A (3:32)

Yeah, that makes a lot of sense.

B (3:34)

The other thing is, you know, think about staying active. I know it's harder for people as they get older, but we know that regular aerobic activity improves blood flow, it lowers blood pressure, and also supports diabetes management. And we know that improved glucose control reduces complications like diabetic retinopathy. And certainly, you know, if mobility is a problem, think about some of the activities. You know, talk to your doctor, physical therapists, you know, could you do something like swimming, for example? And don't underestimate the power of walking daily as well.

A (4:11)

Yeah, that makes a lot of sense. It's not about the specific exercise, it's about the fact that you are being active in some way. And actually, that does bring me to another question I had, which was in particular about glaucoma. So I know that the idea is to keep the pressure down. Are there some do's and don'ts with that? Whether it's for certain types of exercise that you should or shouldn't do, maybe, you know, certain things you shouldn't have a lot of caffeine or medications, that kind of thing.

B (4:47)

Yes. So, you know, with glaucoma, there are two things. With glaucoma, one is intraocular pressure. We talk about, you know, keeping the pressure, you know, lower, but the other is ensuring that there is good blood flow to the optic nerve as well. So in terms of, you know, exercise, you know, we recommend gauging in moderate aerobic exercise, and that really can lower intraocular pressure in the, in the long term. And there have been many articles on that. Now, when it comes to some type of exercises like these yoga inversions and headstands, well, they can temporarily raise the eye pressure. So, again, think about the type of exercise you do if you have glaucoma. And, you know, regarding caffeine, it's not a. No, just, you know, don't drink a lot of caffeine in one sitting because you could get a rise in eye pressure from that.

A (5:38)

What about for diabetic retinopathy? And I think you've touched on some of this a bit already, talking about, you know, managing that glucose level and managing your blood flow. Are there some things particular to diabetic retinopathy that we might not see with other conditions that are going to have a big impact?

B (5:58)

Yeah. So with diabetic retinopathy, that's influenced also by having high blood pressure, pressure and cholesterol. So three things need to be controlled at the same time to lower the risk of progression of diabetic retinopathy. So it's definitely a partnership here with your primary care doctor. You need tight blood sugar control, but obviously not so tight that you drop your sugars and that causes problems, but you want to lower the A1C over the long term to reduce the progression of diabetic retinopathy. Also blood pressure control as well, really, really important as is, you know, cholesterol management. And as you know, you can get monitors for blood glucose, you can get these continuous glucose monitors which see more and more of my patients have. They link to their phone and give them alerts and they like to be able to monitor, you know, what they ate and what happened after they ate. And certainly, you know, many patients have a blood pressure cuff at home and, and some measure it more than once a day. And cholesterol management can be difficult in some patients. But if you start with diets, certainly a Mediterranean diet, as we discussed, that can really help with cholesterol management. But some patients need more. They need statins and other drugs to lower the cholesterol, and that actually lowers the cholesterol deposits that we call hard exudates that happen in the macula in diabetic retinopathy and then again, exercise and smoking. These are just universal things that are good for eyes and good for health.

A (7:30)

Absolutely. So what about with macular degeneration? I think one of the most common things we hear, there are commercials about it, people come to us and ask about it, is a regimen of vitamins that might be particularly helpful for macd. So can you speak to that? Is there a regimen that's really helpful? And aside from that, are there some additional things with macular degeneration that people should consider Consider.

B (7:58)

Yeah, so I get asked this a lot by patients, but also, you know, by their families as well. And you know, if you don't have macular degeneration, we just recommend a healthy diet. Now there's a certain level of macular degeneration and that's intermediate age related macular degeneration where you have Drusen in both eyes or if you have advanced macular degeneration, that's the type of patient that could benefit from a special formulation known as the AREDS2 formula. Now, AREDS stands for the Age Related Eye Disease Study. And that was a very large NIH sponsored clinical trial that was run by the National Eye Institute, published in 2013 and that was a follow up from the original AREDS trial. So we have now AREDS and AREDS 2. And the original AREDS trial again showed that there's a certain combination of vitamins and minerals that can slow the progression of intermediate to advanced age related macular degeneration. And so talking about this formulation, while there was the original AREDS formula and that had, you know, certain doses of vitamin C, E, beta carotene, zinc and copper. And then areds2trial modified this because the beta carotene was found to increase lung cancer risk in smokers and former smokers. And the high dose zinc sometimes just caused a tummy upset. And so yes, that was modified then to the IRID2 formula. So those were removed and lutein, zeaxanthin were added. One of the most common questions I get is, well, shall I continue taking these? Are they working? Well, they slow down the disease, you know, they don't stop it completely. And you know, many patients are on it and then they still get even more advanced macular degeneration. And that's tough. But you know, it reduces the Progression by about 25% or so, you know, over five years. Doesn't restore any lost vision, it's only slowing it some. So you can still get the wet macular degeneration and more advanced disease.

A (10:15)

And what if someone has just been diagnosed with dry macular degeneration and it hasn't really progressed yet? Would you say it's a good idea for them to start at that point or will it really make a difference just once it reaches that intermediate stage?

B (10:32)

The studies have shown that for early macular degeneration, that's when you have a few Drusen in the retina. It hasn't been shown to help. And the biggest benefit's really from the intermediate stage and beyond. So, you know, for the earliest Stages, I recommend just a multivitamin and healthy diet. And, you know, many patients really haven't taken the healthy diet seriously. They're still eating whatever they please. And I know we're all guilty of that, but at least, you know, bringing this type of thing top of mind, especially when people, they want to do something to help it. I think of it like a prescription, right? It's a prescription, you know, for a diet. And it all starts when you first wake up in the morning. You know, what is that choice that you're going to make right at the beginning? You know, is it going to be eggs and spinach and fruit, or is it going to be a sugary pastry, for example, you know, and that can often determine, you know, how the rest of the day goes. So I think that awareness is really, really important.

A (11:31)

Absolutely. I love the way you put that. Just waking up, what choice are you going to make? And that does kind of determine how the rest of the day may play out. It's probably. We hear so much about diet and exercise that it becomes kind of a background thing that we all know we should do. But we'll get to it someday. But if we put that in this perspective of this really can make a difference, and it is something within your control. I'm wondering, as we wrap up here, if people are listening to this and they're thinking, you know, I would like to know of any additional studies there have been about vitamins or any recommendations that are beyond this podcast. Maybe they're just looking for that sort of safe place to go to get these kinds of recommendations. Do you have a couple of resources that you might mention?

B (12:27)

Yes. So good references. The societies that we work with in retina, like the American Society of Retina Specialists, for example, puts out research, really good patient information, patient leaflets that are funded by their foundation, and I often give those out to patients. You have the National Eye Institute that also has resources and videos, but also there's the American Academy of Ophthalmology, and they have a website called ismart as well. And Mayo Clinic also. We have a lot of information that we put out in terms of, you know, patient education. And I was, you know, fortunate to be able to write the Mayo Clinic book on vision. And we're doing a new edition, so that has a lot of things. We've got videos out there and a podcast as well that have some information, but you may actually just want to go to the source and sometimes you want to actually look up those articles. And PubMed P-B M E D.com is the national Library of Medicines online journal repository. And you can look up there the AREDS 2 trial that was published in, you know, 2013. And if you want to read everything about it, you know, the whys and all the data, I think that's important. The diabetic trials, you've got the DCCT trials as well that talk about, you know, diabetes control and diabetic retinopathy progression. So, I mean, there's just, there's a lot out there, but I do think it's important to find some credible sources. So, I mean, these are all the types of sites that I tell my patients about, and often, you know, I'm able to link to them in the electronic medical records so they can click on them at their own pace when they go home. But yes, definitely credible sites is what you want to look for. You'll see a lot of videos out there claiming certain things. And I would just say you might want to be a little bit careful about where some of the stuff comes from.

A (14:27)

Absolutely. You're so right about that. And we will have those links to the resources that Dr. Bakri has just mentioned in our show notes. So if you're looking for kind of that one stop shopping for a place to start, at least we'll have those in the show notes. Dr. Bakri, I really want to thank you for stopping by and sharing all of this wonderful information. I think it's so helpful for people who are just looking for that way to really make some smart decisions and to kind of figure out what those smart decisions are for making sure that they get the best outcome for the eye condition, really. Thank you again for spending a little time with us and I appreciate your dropping by.

B (15:15)

Well, you know, thank you so much. And I really, I just want to extend a heartfelt, huge thank you to Hadley. I mean, the work that you do for people with vision loss is just extraordinary. You know, you're providing information, but also, you know, hope. And I've had so many patients of mine who've benefited from Hadley's resources, just learning, you know, from you, you know, from your site and staying connected with others. And I think you've made people feel a lot less alone. So thank you for everything that you do.

A (15:47)

Thank you. Wow. We love to hear that. Thanks for listening.

B (15:50)

Thank you.

A (15:52)

Got something to say? Share your thoughts about this episode of Hadley Presents or make suggestions for future episodes. We'd love to hear from you. Send us an email@podcastadleyhelps.org that's P O D C A S T Hadley helps. Or leave us a message at 847-784-2870. Thanks for listening.