Tag Archives: Lee Eye Centre Ipoh

Omega 3 fatty acids and Macular Degeneration

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ipoh echo issue 140, Dr Lee Mun Wai, Lee Eye Centre, Stem Cells in Retinal Disease

Dr Lee Mun Wai

Eye Chat – From a Retinal Surgeon’s Perspective

Previously, I had talked about nutritional supplements for age related macular degeneration (AMD) and further research is now ongoing to look at the benefits of omega 3 fatty acids as well as lutein and zeaxanthin in a large clinical trial known as AREDS 2 (Age Related Eye Diseases Study).

What are Omega 3 fatty acids?

These polyunsaturated fats are essential nutrients as they cannot be synthesized in our body. The omega 3 fatty acids are made up of short chain alpha-linolenic acid and the long chain docosahexanoic acid (DHA) and eicosapentanoic acid (EPA). Examples of foods rich in omega 3 fatty acids are fish, shellfish, flaxseed, walnuts and soy bean.

Importance to the retina?

The brain and eye are highly enriched with omega 3 fatty acids which accumulate in these tissues during early neonatal life. DHA is a major structural lipid in the retina particularly the disc membranes of the photoreceptor outer segments. The photoreceptors are very metabolically active as they are responsible for converting light energy into electrical impulses to be transmitted to the brain for interpretation of images. Consequently, a steady supply of DHA is required for normal retinal function. The complete function of omega 3 fatty acids in the retina is still not fully understood but it is postulated that they have other neuroprotective and anti-angiogenic effects.

Omega 3 and Omega 6 fatty acids imbalance

Humans evolved on a diet with a 1:1 ratio of omega 6:omega 3 but in the industrialized countries nowadays, our diets are more like 12:1 or even 18:1! This hugely disproportionate intake of omega 6 fatty acids has been contributory in the observed increased incidence of heart disease, cancer and other inflammatory disorders. Basically, omega 6 fatty acids exert pro-inflammatory effects whereas omega 3 fatty acids exert anti-inflammatory effects but both are required by our body (in proportionate amounts) for normal functioning.

 

Omega 3 and AMD

Age Related Macular Degeneration is the leading cause of blindness in developed nations and intense research into the treatment and prevention of this disease has led to observational studies showing evidence supporting the association between omega 3 fatty acids and AMD. A high intake of individual fatty acids such as linoleic acid and a high cholesterol intake could lead to an increased risk of AMD. In contrast, epidemiological studies have shown that an increased intake of omega 3 fatty acids could have a protective role especially in wet AMD.

Historically, low incidences of AMD have been reported in Japan and Iceland where fish consumption is high but in recent times, more and more of this disease have been seen in these countries which could reflect a change in the dietary behavior towards a more “western diet”.

Striking a Balance – Making a Difference

It is therefore, very important to have the correct balance of omega 6 and omega 3 fatty acids in our diet. In our current food environment, it is very difficult to get away from the omega 6 overload as almost all our food is cooked with sunflower oil or corn oil or other vegetable oils and all these are laden with omega 6. A lot of food manufacturers of health foods in specialty stores will also coat their products with vegetable oil to improve the texture and taste and unwitting consumers who believe they are taking the healthy option, are in fact tipping the scales towards the omega 6 imbalance.

We are currently victims of modern society and of our lifestyles. Knowing that a lot of these “lifestyle diseases” such as high blood pressure, diabetes, heart disease, etc can be prevented with modified behaviour and habits, we should make an effort to change our ways. For some more information on how to “tip the balance in your favour” visit my blog on www.lec.com.my/youcare-eyecare.

For more information about this topic or other eye health subjects, please visit my blog at: www.lec.com.my/youcare-eyecare. Or call Lee Eye Centre : 05-254 0095.

Surgical Management of Retinal Diseases

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Dr Lee Mun Wai

‘Eye Chat’ – from a Retinal Surgeon’s Perspective

World Sight Day is upon us again and this annual advocacy event for “The Right to Sight” marks the coming together of all ophthalmic care providers to increase public awareness of blinding eye diseases. Retinal diseases make up a significant portion of the blinding diseases and with this article, I hope to provide an overview of the surgical management of these diseases.

Retinal Surgery

Schematic diagram of Vitrectomy

Vitrectomy is a specialized microsurgical procedure which is used to treat retinal disorders. The surgeon uses an operating microscope with a specialized viewing system and a highly sophisticated vitrectomy machine together with very fine instruments to perform the surgery. This is usually performed under local anaesthesia and is often a day case procedure.

RETINAL DISEASES WHICH REQUIRE SURGERY

Diabetic eye disease

Diabetes is a fast growing worldwide ‘epidemic’ and eye complications from diabetes are the leading cause of blindness in the working age group. Diabetes causes leakage of blood and protein from the blood vessels of the retina (retinopathy). Advanced diabetic retinopathy requires aggressive laser treatment to prevent progression to blindness but in severe cases, surgery is often required.

Symptoms of eye problems from diabetes may not be obvious until a very late stage. It is therefore very important for diabetics to have regular eye checkups to monitor for retinopathy. The longer the duration of diabetes, the higher the risk of developing retinopathy.

Retinal detachment

This refers to a separation of the retina from the back wall of the eye. The retina will degenerate and lose its ability to function when detached. The most common form of retinal detachment occurs following a break or tear in the retina.

Symptoms of retinal detachment include floaters, flashing lights or blurred vision particularly described by patients as ‘a curtain hanging over their vision’. The prognosis for retinal detachment depends a lot on the extent and duration of detachment. Therefore, it is important that patients present early when they have visual disturbances as described above.

Macular diseases

The macula is the most sensitive part of the retina responsible for high quality vision necessary for tasks such as reading, driving or watching television. In the aging eye, abnormal changes in the macula can lead to formation of scar tissue known as macular pucker or epiretinal membrane. In some cases, a hole in the macula can form. Typically, patients will describe ‘straight lines appearing crooked’ or even a ‘missing portion’ in their central vision. A vitrectomy combined with peeling of this scar tissue would be required to close this hole and restore vision.

Other conditions

Cataract surgery can sometimes be complicated when the cataract dislocates to the back of the eye or in other cases where the intraocular lens implant itself dislocates. Vitrectomy would then be required to retrieve the dislocated lens material.

Other serious conditions which require vitrectomy would include endophthalmitis (intraocular infections) and serious injuries to the eye including intraocular foreign bodies.

Conclusion

Vitrectomy has been a major advance for ophthalmology as retinal specialists are now able to treat certain retinal diseases and prevent significant visual loss in patients where previously they may have gone blind. There have been further improvements made in the instrumentation for modern vitrectomy and the advantages to the patient include shorter operating times, less discomfort and quicker healing.

For more information, contact:  Lee Eye Centre Ipoh Tel: 05-254 0095 or email: enquiry@lec.com.my. Website: www.lec.com.my