995). Excessive sunbathing, or exposure to UV rays reflected from surround-

ing objects such as road surfaces, buildings, sand and water—even whenyou are in the shade—can also increase the risk of cataract, even whenwearing sunglasses. And as the ozone layer becomes more and moredepleted, we are exposed to even more UV rays every day.

The US Environmental Protection Agency (EPA) estimates there will be 4.5 million additional cases of cataract in people born in the US by 2031(BMJ, November 23, 1991).

Daily exposure to UV rays increases the amount of free radicals in theeyes and triples the amount of hydrogen peroxide in the aqueous hu-mour—the fluid occupying the anterior chamber of the eye and the essen-tial vehicle of nourishment to all of the eye’s transparent components. Ifthe quality of this fluid is impaired, less nutrients will reach the lens andthe transparency of the optical structures will decrease.

Our eyes are built with an antioxidant defence system to protect itagainst the free radicals caused by oxidation and UV exposure. Accordingto researchers, the primary antioxidants used by the eyes are vitamin C,vitamin E, vitamin A and beta-carotene, glutathione and various minerals(Better Nutrition for Today’s Living, August 1995; BMJ, 1992; 305: 1392–4; Archives of


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Ophthalmology, February 1991). However, for some reason in some people, this defence mechanism is not doing its job.

How to prevent or delay cataractsSeveral factors contribute to cataract formation, including physiologicalfactors (such as age), medications (such as steroids and gout drugs), ill-nesses (such as diabetes, heart disease and hypothyroidism), and lifestyleand environmental factors (including smoking, obesity, UV and heavy-metal exposure).

Here are some tips to help you stave off cataracts for as long as possible:✔ Stop smoking. Men who smoke over 20 cigarettes a day had the high-

est risk of developing cataracts, and even previously heavy smokerswho had given up still ran a greater risk of cataracts (JAMA, 1992; 268:

989–93). It’s thought that the cadmium in cigarettes accumulates in thelens, and may enhance the accumulation of harmful lead and copper inthe eye (Br J Ophthalmol, 1998; 82: 186–8).

✔ Sport those sunglasses. Japanese researchers reviewing studies donein Japan as well as in Iceland, Australia and Singapore found that thosewho had the highest levels of sun exposure also had the greatest inci-dence of cataracts (Invest Ophthalmol Vis Sci, 2003; 44: 4210–4).

✔ Reduce/eliminate heavy-metal exposure. Long-term, low-level expo-sure to toxic metals—in particular, lead—results in its accumulation in the lens. Such a buildup increases the oxidative burden in the lens,leading to cataracts (JAMA, 2004; 292: 2750–4).

✔ Lose weight. Researchers at Harvard University discovered that peo-ple with a body mass index (BMI) of 30 or more increased their risk of cataract by at least a third compared with those who had a BMI of23 or less (Int J Obes Relat Metab Disord, 2002; 26: 1588–95).

Another study showed that it’s not just the weight that counts, buthow the fat is distributed. Those whose fat is concentrated around theabdomen (central obesity) are more likely to develop cataracts (Am J Clin

Nutr, 2000; 72: 1495–502).✔ Build up your antioxidants. The factors already mentioned under-

score the importance of maintaining a good antioxidant status in youreyes. Cataract-busting nutrients include:



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❖ vitamin A and carotenes. Researchers looking at the 12-year foodintake of over 77,000 nurses found that those who had more lutein and zeaxanthin in their diets had a 22 per cent lower risk of cata-racts (Am J Clin Nutr, 1999; 70: 509–16). Take 30,000–180,000 IU/day of vitamin A depending on cataract severity❖ vitamin C. A potent antioxidant, this vitamin also increases the levels and activity of glutathione (GSH), a polypeptide synthesisedin the lens that is crucial for maintaining antioxidants in the eye.One study—albeit in chicks and, thus, not necessarily applicable tohumans—found that vitamin C slowed the decline of GSH levels(Exp Eye Res, 1985; 40: 445–51). Take at least 2000 mg/day of vitamin C❖ vitamin E. There is a link between low levels of vitamin E and anincreased risk of cataracts. In patients with early-stage cataracts,100 mg of vitamin E twice daily significantly decreased cataractsize, and increased levels of GSH compared with a placebo (Ann Nutr

Metab, 1999; 43: 286–9). Take 100–450 IU/day of vitamin E❖ B vitamins. Folic acid is important for the production and main-tenance of new cells. An Italian study found that those who con-sumed more folic acid were less than half as likely to developcataracts compared with those who were deficient in this water-soluble form of vitamin B (Ann Epidemiol, 1996; 6: 41–6). Take 400 or 800mcg/day of folic acid❖ selenium. A deficiency of this trace mineral is seen in the eyes ofpeople with cataracts, indicating a defective antioxidant systemleading to lens changes (Acta Ophthalmol Scand, 1995; 73: 329–32). Take600 mcg/day of this mineral❖ riboflavin. This B vitamin (B2) is essential for GSH function. Onelaboratory study found that adding flavin adenine dinucleotide(FAD), a riboflavin derivative, to surgically removed cataractsrestored GSH activity (Curr Eye Res, 1987; 6: 1249–56). As B vitaminstend to work together, take B-complex supplements, which usually contain either 50 or 100 mg of riboflavin❖ bilberry (Vaccinum myrtillus). Traditionally used for various eyeconditions, this herb contains anthocyanosides, potent antioxi-dants that are particularly beneficial to the eye and blood vessels.


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In one Italian study, a four-month course of bilberry and vitamin E halted the progression of cataracts in 96 per cent of the studypatients (Ann Ottalmol Clin Ocul, 1989; 115: 109). Take one to two 60-mg(standardised to 25 per cent anthocyanosides) bilberry capsules threetimes a day.

Nutritional helpProper nutrition is the key to maintaining a healthy amount of antioxi-dants in the lens. The late Stanley Evans studied the connection betweennutrition and vision for around half a century. He developed his nutrition-al approach to treating vision problems in Britain in the 1940s, and thenspent 17 years in Nigeria on an extended research programme into thecauses and prevention of blindness.

He made the connection between many eye disorders and nutritionaldeficiency and, after studying which nutrients affected which parts of theeye, he developed a dietary therapy that has helped thousands of cataractpatients.

Mr Evans’ work in Africa demonstrated that cataract is essentially anutritional disorder. In the developed countries, a person’s nutritional sta-tus is reduced by changes in metabolism caused by ageing, which is stillfurther compromised by exposure to UV rays and, in many cases, alcohol,careless eating habits, smoking and stress brought on by illness or pre-scription drugs.

But if the patient improves his diet and maintains a good nutritional status, similar to the treatment used for vision problems in developingcountries, Evans’ research confirms that cataract isn’t likely to develop. He even found that, in many cases when cataract does develop, a properdiet and nutritional intake can arrest its growth.

At the onset of cataract, the protein cells of the lens begin to changegradually. As this change progresses, the cells continue to become lessclear until vision is lost.

If nutritional status is raised before this cycle is complete, according to Evans, the visual acuity can often be restored. As long as the patientmaintains this nutritional status, the cataract won’t develop further andsurgery can be avoided.



44

It has been found that patients with cataract have lower levels of vita-min C, vitamin E and beta-carotene than those without cataract. Thissparked a series of studies focusing on the effects of specific nutritionalsupplements for treating cataract. One study showed that supplementingwith vitamins C and E helped to reduce the risk by 50 per cent (Am J Clin

Nutr, January 1991).A team of Finnish researchers followed a group of men and women,

aged 40 to 83, for 15 years. They found that those who had low serum concentrations of vitamins C and E and beta-carotene had an increased risk of developing cataract as they aged (BMJ, 1992; 305: 1392–4).

Another study, published in The Archives of Ophthalmology (February1991), found that older people who ate a good deal of fruits and vegetables,or took a daily vitamin supplement, were 37 per cent less likely to developcataracts.

Likewise, researchers at Harvard University found that women who atea diet rich in fruits and vegetables (especially those rich in carotenes) hada 39-per-cent lower risk of developing severe cataracts than those with alow carotene intake (BMJ, August 8, 1992).

A study that appeared in The American Journal of Public Health (1994; 84:

788–92) found that supplementing with multivitamins can also reduce therisk of cataract.

Vitamins, minerals and enzymesIt is important to realise that the antioxidant vitamins, minerals andenzymes work synergistically. This means that the effectiveness of one ofthese three nutrients is always dependent on the presence and effective-ness of the other two.

Dr Leslie H. Salov provides a good description of the relationshipsbetween the various antioxidants in the eyes in their book Hidden Secrets forBetter Vision (Fischer Publishing Corp, 1995). As he explains, too muchlight can destroy vitamin C; however, the polypeptide glutathione helps to ‘reactivate’ vitamin C.

Similarly, riboflavin (vitamin B2) is a key factor in the production of glutathione reductase, an enzyme that activates glutathione. Vitamin E andselenium are also essential in the production of glutathione. A deficiency


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in any of these antioxidants will result in the failure of another.

Vitamin A and beta-caroteneVitamin A is facilitated by the essential mineral zinc. The transparency of the cornea is dependent on adequate supplies of this vitamin. A defi-ciency can lead to difficulty in adjusting to changes in lighting, degenera-tion of the mucous membranes of the eye, drying of the cornea and, ulti-mately, degeneration of the delicate cells of the eye—first seen as cloudingof the lens, followed by ulceration and complete lens destruction.

A deficiency in zinc, the symptoms of which resemble vitamin A defi-ciency (such as night-blindness), could lead to a deficiency of vitamin A.

Other important nutrients that work in conjunction with vitamin Ainclude vitamin C and the B-complex vitamins (Health News & Review, Summer

1992).Beta-carotene is normally converted into vitamin A in the body. How-

ever, it also, in itself, acts as an antioxidant. Studies have shown that lowlevels of beta-carotene also increase a person’s risk of developing cataract(Nutrition Research Newsletter, March 1993; JAMA, March 3, 1993).

Vitamin CNot only is vitamin C essential as an antioxidant, but it is also vital to thecrystalline lens and the normal growth of the lens fibres. It has been shownthat low levels of vitamin C indicate an increased risk of developingcataract (American Journal of Clinical Nutrition, January 1991; Nutrition Research

Newsletter, March 1993). An animal study by cataract authority Dr Shambhu D. Varma, of the

Department of Ophthalmology at the University of Maryland MedicalSchool, showed that rat lenses that had lost transparency as a result ofexposure to free radicals were protected by the same free radicals whenfortified with vitamin C (Lens Research 2, 1984–85). Canadian researchersfound that subjects who did not supplement with vitamin C increasedtheir risk fourfold (Nutrition Research Newsletter, March 1993).

GlutathioneMany researchers agree that glutathione is the primary defence mecha-



46

nism of the eye (Ophthalmic Res, 1986; 18: 236–42). One researcher, Dr WilliamB. Rathbun, of the University of Minnesota School of Medicine, has beenstudying glutathione for over 25 years. Dr Rathbun claims that gluta-thione, a peptide containing the amino-acid cysteine, is in short supply inmost people. He believes that the best way to ensure proper amounts is to get enough vitamin C, vitamin E and selenium.

Glutathione is normally found in high concentrations in the cornea and lens of the eye. As pointed out earlier, researchers believe that one reason for the development of cataracts is a riboflavin deficiency, as gluta-thione, found in short supply in cataract, is dependent on riboflavin (Better

Nutrition for Today’s Living, August 1995).According to Dr Eric R. Braverman in the book The Healing Nutrients

Within (Keats Publishing, 1997), glutathione reductase was reduced by 25per cent in the lens of animals with cataracts due to a riboflavin deficiency.

Vitamin E is another nutrient that plays a significant role in the effec-tiveness of glutathione (Townsend Letter for Doctors, June 1995).

Early detectionThe responsibility to notify the patient immediately as soon as a change inthe lens is first discovered rests squarely on the practitioner, so that thepatient has the opportunity to seek help from a nutritionist. The prejudicewith which most eye doctors view nutritional therapy robs the patient of the opportunity of obtaining help, so that he is finally obliged to acceptthe surgeon’s knife as the only solution.

When you are having your eyes examined, always ask your doctorwhether cataract development has commenced or whether there are anysigns that it might develop. If he doesn’t answer your questions satisfac-torily, be insistent. If a cataract has started to develop, instead of waitingfor it to be ‘ripe’ enough for surgery, seek ophthalmic nutritional therapyat once, since more help can be given in the early stages.

The first thing to do is to stop smoking and abstain from alcohol. If youhave been prescribed drugs for any condition, find out if they are likely tocause cataract. If so, ask your doctor to change the drug. Cortisone andother steroids are common culprits.

A good doctor familiar with ophthalmic nutritional therapy should


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examine you for evidence of ocular suppression or abnormality. Your dietwill also be analysed and corrected when necessary. Your eyes will also bephotographed and tested for intraocular tension.

The Evans treatment for cataractsHere’s the nutritional regimen Mr Evans recommended for cataracts,based on his work in Africa. For any patient with cataract, supplementsshould include the following:✔ P r o t e i n, in the form of milk and/or powdered milk or egg products,

or other high-protein foods. The patient’s diet should also be assessed andadjusted to increase protein intake. A minimum intake in cases of eye disorder is70–80 g/day

✔ Dextrose or g l u c o s e, essential to maintain the transparency of the crystalline lens. Take at least 9–15 g/day

✔ Vitamin A, 30,000–180,000 IU/day, according to the eye condition being tre a t e d✔ Vitamin B1, 5–15 mg/day✔ Vitamin B2, 4–12 mg/day✔ Vitamin B6, 4–12 mg/day✔ Vitamin B12, 0.1–0.5 mg/day✔ Vitamin C, 400–3800 mg/day✔ Vitamin D2, 300–3000 IU/day✔ Vitamin E, 100–450 IU/day✔ Vitamin K, essential for normal circulatory function; a deficiency renders the

patient susceptible to haemorrhage. Besides ensuring a much higher rate ofsuccess in eye surg e r y, this vitamin also assists in controlling any possibleh e m o r rh a g e

✔ Nicotinic acid, 15–45 mg three times daily✔ Folic acid, 2–6 mg/day✔ Para-aminobenzoic acid, 10–30 mg/day✔ Calcium pantothenate, 10–30 mg/day✔ Calcium lactate, 250–750 mg/day✔ C h o l i n e, 250–750 mg/day✔ I n o s i t o l, 250–750 mg/day✔ M a g n e s i u m, essential for normal muscle and nerve control, 3 5 – 1 00 mg/day ✔ Potassium, 35–100 mg/day



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✔ Iron and other minerals shown to be necessary to the patient.

The success storiesHere are a few examples out of the hundreds of patients in Britain andAfrica successfully treated with the late Mr Evans’ nutritional therapy.◆ A 55-year-old woman had vision in the right eye that was 60 per cent

of normal. She was only able to count fingers with the left eye. The ophthalmoscope revealed a central opacity in the right eye, while theleft eye was totally clouded.

After one month of nutritional therapy, the vision in the right eye had improved to 150 per cent of normal (still abnormal, but muchimproved), while vision in the left eye had improved to 15 per cent of normal. The media in the right eye was completely clear.

◆ Cataract had begun to develop in a 32-year-old man three weeks beforebeing seen by Mr Evans. The vision in his right eye had fallen to 20 percent of normal, while the sight in the left eye was 200 per cent of normal.The right eye was “milky”, as is so often the case with rapidly develop-ing cataract.

After four weeks of nutritional therapy, the vision in the right eye had improved to 100 per cent of normal. The ophthalmoscope revealedthat the media in the right eye was reasonably clear.

◆ A little girl, aged nine, had cataracts that had developed three weeksbefore she was seen by Mr Evans. The child was very underfed. The parent had taken her to the chemist because the pupil of the right eyewas white, for which the chemist gave her antibiotics. After using theantibiotics for three weeks, and finding that the whiteness was gettingworse, the mother took the child to Mr Evans’ eye centre. The antibioticsno doubt further reduced an already low nutritional state. The sightin the right eye was so bad that the child could perceive only handmovements, while the left eye had perfect sight. The ophthalmoscoperevealed a full-aperture, milky cataract in the right eye.

After four weeks of nutrition therapy, the child’s vision had improv-ed to 16.7 per cent of normal. The refraction of the eye was alsoimproved and brought the eyesight up to normal.

This case demonstrates how nutritional deficiency is often the sole


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cause of cataract, even in children, and that, once a cataract has beensorted out nutritionally, there may also be a marked reduction ofmyopia. This also suggests that a basic flattening of the lens is the resultof malnutrition.

◆ A 60-year-old man could only count fingers with his right eye, while hisleft eye had vision that 10 per cent of normal. A full-aperture cataractcovered each eye. Two weeks of nutritional therapy raised the visualacuity in the right eye to 20 per cent of normal and to 30 per cent of normal in the left eye.

◆ An 80-year-old man with a full-aperture cataract in each eye and eye-sight that was 10 per cent of normal came to Mr Evans for nutritionaltherapy. Within two weeks, the patient’s vision improved to 50 per centof normal.

According to Jane Heimlich in What Your Doctor Won’t Tell You, two eyespecialists in the United States have had similar results.

The late Gary Price Todd, ophthalmologist and author of Nutrition,Health and Disease (Norfolk and Vi rginia Beach, VA: The DonningCompany, 1985), stumbled on his nutritional approach. His story is similarto Evans’. While doing research in Ethiopia, he discovered that eye diseasewas common in children, and blindness endemic in people over 40; he alsomade the connection with their obviously deficient diet.

After experimenting with various supplements in his private practice in Waynesville, North Carolina, Todd came up with this approach. A hairanalysis is done on the patient to determine whether there is heavy-metalpoisoning (true in one-third of all patients) or any mineral deficiencies. Ifso, minerals are prescribed to cover any deficiencies, plus supplementsthat include beta-carotene (a form of vitamin A), vitamin E (400 IU)bioflavonoids, B-complex vitamins and the enzyme glutathione, consid-ered by some researchers to prevent oxidation of the lens (a natural occur-rence that accelerates with age).

Todd claimed that 51 per cent of his patients no longer needed surgeryand, according to a two-year study of 50 patients, 88 per cent hadimproved their eyesight with his treatment regime. Of 18 blind patients, 54per cent had their sight restored.

S a d l y, he was also hounded by the American Academy of



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Ophthalmology and the North Carolina Board of Medical Examiners,which attempted (unsuccessfully) to revoke his medical licence.

Dr Stuart Kemeny is an eye, ear, nose and throat specialist, with trainingin ophthalmology. Kemeny’s treatment regimen includes a multivitamin/mineral supplement containing glutathione, ultraviolet light-absorbingglasses, eyedrops containing glutathione and phenoxazine carboxylic acid,plus an extra 400 IU of vitamin E two or three times a day (but only oncea day if you have high blood pressure), 100 mcg of selenium twice a day,500 mg of vitamin C with bioflavonoids two or three times a day, 100 mgof vitamin B (unless you have cancer) and 30,000 IU of vitamin A with zinc.

His first clinical study in 1980 showed that 54 per cent of the patientshad improved their vision and, two years later, 85 per cent of them haddone so.


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4Glaucoma

Just as we are advised to watch our blood pressure as we get older,the pressure within our eyes is equally at risk with advancing years.

Changes in the ageing eye can lead to less-effective drainage of the clearfluid (aqueous humor) in the eye, resulting in a buildup of intraocularpressure (IOP). A dangerously elevated IOP, or ocular hypertension(OHT), is a major risk factor for glaucoma.

The condition is the third-leading cause of blindness in the world. It can strike at any age, but the elderly are particularly susceptible. Currentestimates of the incidence of glaucoma are a staggering 100–150 millioncases worldwide. With our ageing population—increasing by 50 per centin the US alone over the next 15 years—the numbers are expected to soardramatically (Arch Ophthalmol, 2004; 122: 532–8).

Notorious for its lack of symptoms, glaucoma can cause progressivedamage to the optic nerve without your realising it. The damage ofteninvolves loss of peripheral vision, which is not easily apparent. It’s onlywhen your field of vision has been seriously reduced (when patients com-plain of bumping into things a lot) that the sufferer is likely to finally head off to see a doctor.

What does it do?Glaucoma causes damage when the eye pressure becomes elevated, due toan obstruction in the flow of the aqueous humor, eventually injuring theoptic nerve.

The aqueous humor normally maintains a pressure of 10–20 mmHg tomaintain the shape of the eyeball. If the flow is blocked, the pressureincreases. Exactly how the fluid is blocked determines what type of glaucoma you have.



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◆ Primary open-angle glaucoma (chronic glaucoma) is the most common. Itis characterised by clogged drainage canals that stop the flow of theaqueous humor. Symptoms of this type of glaucoma usually go un-detected because the gradual loss of peripheral vision is not readilyapparent to the patient.

◆ Primary angle-closure glaucoma (acute glaucoma) is more rare than open-angle glaucoma. It occurs when the drainage of the aqueous humor isblocked by the iris pushing against the cornea. This form usuallyappears suddenly, with symptoms such as a dull, severe, aching pain,blurred vision, nausea and vomiting, and the perception of a rainbowand halo around lights and bright objects.

The terminology surrounding glaucoma is somewhat confusing. There arelots of different types and combinations, including:◆ Low-pressure glaucoma, where eye-fluid pressure is normal, or below

normal, but the patient experiences loss of side vision. This is nowthought to be caused by constricted veins.

◆ Ocular hypertension, where the eye-fluid pressure is elevated, but noother signs of glaucoma are evident.

◆ Steroid-induced glaucoma, where steroids contribute by helping to impedethe eye’s drainage canals.

◆ Pigmentary glaucoma, where pigment flakes off from the back of the irisand clogs up the drainage canal. This variety of glaucoma was firstreported in 1949 and may be induced by physical exercise (Ophthalmology,

1992; 99: 1096–103).◆ Pseudoexfoliative glaucoma, where particles flake off from the lens of the

eye and are trapped in the drainage canal. This causes eye-fluid pressureto rise.

◆ Allergic glaucoma, where the release of histamine clogs up the drainagecanal.

◆ Optic nerve disease (a secondary condition to toxins such as tobacco oraspartame), where the patient suffers from malnutrition, perniciousanaemia and malabsorption.

◆ Glaucoma secondary to inflammation, caused by viral infections or otherinflammatory conditions; 28 per cent of patients with herpes eye infec-tions have secondary glaucoma (Glaucoma, 1991; 13: 40–3).


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Are you at risk?While symptoms are rare, there are a number of risk factors that doctorsconsider to determine whether or not you should undergo regular screen-ing tests for glaucoma.

The most obvious of these risks is a raised intraocular pressure. If your pressure is above the norm, your doctor may want to consider per-forming additional tests to evaluate the health of the optic nerve.

However, a high pressure reading does not always indicate glaucoma.Also, a normal pressure reading does not mean you don’t have glaucomaor that you’re not at risk.

While there are over 20 types of glaucoma, the term is most often usedto describe primary open-angle glaucoma (POAG), or chronic glaucoma,the most common form. Here, the aqueous humor—the nutrient fluid pro-duced by the ciliary body (a small gland in the eye)—doesn’t drain prop-erly from the eye and into the bloodstream. Pressure then builds up with-in the eye, resulting in damage to the optic nerve, which has the job oftransmitting visual messages to the brain.

However, although hypertension in the eye’s blood vessels is a key riskfactor for glaucoma, not all rises in eye pressure inevitably cause visualdamage: in some people, the optic nerve is strong enough to withstand theincreased pressure. Equally, those with particularly weak optic nerves can develop glaucoma even if their eye-pressure readings are normal.

Who are those most at risk? Anyone can develop glaucoma, but the risk is significantly greater for those over 40, and the risk doubles for thosewho are aged 75–80. It is suggested that age-related changes to variousparts of the eye may be responsible for the loss of fluid regulation withinthe eye.

Race is another important factor. In a study funded by the US NationalEye Institute, researchers at Johns Hopkins University, in Baltimore, Mary-land, found that glaucoma is three to four times more likely in people ofAfro-Caribbean origin than in white Europeans, and strikes them at ayounger age (Arch Ophthalmol, 2004; 122: 532–8).

Other high-risk groups include family members of those already diag-nosed with the condition, and people who are extremely shortsighted, diabetic or suffering from high blood pressure.



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Glaucoma can also be due to drugs (Drug Saf, 2003; 26: 749–67), including:❖ corticosteroids (these mainly cause or worsen POAG) ❖ sulpha-based drugs❖ antidepressants❖ anticoagulants❖ antihistamines/antacids (H1-/H2-receptor antagonists).

Ironically, drugs such as adrenergic agonists and cholinergics, which areoften used to treat glaucoma, can also sometimes bring the condition on.

As prevention is always better than cure, those who belong to thesehigh-risk groups should have their eyes regularly checked—that meansgoing to your optician’s for that annual eye test—and their eye pressuremonitored.

Glaucoma testsOnce your risk has been determined, your doctor needs to decide whattests to perform. This is where the controversy begins.

There are a variety of tests and instruments your doctor can use. Butthere is also a number of questions surrounding their use: Which tests are more accurate? Which are most cost-effective? Are mass screeningsnecessary and effective? What combination of tests should be used?

There are three types of tests to choose from. They are rated accordingto sensitivity (the higher the sensitivity, the fewer false-negative results)and specificity (the higher the specificity, the fewer the false-positiveresults).

Intraocular-pressure testsTonometry measures the pressure of the fluid within the eye (intra-

ocular pressure). At one time, tonometry was the only test doctors wouldconduct. Mass screenings were organised in an attempt to detect as manycases of glaucoma in the early stages as possible while, at the same time,heightening people’s awareness of the serious nature of glaucoma.

However, it was soon found that tonometry alone did not have thegreatest sensitivity (50–70 per cent) nor specificity (only 10–30 per cent) (Am J Ophthalmol, December 1995). Doctors then had to consider using tonom-etry in combination with other tests.

1.


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Visual-field testsThese tests measure the total area perceptible while looking straight

ahead, including areas beside, below and above the centre line of vision. Most people with glaucoma gradually begin to lose their peripheral

vision first. However, this usually goes undetected by the patient untiltheir central line of vision is affected.

Some doctors view visual-field tests as impractical because of the needfor large, specialised equipment, trained personnel, and 10–20 minutes ofexamination time (Am Fam Phys, December 1995). However, others agree thatsome form of this test is necessary to overcome the limitations of tonome-try. It is also considered cost-effective and accurate (Am J Ophthalmol,

December 1995).

Optic-nerve testsExamination of the optic nerve using an ophthalmoscope is thought

to be one of the most underused tests for glaucoma. The ophthalmoscopecan determine changes in the nerve before problems with the visual fieldare detectable.

This has been found to be the most sensitive and cost-effective test forglaucoma (Am Fam Phys, December 1995). Researchers agree that ophthalmos-copy should be mandatory, but not on its own. Routine tonometry andoccasional visual-field testing is also suggested (BMJ, March 4, 1995).

Tests are being assessed that can determine the retinal function of theeye. These include colour-vision analysis, blue-on-yellow-field-testing,contrast sensitivity, and dark adaptation (Am Fam Phys, December 1995).

One study, sponsored by the US National Eye Institute, found no differ-ences among patients treated with eyedrops and those left untreated. Thereport also claims that no study has used a long-enough follow-up periodto establish that drug therapy prevents blindness. At best, the drugs willdecrease the amount of optic-nerve damage.

The US Preventive Services Task Force does not recommend massscreening for people under 65, and suggests that drugs should only be considered for patients with an intraocular pressure above 35 mmHg(HealthFacts, June 1995).

2.

3.



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Dangers of drug treatmentsDrugs are big business in the glaucoma field. The way doctors prescribeeyedrops (sometimes combining two or more types) to glaucoma patientshas helped to rake in big profits for the ophthalmic drugs industry. World-wide sales of medicated eyedrops for glaucoma average USD$3billion each year, and account for almost half of the total ophthalmic pharma-ceutical market.

Given the predicted rise in glaucoma cases in tandem with the ageingpopulation, that sound you can just about hear is the drug companies rubbing their hands in anticipation.

But these seemingly innocuous drops—which, in most cases, have to betaken for life—cause a laundry list of side-effects, and are often as danger-ous to the body as drugs taken by mouth. ◆ Miotics such as pilocarpine work by constricting the pupil and stimu-

lating the ciliary muscles to increase the drainage of fluid from the eye.Downside: Because miotics reduce the size of the pupil, a common

complaint is blurred or dim vision. This could also artificially inducenight-blindness. Also, as these eyedrops need to be administered fourtimes a day, patients may find it difficult to keep track of their regularuse as prescribed.

◆ Carbonic anhydrase inhibitors are available as eyedrops (Trusopt,Azopt) or in an oral form (Diamox). These agents inhibit the enzymeinvolved in producing the aqueous humor, thereby decreasing IOP.

Downside: Chronic use of these drops can cause an allergic response,with redness and itching of the eye (conjunctiva) as well as scaling on the lower eyelids. When taken orally, the side-effects stretch consider-ably to include frequent urination, tingling in the fingers/toes, skinrash, gastrointestinal disorders, depression, fatigue, impotence, weightloss and lethargy.

◆ Alpha-adrenergic agents (Alphagan, Iopidine) reduce the production of eye fluid while increasing its outflow rate.

Downside: The most common side-effects are burning or itching of the eye, browache, headache, a slight raising of the upper lids, dryeye/mouth/nose, light sensitivity, dizziness, mild sedation, fatigue and depression.


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◆ Beta-blockers have been the mainstay of glaucoma treatment followingtheir launch in the late 1970s. They lower eye pressure by reducingaqueous production. Despite their eroding popularity due to the arrivalof the newer prostaglandin analogues (see below), these agents are stillcommonly prescribed for ocular hypertension and glaucoma.

Downside: Beta-blockers as eyedrops can cause the same systemicadverse effects as when taken orally. The most common side-effectsinvolving the eye include superficial punctate keratitis (scattered pin-points of corneal inflammation), corneal numbness and visual distur-bances (J Am Optom Assoc, 1985; 56: 108–12; Am J Ophthalmol, 1979; 88: 739–43).

Beta-blockers are either non-specific (targetting both beta-1 and -2receptors) or specific (targetting either beta-1 or -2 receptors). Non-specific drops such as timolol (Timoptic, Betimol), levobunolol(Betagen) and carteolol (Ocupress) are generally thought to be moreeffective in lowering intraocular pressure than specific beta-blockerssuch as betaxolol (Betoptic). However, the latter comes with fewer systemic side-effects.

Beta-blocker eyedrops, as with all other ophthalmic drops, enter the body via tear ducts that connect with the nasal cavity. This enablesthe drug to bypass the liver and directly enter the body’s circulation.Consequently, a significant amount of drug is absorbed—a typical dose(one drop of 0.5 per cent timolol solution in each eye) is as potent as a10-mg oral dose for treating hypertension and angina (Ophthalmology,

1984; 91: 1361–3). It’s well known that beta-blockers come with an extensive list of

side-effects—some of which may be lethal. A review of nearly 550reports of adverse reactions with timolol, sent to the National Registryfor Drug-Induced Ocular Side Effects, found that half of these werelinked to systemic reactions affecting the heart, lungs, central nervoussystem, digestion and skin (Ophthalmology, 1980; 87: 447–50).

Cardiovascular effects range from arrhythmias (heart-rate distur-bances) to full-blown congestive heart failure (Clin Physiol Funct Imaging,

2002; 22: 271–8; Acta Anaesthesiol Scand, 1996; 40: 379–81; Am J Hosp Pharm,

1981; 38: 699–701). Ironically, these drugs, which are supposed to help con-trol high blood pressure, cause disturbances in blood-fat levels, which



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could be a risk factor for heart disease. Several studies have shown howbeta-blockers alter the ratio of low-density lipoprotein (LDL, the ‘bad’cholesterol) to high-density lipoprotein (HDL, the ‘good’ cholesterol).

A study of postmenopausal women with either eye hypertension orglaucoma found that those treated with timolol had significant decreas-es in HDL cholesterol, while total (and LDL) cholesterols were increased(J Glaucoma, 1999; 8: 388–95).

Respiratory problems are also a common complication of beta-blockers, particularly in those with a history of lung disease. One casereport described a 67-year-old man with stable chronic obstructive lungdisease going into respiratory arrest just 30 minutes after receiving hisfirst dose of timolol (Chest, 1983; 84: 640–1). Another report told of a 74-year-old long-term asthmatic who developed a severe—and fatal—attack of asthma several hours after taking timolol (Nihon Kyobu Shikkan

Gakkai Zasshi, 1990; 28: 156–9).Nevertheless, drug-induced respiratory side-effects such as breath-

lessness and increased exercise intolerance are often overlooked or written off by doctors as simply being normal signs of ageing among the elderly (who make up the majority of glaucoma sufferers).

Central nervous system side-effects with beta-blockers includedepression, psychosis, hallucinations, confusion, fatigue, insomnia andimpotence (J Clin Psychopharmacol, 1987; 7: 264–7; JAMA, 1986; 255: 37–8).

◆ Prostaglandin analogues such as latanoprost (Xalatan), bimatoprost(Lumigan) and travoprost (Travatan) have toppled beta-blockers offtheir dominant position in the glaucoma drugs market. They lower eyepressure by increasing the size of the ‘holes’ in the drainage system,allowing more fluid to flow out of the eye. The popularity of prosta-glandins for glaucoma therapy has been attributed to their superior eye-pressure-lowering effects (Br J Ophthalmol, 2004; 88: 1391–4) and theireasy-to-comply-with, once-daily dosing.

Downside: All three types of prostaglandins often cause bizarrechanges in eye colour and eyelashes. The eyes may darken due to anincrease in melanin (the eye-colour pigment) in the iris; there may bedarkening of the skin on the eyelids and sometimes under the eyes; and the eyelashes may increase in length and thickness (a benefit).


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Uveitis (inflammation of the nourishing membrane of the eye) is amore serious side-effect commonly seen with latanoprost (Ophthalmology,

1998; 105: 263–8). Glaucoma patients with a history of uveitis were mostlikely to have a flare-up, and a small number of patients with no previ-ous uveitis also developed the condition after using latanoprost eye-drops (Acta Ophthalmol Scand, 1999; 77: 668–72).

Latanoprost can also reactivate the herpes simplex virus and triggerbouts of herpes simplex-related keratitis (Arch Soc Esp Oftalmol, 2000; 75:

775–8; Am J Ophthalmol, 1999; 127: 602–4). In these cases, only stopping thelatanoprost solved the problem.

Prostaglandin eyedrops can also induce macular swelling, especiallyin people who have undergone cataract surgery (Am J Ophthalmol, 2002;

133: 403–5), and they may also cause eye pressure to fall too low, result-ing in eye damage due to detachment of the choroid (the thin vascularlayer between the whites of the eye and the retina) (Am J Ophthalmol, 2001;

132: 928–9). Prostaglandins have been hailed by the medical profession as the best

tolerated eyedrops with the fewest systemic side-effects. Nevertheless,latanoprost can cause cardiovascular effects as well as headache andfacial rash (J Ocul Pharmacol Ther, 2003; 19: 405–15; BMJ, 2001; 323: 783). A casereport from Germany described a young patient using a beta-blocker–latanoprost combination drug treatment to treat his aniridiaand glaucoma having to endure heavy sweating over his entire body for up to two hours due to using the drops (Ophthalmologe, 1998; 95: 633–4).A study comparing latanoprost with the alpha-adrenergic brimonidinefound that nearly half the patients using latanoprost complained of“hands and feet that became cold easily” (Ophthalmology, 2002; 109: 307–14).

Eyedrops in your lensesIn acknowledgement of these drug side-effects, the medical industry isnow working on a new generation of treatments for glaucoma as well asfor hard-to-treat retinal diseases. These novel ideas include contact lensesthat incorporate nanotechnology to deliver drugs directly into the eye.

Medicine understands that 95 per cent of the medication administeredvia eyedrops drains into the nasal cavity and enters the bloodstream—



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hence, the adverse systemic effects. The assumption is that, if a drug can be directed to only go where it’s needed, then most of the unwanted side-effects will disappear.

While this appears to be a valid line of reasoning, there is still the issueof the delivered drugs themselves and their long-term risks. Eyedrops or high-tech contact lenses—they are both just time-bombs in different gift-wrapping.

CorticosteroidsA c c o rding to the late Stanley Evans, serious damage has been done to the eye by the use of steroid and cortisone drops.

In a number of cases, cortisone drops cause the pupil to be fully dilatedand paralysed and, so, intolerant to light. The oversized pupil (often in just one eye) is also disfigured. And in some cases, even after the drug had caused the damage, it was still being prescribed. In yet other cases,steroid and cortisone drops have been used to treat eye infections, causingserious corneal ulceration; besides impairment of vision, this also causeddisfigurement.

The side-effects of these eye drugs have been well documented. In 1975,T.F. Schlaegel reported to the American Academy of Ophthalmology thatthe use of corticosteroids can cause serious eye disturbances, some ofwhich have caused blindness, including optic-nerve changes, swelling ofthe optic-nerve head, changes in the crystalline lens and myopia.

There have also been reports in various medical journals concerningpatients treated with steroids for arthritis developing cataract, and patientsusing steroids to relieve the discomfort of contact lenses subsequentlydeveloping cataract or glaucoma.

Other reported side-effects include extensive and irreversible retinaldamage, corneal perforation necessitating corneal transplants, an increasein intraocular tension in glaucoma patients, swelling of the optic disc andother eye disturbances.

Surgical approaches to glaucoma treatmentLaser and surgical treatments are available for glaucoma, but these areoften aggressive, invasive procedures and, despite advances in technology,


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still second in line—after drugs—as a standard glaucoma treatment, oronly reserved for cases where drug therapy has failed.

The more commonly available surgical procedures include:◆ argon laser trabeculoplasty (ALT). The most frequently performed laser

procedure for open-angle glaucoma, this uses an argon laser to burn50–100 ‘spots’ in the eye’s drainage system—the trabecular meshwork,the spongy tissue at the front of the eye—to improve eye-fluid flow.

The effectiveness of ALT varies but, in general, it controls eye pres-sure best within the first year of treatment. After that, it becomes lessand less effective so that most patients need to either go back to drugsor undergo further laser treatment (Am J Ophthalmol, 1995; 120: 718–31).

◆ selective laser trabeculoplasty (SLT). This is considered to be gentlerthan ALT as, instead of creating thermal burns, it targets the melaninpigment in cells of the trabecular meshwork, triggering a cellular reac-tion that improves fluid drainage.

It works as well as ALT, lowering eye pressure in nearly 90 per centof eyes. And, as SLT is less aggressive, it is more suitable for repeat treat-ments (Arch Ophthalmol, 2003; 121: 957–60).

◆ trabeculectomy, or filtrating microsurgery. This is the usual non-lasersurgery for glaucoma. It involves removing a piece of tissue frombetween the sclera (the whites of the eyes) and the trabecular meshwork,thus creating an alternative route for the aqueous fluid to escape. Thefluid is then channelled into a reservoir, or ‘bleb’, under the eyelid, fromwhere it is eventually absorbed into blood vessels.

This has a high success rate (nearly 95 per cent two years after treat-ment), but still relies on the use of antimetabolites (in the form of eye-drops) to ensure that the bleb doesn’t heal and close up.

◆ non-penetrating filtrating surgery. This procedure is less invasive thana trabeculectomy as the surgeon only works on the outermost layer ofthe eye.

However, it is trickier to perform, and has a success rate of only 60per cent (Chin Med J [Engl], 2004; 117: 1006–10).

Drug-free treatmentA large number of glaucoma cases are the result of nutritional deficien-



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cies. For example, it is often due to a weakened antioxidant defense system(Am J Ophthalmol, 2004; 137: 62–9). One study of patients with advanced-stageglaucoma found significantly reduced amounts of glutathione, an essentialcomponent of the cellular antioxidant system, in eye fluid (Vestn Oftalmol,

1992; 108: 13–5). So, filling the following nutritional gaps in your diet couldhelp to prevent or even treat the condition.✔ Vitamin A and other carotenoids. In countries where malnutrition is

widespread, vitamin-A deficiency is linked to blindness. The vitaminis essential for a healthy retina and for strengthening the mucous membranes that surround the eyes. Beta-carotene, a carotenoid thatgoes to make vitamin A, is also a powerful antioxidant. A Romaniananimal study suggests that two other carotenoids, lutein and zeaxan-thin, are also important for treating glaucoma, and can reduce damageto retinal nerve cells and the optic nerve (Oftalmologia, 2003; 59: 70–5).

Suggested daily dose: 25,000 IU✔ Vitamin C. In 30 patients with open-angle glaucoma (OAG), highdose

vitamin C (an average of 10 g/day) lowered eye pressure in all cases-with no adverse effects (J Orthomol Med, 1995; 10: 165-8).

Suggested daily dose: 3000 mg✔ Vitamin E. This and other fat-soluble antioxidants are believed to

prevent the eye’s drainage system from deteriorating as well as inhibit-ing cell death (Br J Nutr, 2004; 91: 809–29).

Suggested daily dose: 500 mg✔ B vitamins. Glaucoma patients are often highly deficient in vitamin

B1 (thiamine) (Ann Ophthalmol, 1979; 11: 1095–100). In one study, althoughvitamin B12 (cobalamin) did not lower eye pressure, it did halt visual-field loss for up to five years (Glaucoma, 1992; 14: 167–70).

Suggested daily dose: 50 mg (vitamins B1, B2 or B6); 50 mcg (vitaminB12)

✔ Alpha-lipoic acid (ALA). Supplementing with ALA increased gluta-thione (antioxidant containing the amino-acid cysteine, needed for cellenergy and proper immune function) in the red blood cells of glau-coma patients (Vestn Oftalmol, 1992; 108: 13–5). In one Russian study of 45 patients with early-stage glaucoma, one group was given 150 mg/day of ALA for a month, another was given 75 mg/day for two months


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and a third group used only medicated eyedrops. The most improve-ment in eyesight and in fluid release was seen in the patients taking the highest dose of ALA, despite the shorter treatment time (Vestn

Oftalmol, 1995; 111: 6–8).✔ Omega-3 fatty acids. Glaucoma patients have lower levels of eicos-

apentaenoic acid (EPA) and docosahexaenoic acid (DHA) comparedwith their healthy siblings (Prostaglandins Leukot Essent Fatty Acids, 2006; 74:

157-63), and research—at least in rats—shows that an increased intakeof these omega-3 fats can significantly reduce eye pressure (Invest

Ophthalmol Vis Sci, 2007; 48: 756-62). ✔ Magnesium, zinc and iron. Deficiencies in these minerals are asso-

ciated with glaucoma (Vestn Oftalmol, 1994; 110: 24–6). In one study,121.5 mg of magnesium improved the eyesight of glaucoma patients(Ophthalmologica, 1995; 209: 11–3).

A number of herbal and plant extracts may also benefit glaucoma patients. These include:✔ Ginkgo biloba. This herb can successfully treat glaucoma and even

improve damage to the visual field (Ophthalmology, 2003; 110: 359–62). Itworks by enhancing the general blood circulation (J Ocul Pharmacol

Ther, 1999; 15: 233–40), reducing glaucoma-inducing vasospasm (whereblood flow is decreased by a sudden contraction of blood vessel walls)and thinning the blood. Ginkgo also reduces cell toxicity and cell death(Med Hypoth, 2000; 54: 221–35).

✔ Coleus forskohlii. Forskolin, the active ingredient in this plant, isinvolved in the production of cyclic adenosine monophosphate(cAMP), which decreases eye-fluid flow, thereby decreasing eye pres-sure. A number of studies have shown that eyedrops containingforskolin can significantly lower eye pressure for at least five hours.Indeed, in one, it decreased the aqueous flow rate by 34 per cent inhealthy human volunteers (Lancet, 1983; i: 958–60; Exp Eye Res, 1984; 39:

745–9). ✔ Salvia miltiorrhiza (danshen). Often used in traditional Chinese medi-

cine, this plant’s beneficial effects on the microcirculation of retinalnerve cells and the optic nerve have been demonstrated in animalswith ocular hypertension (Chin Med J [Engl], 1993; 106: 922–7; Zhonghua Yan



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Ke Za Zhi, 1991; 27: 174–8). In humans, daily injections of a solution (2g/mL) of this plant, either alone or in combination with other Chineseherbs, led to long-term vision improvements in patients with mid-to-late-stage glaucoma (Chin Med J [Engl]), 1983; 96: 445-7).

Evidence that exercise may helpRegular aerobic exercise has been associated with a reduction in intra-ocular tension and may represent an alternative treatment to drug therapy.Researchers monitored the intraocular pressure in nine sedentary patientsbefore and after a three-month programme of aerobic exercise. They foundthat the intraocular pressure decreased at the end of the programme and returned to the elevated pressure within three weeks without condi-tioning (JAMA, October 23, 1991).

So, take plenty of daily exercise—at least 30 minutes of brisk walkingeach day.

Acupuncture: a last resortAcupuncture has been used successfully for the treatment of incurable eye disorders (Acupunct Electro Ther Res Int J, 1983; 8: 171–255). It has been shownthat enkephalins (molecules produced naturally by the central nervoussystem to numb pain) reduces eye-fluid pressure (Ophthalmol Res, 1993; 25:

10–5).Various reports suggest that acupuncture may be beneficial (J Trad Chin

Med, 1989; 9: 171–2), and may be helpful in cases where conventional medi-cines fail to stop the progressive loss of vision (J Trad Chin Med, 1992; 12: 142–6).

But acupuncturists are quick to point out that deep nerve stimulus withneedles is: “. . . not a substitute for conventional methods of treatment. But when every kind of routine treatment has been enhausted, acupunc-ture may offer some hope to patients” (Res Int J, 1985; 10: 79–93).


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5Age-Related Macular Degeneration

Failing eyesight has become so closely associated with old age that thecondition has become known as AMD, or 'age-related macular

degeneration'. Around 15 million Americans and four million Britonss u ffer from the pro b l e m — w h e re the sharpness of our central visiondeteriorates—and health experts now fear that AMD will take on epi-demic proportions once the babyboomers reach their 60s and 70s.

AMD comes in two forms—'wet' and 'dry'. The dry type is by far them o re common. This type occurs when photoreceptors in the central partof the eye, or 'macula', deteriorate and die. In contrast, the wet variety iscaused by abnormal blood-vessel growth, which can lead to blood andp rotein leakages, irreversible and rapid vision loss, and even blindness.Also, the dry form can worsen and become wet.

Because medicine has associated AMD with the ageing process, it has-n't looked much beyond that for other causes of the condition. This viewhas also influenced its treatment. Medicine contends that it has nothingto offer the suff e rer who has dry AMD, and has only recently begun too ffer regular injections of anti-angiogenic drugs designed to re v e r s eblood-vessel growth in those with the wet form. However, it's a contro-versial—and painful—treatment, and only one of the dru g s — L u c e n t i s(ranibizumab)—is approved in the US for wet AMD treatment.

H o w e v e r, doctors are now starting to recommend something called'photodynamic therapy' (PDT), using the light-activated drug Vi s u d y n e(verteporfin), for some forms of wet AMD. The drug is injected into thepatient's arm and, after a short wait, a laser beam is shone into thepatient's eyes to activate the drug, which is supposed to seal up abnor-mal blood vessels and destroy any that are leaking. However, PDT hasp roved to be less effective than Lucentis injections in a study of 423



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AMD patients over a two-year period (O p h t h a l m o l o g y, 2009; 116: 57-65.e5).

Possible causes of AMDWhile macular degeneration primarily affects older people, there's littleevidence to suggest that ageing is, on its own, the major cause of such fail-ing eyesight. AMD affects 10 per cent of people aged up to 74 years and,despite its name, increases to only around a third of those between 75 and85 years of age (www.agingeye.net/maculardegen/maculardegeninformation.php).

Medicine believes that one of its causes could be exposure over the yearsto direct sunlight and, especially, to blue-spectrum light. Doctors oftenadvise older people to wear sunglasses in direct sunlight to lessen theirrisk of developing AMD. This advice, however, may have been based on aseries of animal studies that did not properly replicate the human experi-ence. In a series of laboratory tests, researchers shone intense ultravioletlight into animals' eyes, which were held open mechanically. Aside fromthe fact that these studies amounted to extreme animal cruelty, the testsalso failed to take account of the blinking reflex and the way that wehumans have of avoiding looking directly at the sun.

This idea has also been supported by a Cambridge, UK, study of 446AMD suff e rers that found that direct sunlight is not a cause (Br J

Ophthalmology, 2006; 90: 29-32), whereas other studies suggest that, in fact, sun-light is important for good health. Blue light, in particular, helps the bodyto release melatonin, which protects the heart and the eyes by keepingblood pressure levels low (J Clin Endocrinol Metab, 2003; 88: 4502-5).

Another commonly held belief—that alcohol can cause AMD—may alsobe mistaken. A major study involving 4439 people living in Beijing and inrural areas of China could find no connection between wine- and beer-drinking, and AMD (Ophthalamology, 2009; August 25, published online ahead of

print). Instead, there's growing evidence to suggest that AMD is more likely to

be the result of a mineral imbalance that is cumulative and so becomesmore apparent as we get older. Low levels of zinc and copper are com-monly found in people with AMD, as one study discovered when it ana-lyzed the health profiles of 44 subjects with the condition. On average, thesubjects' zinc and copper levels were 24-percent lower than those of the


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healthy controls. The researchers, from the Mayo Clinic in Rochester,Minnesota, also pointed out that, as shown by other studies where sup-plements were able to slow the progress of AMD, there appears to be adirect causal link between zinc and copper levels, and failing eyesight (Am

J Ophthalmol, 2009; 147: 276-82.e1). On the other hand, iron tends to cluster in the retina, and may also play

a role in a broad range of ocular diseases, including AMD (along withglaucoma, cataract and conditions causing intraocular haemorrh a g e )because of iron-induced ocular oxidative damage (Prog Retin Eye Res, 2007; 26:

649-73). Too much lead can also cause AMD. One study of 25 AMD patients dis-

covered that they all had retinal lead levels that were up to 75 per centhigher than those found in people with healthy eyes (Am J Ophthalmol, 2009;

September 4, published online ahead of print). What's more, new breakthrough research suggests that AMD could be

an inflammatory disease brought about by a polymorphism (variation) inthe complement factor H (CFH) gene. Researchers from the US NationalEye Institute (NEI) and the National Cancer Institute (NCI) reckon that thegene variation could be responsible for half of all cases of AMD. Indeed,people who carry the polymorphism are nearly six times more likely todevelop the condition (Science, 2005; 308: 385-9).

The role of fatsA group of researchers from Harvard Medical School and the HarvardSchool of Public Health set out to determine whether diet had any affect on the development of AMD. They selected 261 participants,aged 60 or older, with early or intermediate AMD and visual acuity of20/200 in at least one eye. For four-and-a-half years, the researchers stud-ied the participants’ dietary intake and compared it with the progressionof their disease. Specifically, they looked at the amount and type of fat theparticipants were consuming in their daily diets (Arch Ophthalmol, 2003; 121:

1728–37).What they found was extraordinary. Those consuming high-fat diets

were three times more likely to progress to advanced forms of AMD com-pared with those whose intake of fat was lowest.



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But the risks relating to the kinds of fats consumed confounded theusual expectations. Although intake of any animal fat was associated with a doubling of risk of the disease, higher levels of animal-fat intake did not increase the risk any further. In other words, you increase your risk of developing AMD by eating flesh foods, but your risk doesn’tincrease with the quantity of meat that you eat.

The real risk for AMD was associated with vegetable-fat intake. Consu-ming high levels of these types of fats nearly quadrupled the risk of thedisease progressing. These fats included the monounsaturated, polyunsat-urated and trans unsaturated fats. And in this case, quantity did matter.The more of these you ate, the greater your risk.

The researchers also made another connection that is most unusual inthese types of studies. They noted a doubling of risk with intake ofprocessed foods, which are usually laden with these types of processedvegetable fats.

Other kinds of fats proved protective. Fish and nuts, both rich in omega-3 fatty acids, slowed progression of the disease—so long as your intake ofthe usual omega-6 fatty acids was also low.

Other clues suggest that processed foods lie at the heart of AMD. A sur-vey of more than 4000 people, carried out by re s e a rchers at Tu f t sUniversity in Boston, MA, concluded that up to 20 per cent of all cases ofAMD could have been avoided by a diet lower in processed foods such aswhite bread, cakes and biscuits (Am J Clin Nutr, 2007; 86: 180-8). Indeed, whilethe condition is the leading cause of blindness among the American,Canadian and English elderly, it is rare in the developing countries where,nevertheless, there is a high incidence of blindness from other eye diseasessuch as glaucoma and cataracts. These countries do not consume a highlyprocessed diet.

Link with heart diseaseAMD is also a cousin of coronary heart disease, and shares with it severalcommon ancestors, such as atherosclerosis (Am J Epidemiol, 1995; 142: 404–9),hypertension (Arch Ophthalmol, 2000, 118: 351–8) and high cholesterol. AMDalso afflicts nearly 40 per cent of those with diabetes (J Longev, 1998; 4: 24–6).

Many other risk factors for heart problems are also risk factors for



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AMD. These include smoking (especially in women), age (3.8 per cent ofAmericans have either intermediate or advanced AMD by the time theyreach age 50–59 and, by the time they are 70–79, this proportion will haveincreased to 14.4 per cent) and gender (women appear to be at a slightlygreater risk than men).

Increasingly, the evidence points to industrialised food-processing in theonset of heart disease and diabetes. More and more studies of heartpatients are finding they have elevated levels of homocysteine, an aminoacid derived from the normal breakdown of proteins in the body. Raisedlevels of this amino acid are an indication that something has gone awry.

Crucial to this process is the presence of adequate levels of certain B vitamins. Other studies of heart patients have shown that they are defic-ient in these vitamins, and that adequate B-vitamin supplementation canreduce the incidence of heart attack and angina (Res Commun Mol Path

Pharm, 1995; 89: 208–20). Links have also been made between the onset of diabetes and heart disease and deficiencies of chromium.

Natural sugars and grains contain adequate concentrations of chro-mium to support the metabolism of high-carbohydrate foods. However,virtually all B vitamins and chromium are removed during the refiningprocess of most of the sugars and processed foods that now make up the bulk of the typical Western diet. Diets high in processed carbohydrates arenearly always deficient in chromium.

Aspirin accelerates the damageAnother area that medicine has never explored is its own hand in thedevelopment of the AMD epidemic. Many of the drugs routinely pres-cribed for older people may well accelerate eye damage.

Doctors push aspirin because it thins the blood, thereby reducing therisk of bloodclots. But, apart from poor effectiveness and the risk of gas-trointestinal bleeding, research suggests that long-term aspirin use canaccelerate macular degeneration and contribute to retinal haemorrhage.

Over two decades ago, Dr J.D. Kingham wrote a letter to the prestigiousNew England Journal of Medicine (1988; 318: 1126–7) in which he noted that, inhis clinic, many of the elderly patients who came to him with decreasedcentral vision and macular haemorrhages had a history of recent ingestion



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of aspirin and other drugs known to affect platelet function or the blood-clotting process.

NSAIDs (non-steroidal anti-inflammatory drugs) have been shown toincrease the risk of cataracts—itself a risk factor for the later developmentof AMD—by as much as 44 per cent (Ophthalmology, 1998; 105: 1751–8).

Many other common drugs, however, also contribute to a slow andsteady degeneration in the eye, and hasten the onset of macular degenera-tion by making the eye more light-sensitive. These include certain anti-biotics, psychotherapeutic medications and NSAIDs (Int J Toxicol, 2002; 21:

473–90). Phenothiazine antipsychotics, antidopaminergics (for motion sick-ness) and calcium antagonists have also been associated with AMD (Arch

Ophthalmol, 2001; 119: 354–9).However, some of these adverse effects of drugs are temporary. People

taking sildenafil (Viagra), for example, often experience transient visualchanges, described as ‘blue tint’, that usually lasts for four hours after tak-ing the drug, according to the Viagra package insert.

This greater affinity for blue light is linked to the way that sildenafilaffects the rods and cones in the retina, the cells that process colour infor-mation. In a small study of men and women taking 200 mg of Viagra daily, 64 per cent of those who completed the studyreported visual disturbances. The participants were given an electroretino-gram, a test that looks at the behaviour of the rods and cones in the retina.While the test results were within normal limits, they also confirmed thattaking the drug caused a slightly depressed function in the cone cells,which are responsible for detailed daytime colour vision (see below).

The hungry eyeAspirin also apparently interferes with many of the nutrients that arespecifically essential for eye health. To understand why this is important,it is necessary to know some basics about how the eye works.

Four types of cells in the human retina capture light and process visualinformation. One type, the rod cells, regulates night vision. The other threetypes, called cone cells, control colour vision. This constant processing of visual information can cause a great deal of (normal) wear and tear in the cells of the eye.



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To continue to function optimally, our eyes require a constant supply ofnutrients. High levels of antioxidants, such as vitamins C and E, beta-carotene and lutein as well as zinc, selenium and copper, are all naturallypresent in the macula.

Our eyes also require a great deal of oxygen. But where the oxygen-containing environment is especially rich and the metabolic rate is high, as it is in the macula, high levels of oxidative free radicals are also gener-ated. So, in addition to providing nourishment, the antioxidants found inthe eyes also protect against free-radical damage.

Taking aspirin can increase the turnover of vitamin C in the body, lead-ing to a possible deficiency (BMJ, 1975; I: 208). Similarly, taking 3 g/day ofaspirin has been shown to decrease blood levels of zinc (Scand J Rheumatol,

1982; 11: 63–4). Aspirin also appeared to increase the loss of zinc through the urine in this study, and this effect was noted as early as three days afterstarting the aspirin regimen.

Moreover, aspirin can enhance the blood-thinning effects of vitamin E in some individuals. In one double-blind study of smokers, those who tookaspirin plus 50 IU/day of vitamin E had a statistically significant increasein the incidence of bleeding gums compared with those who took aspirinalone (Ann Med, 1998; 30: 542–6). This increased risk of bleeding could have atheoretical impact on the eyes.

Gastrointestinal (GI) bleeding is another common side-effect of takingaspirin. Often, this problem will go undetected for rather a long time. Thelong-term blood loss due to regular aspirin use can lead to iron-deficiencyanaemia.

Another potential problem area is foods containing salicylates, the mainingredient in aspirin.

But aspirin may have another damaging effect. As well as depleting levels of important nutrients, aspirin can disrupt the normal circadianrhythms of the sleep–wake cycle.

The hormone melatonin is produced by the pineal gland at night. Ithelps us to sleep, but it also boosts immune function and, for those at riskof AMD, it helps to lower blood pressure (Hypertension, 2004; 43: 192–7) andprotects the retinal pigment from oxidative stress (Exp Eye Res, 2004; 78:

1069–75).



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NSAIDs (including aspirin) work, in part, by inhibiting prostaglandins,which produce pain and inflammation. They also contribute to the reg-ulation of body temperature and the production of melatonin (J Pharm

Pharmacol, 1987; 39: 840–3).One double-blind study found that night-time body temperature did

not drop to its usual levels after taking either aspirin or ibuprofen (Physiol

Behav, 1996; 59: 133–9). This was because taking these NSAIDs at night sup-pressed normal levels of melatonin. Earlier reports have confirmed thathealthy individuals taking NSAIDs experience melatonin suppression andalterations in their normal sleep patterns (Sleep Res, 1992; 22: 165; Physiol

Behav, 1994; 55: 1063–6). Such chronic disruption may allow blood pressure to rise, which may

have negative effects on the eye, as well as expose the retina to greater levels of oxidative stress.

Physicians themselves are suffering from a kind of ‘blindness’ that pre-vents them from seeing the obvious role of diet and drugs in the develop-ment of AMD. The best a doctor might do for an AMD sufferer is to putdown his prescription pad and say: “Don’t take two aspirin.”

The AMD-free dietJust as most of the risk factors for AMD parallel those of heart disease,most of the best alternative measures to keep the heart healthy can alsomaintain eye health. So, you can reduce your risk of AMD by making a few basic changes in your lifestyle:✔ Consume an organic, unprocessed diet that is low in fat, and high in

fruit and vegetables. ✔ Eat brightly coloured fruits and vegetables. People who consume red,

orange and yellow fruits and vegetables—which are high in beta-carotene, another antioxidant—are also at low risk of developing AMD(Am J Epidemiol, 1988; 128: 700–10).

✔ Eat your greens, especially spinach. Deeply coloured foods—such asspinach, collard greens and kale—are particularly rich in carotenoids,especially lutein and zeaxanthin. These nutrients have an affinity forthat part of the retina where macular degeneration occurs. Once there,they can protect the retina from damage caused by sunlight (Methods



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Enzymol, 1992: 213: 360–6). One study found that people who ate spinachevery day suffered only one-tenth as much from AMD as those whoseldom ate it. For patients already with the condition, eating spinachprevented it from getting worse (JAMA, 1994; 272: 1413–20).

✔ Eat more fish. People who eat fish more than once a week have half therisk of developing AMD compared with those who eat fish less thanonce a month (Arch Ophthalmol, 2000; 118: 401–4).

✔ Keep your weight down.✔ Don’t smoke.✔ Drink a glass of red wine a day (Am J Ophthalmol, 1995; 120: 190-6) as, in

one study, those who drank one glass a day reduced their risk of AMDby 20 per cent compared with those who either drank beer or spirits,or were teetotalers (Lancet, 1995; 351: 117).

✔ Take regular exercise, as this can help keep your blood pressure with-in normal ranges as effectively as many drugs.

✔ Avoid foods containing salicylates. Not so long ago, the AmericanHeart Association audaciously credited the decline in heart attacks inthe US since 1965 to the growing ingestion of artificial flavourings inprocessed foods (Sci News, 1993; 144: 19). These flavourings, used ineverything from crisps to toothpaste, contain aspirin-like chemicalsknown as ‘salicylates’. The typical Western diet includes enough pro-cessed foods to provide the equivalent of more than one children’saspirin daily (Health Alert, 1996; 13: 6–7). If you regularly consume suchfoods alongside a daily aspirin, you will be getting the equivalent ofnearly two aspirin daily with no real benefit to your heart or eyes.

Solutions from natureThe best treatment is prevention. To make sure you don’t develop AMD:✔ Supplement, especially with antioxidants (Arch Ophthalmol, 1994; 112: 222–7) .

A large multicentre clinical trial, sponsored by the US National EyeInstitute, found that vitamins can reduce the risk of severe vision loss by25 per cent in some cases of AMD (Arch Ophthalmol, 2001; 119: 1417–36). Thespecific daily amounts used by the study re s e a rchers were: vitamin C, 500mg; vitamin E, 400 IU; beta-carotene, 15 mg (equivalent to 25,000 IU of vit-amin A); zinc (as zinc oxide), 80 mg; and copper (as cupric oxide), 2 mg.



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✔ Try herbs. Ginkgo biloba improves circulation and is an antioxidant—aim to take 120 mg/day. Oligomeric proanthocyanidin complexes(OPCs) from grape seed/skin or bilberry extract are also powerfulantioxidants—a useful dose is 200–300 mg/day from grape seed/skinor 150 mg/day from bilberry.

✔ Drink green tea (unprocessed, preferably organic), which containsantioxidants that can slow or even halt the progression of AMD (VRP

Nutr News, 1997; 11: 4, 10).If you already have AMD, you may be able to stop its progression if you start treatment in its early or intermediate stages. Follow the dietarysuggestions mentioned above, and also (after checking with a nutritionalpractitioner, as these are very high doses) supplement with: ✔ high-dose antioxidants. Of seven studies, three showed improvement

with nutritional supplements (Ophthal Physiol Opt, 2003; 23: 383–99).✔ lutein (10 mg/day). In the major Lutein Antioxidant Supplementation

Trial (LAST), lutein with or without antioxidants was found toimprove vision (Optometry, 2004; 75: 216–30).

✔ zinc (45 mg/day) helped prevent vision loss in one study (Arch Ophthal-

mol, 1988; 106: 192–8). Zinc has also been shown to work in concert withhigh-dose multi-vitamin/mineral supplements (Curr Opin Ophthalmol,

2003; 14: 159–62).✔ Ginkgo biloba. After four weeks, Ginkgo at doses of either 60 mg or

240 mg/day led to “marked improvement” of vision in AMD patients,although the higher dosage produced nearly twice the improvement of the lower one (Wien Med Wochenschr, 2002; 152: 423–6).

Other possible treatmentsIf AMD is an inflammatory disease (see page 67), then high-dose anti-inflammatory supplements could be an effective therapy.

Vitamin B12 supplements have been successfully used to reduce thesymptoms of other inflammatory conditions such as bursitis (Lininger SW Jr

et al., The Natural Pharmacy: Complete Home Reference to Natural Medicine. New York, NY:

Three Rivers Press, 1999), and vitamin C, at high doses, has been proven tohave anti-inflammatory properties (Exp Eye Res, 1986; 42: 211-18). Vitamin Emay be especially useful as it is able to suppress the symptoms of inflam-



75

mation in specific parts of the body (J Vitaminol, 1972; 18: 204-9). Copper and zinc are both strong anti-inflammatories, and AMD suffer-

ers are usually deficient in both. Inflammation requires a higher copperintake to maintain levels of enzymes that are vital to the body's anti-inflammatory processes, at least in animal studies (Agents Actions, 1985; 16:

504-13). In addition, findings in animal (rat) studies showed that zinc is animportant healing agent during inflammation (Int J Tissue React, 1981; 3: 73-6).

In clinical studies, zinc was able to help 70 per cent of men sufferingfrom prostate problems (Bush IM et al., 'Zinc and the Prostate', presentation at the

annual meeting of the American Medical Association, Chicago, 1974). Supplementalzinc, copper and manganese also reduced the risk of rheumatoid arthritisin more than 29,000 women aged 55-69 years and followed for 18 years (Am

J Epidemiol, 2003; 157: 345-54). High-dose supplements of zinc and copper, and of vitamins A, C and E-

the usual antioxidants-prevented the progression of AMD in one study.The researchers, from the Age-Related Eye Disease Study Group in NewZealand, also found that most people are taking levels of vitamins that aretoo low to be effective. Yet, at the correct dosages, any combination of mul-tivitamins and individual supplements can prevent AMD from worsening(N Z Med J, 2009; 122: 32-8).


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6Common Complaints

Dry eyes'Dry eye' is a catch-all term used to cover all disorders where the pre-corneal tear film of the eye is deficient. This thin layer of fluid covers thecornea and the corners (cul-de-sac) of the eye (where the tear ducts lie),and the conjunctiva, the thin mucous membrane that lines the inner sur-face of the eyelids. The job of this fluid is to nourish the cornea, remove anyforeign entities like bacteria and lubricate the eyelids. This helps the eyesto blink which, in turn, helps to spread the tear film over the surface of theeye.

When it isn't due to surgery, dry eye can also result from a problem withthe meibomian glands, which secrete the fatty component of tears, or asimple deficiency of the tear film itself. People who don't blink oftenenough or whose eyes don't spread the tear film efficiently can also sufferfrom dry eye. It tends to mostly affect women after the menopause, but itcan be seen in men or women of any age, and be linked to psoriasis,rheumatoid arthritis or psoriatic arthritis. Unfortunately, it is also a com-mon adverse effect of laser eye surgery.

To combat the problem, medicine has come up with 'ocular' lubricants—artificial tears. These work by bulking up the volume of the tear film.However, they can only do this in contact with the eye surface. The first generation of these agents were made of cellulose ethers such asmethylcellulose, known to be highly viscous. They were of variable effec-tiveness, so medicine moved on to polymers such as polyvinyl alcohol andpolyvinylpyrrolidone. This generation of artificial tears work, but needs tobe reapplied too often for comfort.

C o n s e q u e n t l y, the pharmaceutical companies have now turned to



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longer-acting gels containing polymers, such as polyacrylic acid. Theseswell up in water and retain moisture, and relieve the condition for longerthan the earlier polymers—without reapplication (Acta Ophthalmol Scand,

1997; 75: 457-61; Eur J Ophthalmol, 1998; 8: 81-9).But at what cost? These preparations use preservatives like benzalkoni-

um chloride, toxic to the cornea, which keeps the eye moist. Thus, usingartificial tears containing this preservative for any length of time is likelyto make the problem worse and impair vision over the long term (Am J

Ophthalmol, 1988; 105; 670-3). Although the newer preservatives sodium perboate and polyquaterni-

um are thought to be less dangerous (Curr Eye Res, 1991; 10: 645-56), using anychemical in your eye for any length of time can create further problems.The conjunctiva, which comes in contact with the tear film, is highly per-meable—some two to 30 times more permeable to drugs than the cornea(Pharmaceut Res, 1991; 8: 1039-43).

In a sense, when you use artificial tears or any chemical eye solution,you are mainlining chemicals or plastic directly into your eye. And this isexacerbated by artificial-tear solutions. When patients treated withpolyvinylpyrrolidone without preservative were compared with thoseusing the same preparation with preservative, the preservative-treatedg roup showed an increased permeability of their eye surface (A r c h

Ophthalmol, 1992; 99: 873-8). Another possible treatment is a lubricating lotion containing white

paraffin, which melts on contact with a hot object like the eye. However,these tend to make blurred vision worse.

Aside from the dangers, artificial tears are a poor substitute for the realthing. Tears are a complex mix of water, electrolytes and proteins, and con-tain both antibodies and enzymes to fight off bacteria and infection.

Natural ways to make your eyes wetterEncourage your eyes to produce more lubrication by using:◆ vitamin A, the premier vitamin for eye health. Suggested dosage: 10,000

IU/day, plus at least 400 IU/day of vitamin D. Also, increase yourintake of vitamin A-rich foods like eggs and fish like salmon

◆ omega-3 fatty acids from either fish oils or flaxseed. Suggested dosage: 1000


● 6 Common Complaints

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mg three times a day ◆ glutathione and lutein, nutrients known to improve lubrication of the eye.

Suggested dosage: 500 mg/day of glutathione; 6 mg/day (three cups ofspinach a week) of lutein

◆ B-complex vitamins, particularly B2, which can help a wide variety of eye prob -lems. Suggested dosage: 50 mg/day (B-complex)

◆ vitamin C. Suggested dosage: at least 3 g/day◆ Cineraria eyedrops, a homeopathic remedy to help with the irrigation of

the eye, available from Helios (+44 (0)1892 537 254; www.helios.co.uk) ◆ rose hydrosol (flower water), available from a reputable supplier of essen-

tial oils◆ warmed oil, such as castor oil, rubbed externally on your eyelids last thing

before going to bed ◆ warmed compresses which, placed over closed eyes for five minutes, can

help to restore the tear film.

Other strategies include:◆ using a humidifier, especially in the winter◆ making an effort to blink more often ◆ resting your eyes periodically during the day.

The painkiller connectionAlthough many elderly people complain of dry eyes and dry mouth, thisphenomenon may not be a natural part of the ageing process, but a side-effect of drugs, according to evidence.

American researchers in Maryland studied 2481 patients, aged 65–84, toassess the prevalence of dry eyes, dry mouth or both, and whether thesewere associated with rheumatic disease and other factors.

More than a quarter of the study group reported these symptoms ontheir own, and a further 4.4 per cent experienced both. After adjusting for age, gender and race, there was no association found with rheumatoidarthritis, smoking, alcohol consumption or the presence of autoantibodies.

However, various classes of drugs were associated with dry eyes andmouth in about a third of cases. These included painkillers and fever-reducing drugs (such as aspirin) at the lowest end of the risk scale, and



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antidepressants and antipsychotics at the highest end. Doctors are advised to consider the role of medications when elderly

patients present with dry eyes and mouth (Arch Intern Med, 1999; 159: 1359–63).

FloatersFloaters are little clumps of gel or cells floating through the thick transpar-ent gel of the eyeball. They can appear as specks, strands, webs or othershapes, and may momentarily be confused with dust or tiny insects flyingacross the eye. Strictly speaking, what we are seeing are the shadows ofthese irregularities in the vitreous fluid that separates the lens and retina.This gel-like fluid maintains the eye's shape, aids the transmission of lightto the retina, absorbs shock and holds the retina in place.

Over the years, the vitreous fluid inevitably thickens, dries and shrinks,which is why floaters are more commonly seen in people over 40. If theironset is gradual, they are very likely harmless and require no treatment.

However, if there is a sudden appearance of multiple floaters, this maybe a sign of posterior vitreous detachment (PVD), the separation of vitre-ous fluid away from the retina. By age 70, PVD has usually already takenplace gradually. However, floaters as well as PVD occur more often—andearlier—in shortsighted people, in diabetics and in those who have under-gone cataract surgery, or laser surgery for the eye or skin, and as a result oftrauma (Graefes Arch Clin Exp Ophthalmol, 2005; 26 July: 1-5; Am Fam Physician, 2004;

69: 1691-8; Dermatol Surg, 2002; 28: 1088-91).In addition, in about 25 per cent of cases, floaters indicate a sight-threat-

ening condition such as tears or detachment of the retina, which is whenany part of the retina gets pulled away from the back wall of the eye. If leftuntreated for several days, permanent vision loss or blindness will result. So, if floaters appear suddenly and are accompanied by light flashes or lossof peripheral vision, it may be prudent to visit an eyecare specialist imme-diately. Posterior uveitis (chronic eye inflammation brought about byinfectious disease or an autoimmune disorder) can also be sight-threaten-ing. But, unlike PVD, posterior uveitis is associated with a gradual blur-ring of vision.

A surgical procedure called a 'vitrectomy' can remove floaters, but thisshould only be done if your vision is severely limited and any other possi-



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ble causes—of which there are many—are ruled out. Indeed, the mostcommon complication of vitrectomy is cataract, so you may well be trad-ing a small problem for a more serious one (Br J Ophthalmol, 2001; 85: 546-8; Am

J Ophthalmol, 1988; 105: 160-4).Floaters have also been linked to candidiasis, an overgrowth of the

yeast-like fungus Candida albicans, and may simply be a symptom of thissystem-wide problem (Postgrad Med J, 2001; 77: 119-20). Candidiasis can becontrolled by eliminating sugar and yeast from the diet, which is certainlya safer and simpler solution than surgery.

According to traditional Chinese medicine (TCM), floaters are the resultof a poor blood circulation that fails to nourish the optic nerve and sur-rounding muscles of the eye. In TCM terms, the cause of this weak circu-lation is congestion of the liver, kidneys and colon, so herbs that supportthese organs can improve vision, strengthen the retina and blood vessels,and keep the vitreous fluid free of debris. Although scientific studies arelacking, the anecdotal evidence points to the fruit of Lycium barbarum - orChinese wolfberry (gou qi zi), a member of the nightshade family - as apopular TCM remedy that can nourish and support the liver and kidney,and treat a slew of eye problems (including floaters, excessive tearing andcloudy vision) while helping to prevent serious eye diseases.

While there is no proven or universal cure for floaters, the nature of thecondition suggests that lifestyle changes, and a programme of supple-ments and herbs to feed, stimulate and hydrate the vitreous fluid, maywell improve the condition. For example, the anthocyanosides (flavonoidcompounds) found in bilberry (Vaccinium myrtillus) have been shown toimprove circulation in the blood vessels of the eye, maintain the integrityof capillaries, stabilise collagen, and correct the signs of retinal damage(Biochem Pharmacol, 1983; 32: 53-8; Angiologica, 1972; 9: 355-74; Minerva Med, 1977; 68:

3565-81). Ginkgo biloba, too, improves eye circulation by preventing clotting of

blood platelets and causing blood vessels to dilate. Ginkgo works in syner-gy with bilberry, so taking this herbal combination is an excellent choicefor improving overall eye health. In one German study, taking Ginkgo as ahard candy (160 mg/day for four weeks, then 120 mg/day) resulted inimproved eyesight in patients with severe degenerative circulatory distur-



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bances, visual-field defects and retinal problems (Klin Monatsbl Augenheilkd,

1980; 177: 577-83).Finally, whereas most floaters are found in the vitreous fluid, it is impor-

tant not to overlook another, simpler cause of the problem. You could besuffering from debris in the tear film. Many people, especially those proneto allergies, blepharitis (eyelid inflammation) or styes can accumulatemakeup, mucus and other material within their tears. Floaters due to tear-film debris move when you blink, whereas vitreous floaters respond moreto eye movements than to blinking.

BlepharitisBlepharitis, or inflammation of the eyelids, is a chronic condition that canlead to redness, dryness, burning, itching and irritation of the eyes. Themost common causes are poor eyelid hygiene, bacterial infection andexcess oil production by the meibomian glands in the eyelid. Wearing con-tact lenses and eye makeup can make blepharitis worse. Identifying thecause is key in any healing plan.

Conventional treatment usually involves keeping the eyelids clean,applying warm compresses, using anti-dandruff shampoo and, when nec-essary, antibiotics or steroid eye drops. However, these measures tend toease symptoms rather than cure. What's more, medicated eye drops cancause serious side-effects, such as increased pressure in the eye, andchanges to the lens and cornea (Can J Ophthalmol, 2008; 43: 170-9).

Nutritional therapies◆ Essential fatty acids. Supplements of both omega-6 and omega-3 fatty

acids may help against blepharitis. In 57 patients with meibomian glanddysfunction (a common form of blepharitis), warm compresses, eyelidmassage and eyelid margin scrubbing, combined with a daily dose ofomega-6 (28.5 mg of linoleic acid and 15 mg of gamma-linolenic acid),reduced symptoms better than either treatment alone (Cornea, 2007; 26:

260-4). ◆ Omega-3 supplements (two 1000-mg capsules three times a day) led to sig-

nificant improvement in blepharitis sufferers after one year of treatment(Trans Am Ophthalmol Soc, 2008; 106: 336-56).



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◆ N-Acetylcysteine (NAC). This amino acid appears to help prevent dryeyes. In 40 patients with chronic blepharitis, the addition of oral NAC(100 mg three times daily) to their conventional therapy (topical antibi-otics and steroids, and artificial tears) significantly increased tear quan-tity and improved tear quality, compared with the conventional therapyalone (Cornea, 2002; 21: 164-8).

◆ Vitamin A. The daily use of eye drops containing vitamin A (Viva-Drops;Vision Pharmaceuticals) led to the complete resolution of chronic ble-pharitis that had failed to respond to topical antibiotics and steroids-albeit in a single case study (Altern Med Rev, 2008; 13: 191-204).

◆ Other nutrients. Deficiencies of vitamin B6, biotin, riboflavin and zinchave each been reported to result in blepharitis in humans and animals.Multivitamin and mineral supplements containing these nutrients aretherefore recommended as supportive treatment in cases of blepharitis(Altern Med Rev, 2008; 13: 191-204).

Other solutions◆ Homeopathy. There is a range of homeopathic remedies for eye infection

and inflammation, including S u l p h u r, Natrum Muriaticum, HeparSulphuris Calcareum and Mercurius Solubilis. However, it's best to let aqualified homeopath make a diagnosis, and choose the best remedy foryour constitution and symptoms.

◆ Honey. Honey—especially good-quality manuka honey, which has awide range of antibacterial activity—can be used topically to treat bac-terial eye infections (J Med Food, 2004; 7: 210-22). In 102 patients with eyeinfections, including blepharitis, improve-ment was seen in 85 per centof cases (Bull Islam Med, 1982; 2: 422-5). Apply the honey to the eyelid (butnot the eye) as you would an ointment.

◆ Herbs. Calendula (marigold), chamomile, eyebright and comfrey havetraditionally been used for eye inflammation. For rapid relief of rednessand swelling, try a compress of eyebright (15 g of dried herb in 500 mL(16 oz) of water, boiled for 10 minutes). Make sure that the preparationis sterile by making a fresh brew every time and throwing away theexcess.

◆ Hygiene. Any treatment for blepharitis should always be combined with



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a strict eyelid cleaning routine. Clear away oil and debris from aroundthe eyelash follicles by applying warm compresses (using a cloth or cot-ton wool warmed with hot water) to the eyelids several times a day.Immediately after this, moisten a cottonbud with a solution of warmwater and sodium bicarbonate (1 tsp in a cup of water will do), and useit to gently clean along the eyelashes. Avoid touching the eye itself andalways use water that's been freshly boiled, then cooled.

Herbs for the eyesPeople with eye problems consulting conventional ophthalmologists aregenerally told there is no solution other than drugs, surgery or glasses.However, herbal medicine has had great success in treating glaucoma,myopia, night blindness, macular degeneration, retinitis pigmentosa (aprogressive loss of vision due to retinal degeneration) and even diabeticretinopathy.

This has been highlighted in Botanical Influences on Illness: A Sourcebookof Clinical Research (Tarzana, CA: Third Line Press, 1994), a superb referencemanual co-authored by WDDTY panellist Dr Melvyn R. Werbach and DrMichael T. Murray.

A single 200-mg dose of Vaccinium myrtillus (bilberry or European blue-berry) extract (VME) brought about measurable improvements (as assess-ed by electroretinography) in patients with glaucoma and myopia (Arch

Med Int, 1985; 37: 29–35). In other cases, VME measurably improved the eye-sight of 80 per cent of treated patients (Ann Oftalm Clin Ocul, 1966; 92: 596–605).

Another study of patients given 400 mg/day of VME and 20 mg/day of beta-carotene demonstrated improved adaptation to light and nightvision, and enlargement of the visual field (Ann Oftalm Clin Ocul, 1965; 91:

371–86). Further trials confirm that VME, when used with vitamin E, canimprove myopia (Klin Monatsbl Augenheilkd, 1977; 171: 616–9).

Finally, 31 patients with various types of retinopathy, including thatcaused by anticoagulant (blood-thinning) drugs or diabetes, were treatedwith VME. The results showed reduced permeability and haemorrhage(Klin Montsbl Augenheilkd, 1981; 178: 386–9).

Pycnogenols (PCG), which contain complexes of vitamin C-likebioflavonoid nutrients are made from the leaves of the hazelnut bush, the



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bract (the little leaves below the flower petals) of the lime tree, and the bark of the Landes pine tree or grapeseed skin (Vitis vinifera). At doses of150–300 mg/day, PCG has been shown to significantly improve visual performance in the dark and after glare (J Fr Ophtalmol, 1988; 88: 173–4, 177–9).

In a well-controlled, double-blind study, an extract of Ginkgo bilobaleaves (GBE) brought about significant improvement in chronic cerebro-retinal ischaemia (lack of adequate blood supply to the eyes) in elderlypatients (Klin Montsbl Augenheilkd, 1991; 199: 432–8). GBE also led to significantlong-term improvement in patients with senile macular degeneration(Presse Med, 1986; 15: 1556–8) and severe retinal circulatory disturbances orglaucoma (Klin Montsbl Augenheilkd, 1980; 177: 577–83).


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7The Bates Method

Imagine being able to cure your vision problems without glasses or contact lenses, without drugs or without surgery—all you have to do is

relax. That’s exactly what patients of Dr William Bates (1860–1931) wereable to do. Dr Bates, author of Better Eyesight Without Glasses, was a pioneerin ophthalmology who was practising in New York at the turn of the century. He was the first to consider stress as the root cause of visionimpairment, including myopia (nearsightedness) and hyperopia (farsight-edness).

Exercise your eyes back into shapeExamining thousands of patients at the New York Eye and Ear Infirmary,Dr Bates’ research lead him to the conclusion that eyes could be exercisedback into shape in the same way that other muscles in our bodies can beexercised.

Dr Bates found that a person’s level of vision fluctuates throughout theday, at various times shifting from nearsightedness to farsightedness andback. The degree of visual impairment would increase according to theamount of stress the individual was under at a given time of the day. Forexample, a cold, a loud noise or sleep would elicit a change in the vision of patients. Patients known to have 20/20 vision would even display somevisual impairment when subjected to a stressful situation.

Observations like these lead Dr Bates to the conclusion that a person’slevel of vision is not permanent. If it can change so often throughout theday, it can certainly be changed in the long term.

As a result, Dr Bates created a series of exercises to relax and strengthenthe muscles surrounding the eye. He believed that “. . . perfect sight is aproduct of perfectly relaxed organs, unconsciously controlled”, and that



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eyeglasses were useless tools that locked the eyes into a constant state of tension.

Bates used his own techniques to cure himself of advanced farsighted-ness—the type we believe to be part of the normal process of ageing.Today, we understand that Dr Bates’ work provides a different theory ofseeing, which looks upon human vision as holistic—a combination ofmind, body and spirit.

The Bates method is not simply an exercise programme, but a means ofcorrecting bad habits such as straining to see, and developing a greaterawareness of what we are looking at. The Bates method can work ex-tremely well on young children or people whose problems are caughtearly, such as those in their 40s who are only just losing their ability tofocus close up. However, it can help every type of visual disorder and isalso effective as preventative medicine.

The best way to embark on the Bates method is to work with a qualifiedBates teacher, who will assess you and individually tailor exercises for you.

Exercises used in the Bates method include:◆ palming. Carefully cover your closed eyes with the palms of your hands

(making sure your hands are warm) to block out all of the light, butwithout pressing against the surface of the eyeball. You should ‘see’absolute blackness. If you don’t (in other words, if you see kaleido-scopic colours), you do not have perfect vision.

To correct the problem, try focusing on a black object at a comfortabledistance in front of you. Stay relaxed. Now close your eyes and ‘see’ thesame black object.

If this doesn’t work, try imagining a small black dot growing largerand larger until it envelopes the entire area behind your eyes, or a blackfur or black hole.

Relax with your palms over your eyes for several minutes. As yoursight improves, the blackness will become deeper and darker.

You should do this exercise several times a day. The improvementwill be slow and gradual.

◆ lighting. Relax and sit in a chair in the sunshine or six feet from a 150-watt lightbulb. With your eyes closed, lift your face to the light and


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slowly move your head from side to side for three to four minutes.Gradually increase the amount of time you spend in the light.

This exercise will warm parts of the eye, relax the muscles, reduceredness and itchiness, and stimulate the retina.

◆ shifting. Shift your sight back and forth between any letter on a Snell-en chart (the chart of letters everyone has probably seen at the doctor’soffice) and another letter that is several spaces along, but on the sameline. Then, shift your sight back and forth between one of the larger letters at the top of the Snellen chart and one of the smaller letters at thebottom of the chart. Finally, shift your sight back and forth between anentire Snellen chart three to five feet away and one 10 to 20 feet away.

◆ lazy eights. Close your eyes and draw a number eight with your nose.Be sure to move your head slowly and evenly. Repeat this exercise anumber of times, changing the size and direction of the eight. You canalso try this exercise while drawing other simple objects like a wagonwheel. This will relax all of the muscles surrounding the eye, andincrease the circulation in the head and neck.

For further information on the Bates method, contact the Bates Associationfor Vision Education (BAVE). BAVE is a group of professionals dedicatedto the teaching of vision improvement. All members of the BatesAssociation are fully qualified teachers of the Bates Method of VisionEducation. To find out more about the method, and to find a teacher nearyou, visit the website: www.seeing.org/bave2/bave.htm.

For teachers in the US, Canada and elsewhere around the world, visitthe Association of Vision Educators’ website at: www.visioneducators.org/index.html.

Integrated Vision TherapyFollowing on from the Bates idea of eye exercises, Dr Robert-MichaelKaplan has added other recommendations:✔ Listen to relaxation tapes to assist in coordinating the left and right sides of

the brain✔ Eat a better diet ✔ Spend time in natural light without glasses✔ Wear a one-eyed patch over your best (dominant) eye for, at most, four hours

● 7 The Bates Method


to help vision in the weaker eye✔ Use glasses if you’ve been wearing contacts✔ Get your eye doctor to prescribe vision-fitness glasses to correct your vision to

20/40, which will force your eyes to work a little harder. (Needless to say,never wear them when you are doing something potentially life-threateninglike driving)

✔ Engage in regular aerobic exercise. Try to choose an activity that you can dowithout your glasses

✔ Set life goals to ‘see’ your life clearly✔ Copy an eye chart and place it on a wall five feet away (have a smaller one for

close-up vision) and periodically measure how such factors as stress affectyour perception.

Dr Kaplan also recommends vision ‘games’, depending on your problem,such as zooming—shifting your focus quickly from near distance to fardistance, which helps with age-related focus problems.

Recommended readingW.H. Bates. The Bates Method for Better Eyesight Without Glasses. Grafton

Books, 1979Harry Benjamin. Better Sight Without Glasses. Thorsons, 1992Peter Mansfield. The Bates Method: A Complete Guide To Improving Eyesight

Naturally. Vermilion, 1995Robert-Michael Kaplan. Seeing Without Glasses: I m p roving Your Vi s i o n

Naturally. Beyond Words Publishing, 1994; The Power Behind Your Eyes:Improving Your Eyesight with Integrated Vision Therapy. Healing ArtsPress, 1995

L. H. Salov, W.L. Fischer. Hidden Secrets for Better Vision. Fischer, 1995

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Documents

Good Sight Guide 2010