Wednesday, February 21, 2018


As a Board Certified Ophthalmologist, I like to share news about eye health with my patients that will enhance their life.  I strongly believe that lifestyle choices affect your eye health.  Now we have several studies to confirm that we can prevent glaucoma  Dr. Pasquale of Cornell University emphasized that there is not any particular proven strategy to prevent glaucoma, but he shared six suggestions that show promise:
  1. Eat many green, leafy vegetables. “These are a great source of nitrates that can be converted into nitric oxide,” Dr. Pasquale said. “In primary open-angle glaucoma, there is impaired nitric oxide signaling.” There are drugs in development that will target this highly druggable pathway, he added.
  1. Protect the eyes from the sun starting at an early age. “There is considerable evidence that sunlight reflected off water and snow may be associated with an increased risk of exfoliation syndrome,” Dr. Pasquale said. “A good strategy to start in your younger years is to protect your eyes from the sun.”
  1. Maintain good dental health. This strategy may sound odd initially, but there is a theory that periodontal disease could trigger neuroinflammatory markers that reside in the base of the tooth and travel via the blood to the optic nerve. “At least two studies show that those with poor dental health had a greater open-angle glaucoma risk,” he said.
  1. Exercise in moderation. Moderate exercise is associated with a lower intraocular pressure (IOP), but vigorous exercise appears to be associated with primary open-angle glaucoma.
  1. People should see an ophthalmologist regularly, especially if there is a family history of glaucoma.Dr. Pasquale is involved with a NEIGHBORHOOD consortium focused on finding common gene variants for glaucoma. “We hope this effort will translate into people finding out earlier if they are at an increased risk for glaucoma,” Dr. Pasquale said.
  1. Maintain a healthy body weight. A higher body weight and body mass index are associated with metabolic syndrome and diabetes risk. They could also lead to an elevated IOP. However, someone who is thin, has a low body mass index, low blood pressure, and cold hands and feet could have a disturbed autoregulation, leading to an increased risk of normal tension glaucoma.

Friday, January 19, 2018

Shingrix Vaccine is a MUST for patients 50 and older to prevent painful shingles outbreaks

A controversy existed because the American Academy of Ophthalmology and the American Dermatologic Society recommended that patients over 50 years be vaccinated for shingles but the CDC recommendation was 60 years and above, Pepose said.
Now all recommendations are in line.
In October, the U.S. FDA indicated all healthy adults over 50 years be vaccinated and Shingrix (GSK) was selected as the preferred vaccine.
There are 1 million new cases of zoster annually in the U.S. versus 35,000 new cases of herpes simplex keratitis (HSK), he said. Along with 100,000 new cases of zoster ophthalmicus.
One in two people over 70 years will get shingles in their lifetime, he said.
The risk of stroke increases by 30% within 1 year of zoster and 4.5 times following herpes zoster ophthalmicus, Pepose said.
“This is thought to be related to varicella zoster virus (VZV) travelling down the afferent sensory fibers of the trigeminal nerve to internal carotid and its intracranial branches,” he said.
There are common misconceptions about shingles, he added.
It was thought that the vaccine could perhaps curb immunity in older patients.
“It turns out the incidence of zoster was increasing with age even before the production of the vaccine,” Pepose said.
The vast majority of zoster patients are healthy, he said. The mean age of onset for shingles is 52 years.
The ocular disease usually occurs weeks after.
“Although zoster is more severe in immunocompromised individuals, 92% of zoster patients are healthy,” he said.
The risk of PHN increases with age. PHN is associated with depression and is the leading cause of suicide in chronic pain patients over 70 years.
“Both varicella and varicella vaccine establish an immune response and lifelong neuronal latency, but changes in cell-mediated immunity lead to reactivation,” Pepose said.
He added that only 24% of eligible patients aged 60 years or older have been vaccinated.
“All patients over age 50 years should be vaccinated. I think you’ll have to be cautious with this in first quarter as the reimbursement is going through for the insurance company,” he said.
Zoster trials are ongoing.
“In those who currently have zoster, I wouldn’t vaccinate after it clears but wait a year and then vaccinate. I don’t think there is any evidence that proves the vaccine causes reactivation,” he concluded. – bAbigail Sutton

Pepose JS. The shingles vaccine and zoster ophthalmicus. Presented at: Hawaiian Eye; Jan. 13-19, 2018; Wailea, Hawaii.