WEBVTT
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You are keeping up with your eye checkup
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and you're consistent
with your medication,
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but do you ever wonder if there's more
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that you could be doing at home
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to ensure the best possible
outcome for your eye condition?
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In this episode, Dr.
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Sophie Bakri joins us
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to share lifestyle choices that can help.
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I'm Ricky Enger and this is Hadley Presents.
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Welcome to the show, Dr. Bakri.
I'm delighted to have you.
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Thank you so much. Thanks for having me.
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Yes, we really appreciate it.
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I know that a question people often
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have is, you know, surely
there's more I could be doing.
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I feel like some of these
things are out of my control,
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but you know, maybe there are things
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that I really do have some
say in that I could be doing.
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And before we get into that,
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I'm wondering if you could
just tell us a bit about
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yourself, kind of your
background, what you do.
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So I'm Dr. Sophie Bakri.
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I'm a retinal surgeon
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and chair of ophthalmology
at Mayo Clinic in
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Rochester, Minnesota.
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I've been in practice for about 20 years
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and my practice focuses
on diseases of the retina,
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so conditions like macular degeneration,
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diabetic retinopathy, retinal
detachments, macular holes,
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epiretinal membranes, retinal vein,
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occlusions, and many more.
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I've been fortunate to care for thousands
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of patients over the years
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and one of the things I've learned is
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that preserving vision
isn't only about treatments
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or surgeries, it's also
about empowering patients
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to make daily choices
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that influence the
course of their disease.
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And that's why I'm really excited about
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today's conversation.
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Absolutely, you are the ideal
person for us to be chatting
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with about this.
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So I know
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that every retinal disease is unique,
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but I'm sure that there
are probably some things
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that are just gonna be universally helpful
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for people to do.
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Can you talk about a few of those
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and why particularly those things are
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helpful for eye health?
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Yeah, so there are definitely
some universal lifestyle
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approaches and many of them apply not
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to just stop ophthalmic disease,
but general health as well.
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I think really the big one is
don't smoke smoking, doubles
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or triples the risk of vision
loss from macular degeneration
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and worsens diabetic eye disease.
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And there have been many
population studies such
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as the Beaver Dam eye study
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and others that have really
shown this very clearly.
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So I think the data here
is indisputable don't smoke
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and also you probably wanna
avoid secondhand smoke as well.
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The other thing is thinking about diet.
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Everybody has a certain
number of calories they need
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or they'll consume, and within
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that you wanna eat a nutrient rich diet.
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So in terms of the retina,
think about leafy greens.
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Fish high in omega threes
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and in particular, you
know, we think about salmon,
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think about colorful fruits.
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I always tell my patients,
you know, eat the rainbow.
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The more colors the better.
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And of course colorful
vegetables as well and
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and have a balanced diet.
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So think about eggs as well. Nuts.
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And you know, if I was to
sum it up, I would just say,
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you know, think about a
Mediterranean diet so that,
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you know, minimizes meat, minimizes sugars
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and increases the amount of
beans, pulses, vegetables,
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fruits, leafy greens.
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And of course on the Mediterranean,
you know, they eat a lot
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of fish and that's a good thing.
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Yeah, that makes a lot of sense.
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The other thing is, you know,
think about staying active.
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I know it's harder for
people as they get older,
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but we know that regular
aerobic activity improves blood
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flow, it lowers blood pressure
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and also supports diabetes management.
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And we know that improved
glucose control reduces
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complications like diabetic retinopathy.
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And certainly, you know,
if mobility is a problem,
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think about some of the
activities, you know, talk
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to your doctor, physical
therapists, you know,
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could you do something
like swimming, for example,
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and don't underestimate the
power of walking daily as well.
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Yeah, that makes a lot of sense.
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It's not about the specific
exercise, it's about the fact
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that you are being active in some way.
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And actually that does bring
me to another question I had,
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which was in particular about glaucoma.
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So I know that the idea is
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to keep the pressure down.
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Are there some dos
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and don'ts with that, whether
it's for certain types
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of exercise that you should
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or shouldn't do, maybe you know,
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certain things you shouldn't
have a lot of caffeine
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or medications, that kind of thing?
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Yeah, so you know with glaucoma
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that there are two things with glaucoma.
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One is intraocular pressure, right?
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We talk about, you know,
keeping the pressure, you know,
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lower, but the other is ensuring
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that there is good blood flow
to the optic nerve as well.
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So in terms of, you
know, exercise, you know,
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we recommend engaging in
moderate aerobic exercise and,
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and that really can lower
intraocular pressure
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in the, in the long term.
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And there have been many articles on that.
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Now when it comes to some type
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of exercises like these yoga inversions
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and headstands, well they can temporarily
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raise the eye pressure.
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So again, think about the type
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of exercise you do if you have glaucoma
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and you know, regarding
caffeine, it's not a no just,
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you know, don't drink a lot
of caffeine in one sitting
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because you could get a rise
in eye pressure from that.
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What about for diabetic retinopathy?
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And I think you've touched on
some of this a bit already,
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talking about, you know,
managing that glucose level
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and managing your blood flow.
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Are there some things particular
to diabetic retinopathy
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that we might not see
with other conditions
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that are gonna have a big impact?
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Yeah, so with diabetic
retinopathy, that's influenced also
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by having high blood
pressure and cholesterol.
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So three things, you know, need
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to be controlled at the
same time to lower the risk
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of progression of diabetic retinopathy.
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So it's definitely a partnership
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with your primary care doctor.
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You need tight blood sugar control,
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but obviously, you know,
not so tight that you,
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that you drop your sugars
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and that causes, you know, problems
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but you wanna lower the
A1C over the long term
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to reduce the progression
of diabetic retinopathy.
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Also blood pressure
control as well, really,
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really important as is, you
know, cholesterol management
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and as you know, you can get
monitors for blood glucose,
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you can get these
continuous glucose monitors,
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which seeing more
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and more of my patients have,
they link to their phone and
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and and give them alerts
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and they like to be able to
monitor, you know, what they ate
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and what happened after they ate.
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And certainly, you know,
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many patients have a blood
pressure cuff at home and,
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and some measure it more than once a day
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and cholesterol management can be
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difficult in some patients.
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But if you start with diet,
certainly a Mediterranean diet
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as we discussed, that can really help
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with cholesterol management.
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But some patients need
more, they need statins and
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and other drugs to lower the cholesterol
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and that actually lowers
the cholesterol deposits
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that we call hard exudates
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that happen in the macular
in diabetic retinopathy.
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And then again, exercise and smoking.
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These are just universal things
that are good for eyes and
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and good for health.
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Absolutely. So what about
with macular degeneration?
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I think one of the most
common things we hear,
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there are commercials
about it, people come to us
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and ask about it is a regimen of vitamins
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that might be particularly
helpful for macd.
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So can you speak to that?
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Is there a regimen that's really helpful?
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And aside from that, are
there some additional things
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with macular degeneration
that people should consider?
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Yeah, so I get asked
this a lot by patients
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but also, you know, by
their families as well.
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And you know, if you don't
have macular degeneration,
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we just recommend a healthy diet.
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Now there's a certain level
of macular degeneration
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and that's intermediate
age-related macular degeneration
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where you have drusen in both eyes
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or if you have advanced
macular degeneration,
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that's the type of patient
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that could benefit from a
special formulation known
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as the AREDS two formula.
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Now ARES stands for the age
related eye disease study
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and that was a very large
NIH sponsored clinical trial
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that was run by the National
Eye Institute published
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in 2013.
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And that was a follow up from
the original AREDS trial.
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So we have now AREDS and AREDS two
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and the original ARES trial again showed
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that there's a certain
combination of vitamins
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and minerals that can slow the
progression of intermediate
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to advanced age-related
macular degeneration.
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And so talking about this
formulation while there was the
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original AREDS formula
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and that had, you know, certain doses
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of vitamin CE beta betacarotene, zinc,
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and copper.
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And then AREDS two trial modified this
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because the betacarotene was found
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to increase lung cancer risk
in smokers and former smokers
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and the high dose zinc
sometimes, you know,
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just caused a tummy upset.
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And so yes, that was modified
then today would two formula.
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And so those were removed
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and lutein zeaxanthin were were added.
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But one of the most common
questions, you know, I get is,
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well, shall I continue
taking these, you know,
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are they working well?
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They slow down the disease,
you know, they, they don't,
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they don't stop it completely and,
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and you know, many patients are on it
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and then they still get
even more advanced macular
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degeneration and that that's tough.
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But you know, it reduces
the progression by about 25%
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or so, you know, over five years doesn't
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restore any lost vision.
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It's only slowing it some,
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so you can still get the
wet macular degeneration
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and more advanced disease.
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And what if someone
has just been diagnosed
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with dry macular degeneration
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and it hasn't really progressed yet,
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would you say it's a good idea for them
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to start at that point?
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Or will it really make a
difference just once it reaches
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that intermediate stage?
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The studies have shown that
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for early macular degeneration,
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that's when you have a
few drusen in the retina.
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It hasn't been shown to help.
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And the biggest benefits
really from the intermediate
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stage and and beyond.
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So, you know, for the
earlier stages I recommend a
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multivitamin and healthy diet and,
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and you know, many patients
really haven't taken the healthy
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diet seriously.
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They're still eating whatever they please.
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And I know we're all guilty of that,
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but at least, you know,
bringing this type of thing top
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of mind, especially when people, they want
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to do something to help it.
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I think of it like a prescription, right?
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It's a prescription, you know, for a diet
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and it all starts when you
first wake up in the morning.
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You know, what is that choice
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that you're gonna make right
at the beginning, you know,
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is it gonna be eggs and spinach and fruit
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or is it going to be a
sugary pastry for example?
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You know, and that can
often determine, you know,
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how the rest of the day goes.
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So I think that awareness is
is really, really important.
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Absolutely. I love the way
you put that, just waking up,
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what choice are you going to make?
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And that does kind of
determine how the rest
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of the day may play out.
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It's probably, we hear so much about diet
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and exercise that it becomes
kind of a background thing
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that we all know we should do,
but we'll get to it someday.
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But if we put that in this perspective of
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this really can make a difference
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and it is something within your control.
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I'm wondering as we wrap up
here, if people are listening
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to this and they're thinking,
you know, I would like to know
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of any additional studies
there have been about vitamins
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or any recommendations that
are beyond this podcast,
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maybe they're just looking for
that sort of safe place to go
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to get these kinds of recommendations.
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Do you have a couple of
resources that you might mention?
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Yes, so good references.
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The societies that we work with in retina,
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like the American Society of
Retina Specialists for example,
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puts out really good patient
information, patient leaflets
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that are funded by their foundation
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and I often give those out to patients.
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You have the National Eye
Institute that also has resources
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and videos, but also
there's the American Academy
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of Ophthalmology and they
have a website called I Smart
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as well and Mayo Clinic also,
we have a lot of information
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that we put out in terms of,
you know, patient education
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and I was, you know, fortunate to be able
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to write the Mayo Clinic book on vision
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and we're doing a new edition,
so that has a lot of things.
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We've got videos out there
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and a podcast as well that
have some information,
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but you may actually just
wanna go to the source
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and sometimes you wanna
actually look up those articles.
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And PubMed, P-U-B-M-E d.com
is the National Library
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of Medicines online journal repository.
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And you can look up
there the AREDS two trial
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that was published in, you know, 2013
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and if you wanna read
everything about it, you know,
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the wises and, and all the data.
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I think that's important.
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The diabetic trials,
you've got the DCCT trials
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as well that talk about,
you know, diabetes control
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and diabetic retinopathy progression.
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So I mean there's just,
there's a lot out there,
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but I do think it's important
to find some credible sources.
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So, I mean, these are
all the types of sites
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that I tell my patients about and,
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and often, you know, I'm, I'm able to link
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to them in the electronic medical records
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so they can click on them at their own
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pace when they go home.
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But yes, definitely credible sites is
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what you want to look for.
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You'll see a lot of videos out
there claiming certain things
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and I would just say you might
wanna be a little bit careful
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about where some of the stuff comes from.
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Absolutely. You're so right about that.
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And we will have those links to
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the resources that Dr.
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Bakri has just mentioned
in our show notes.
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So if you're looking for kind
of that one stop shopping
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for a place to start,
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at least we'll have
those in the show notes.
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Dr. Bakri, I really wanna
thank you for stopping
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and sharing all of this
wonderful information.
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I think it's so helpful for
people who are just looking for
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that way to really make
some smart decisions
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and to kind of figure out
what those smart decisions are
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for making sure that
they get the best outcome
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for the eye condition.
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Really thank you again for
spending a little time with us
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and I appreciate your dropping. Bye.
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Well, you know, thank, thank you so much
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and I really, I just
wanna extend a heartfelt
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huge thank you to Hadley.
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I mean the work that you do for people
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with vision loss is just extraordinary.
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You know, you're providing information
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but also, you know, hope.
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And I've had so many patients
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of mine who've benefited
from Hadley's resources,
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just learning, you know, from
you, you know, from your site
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and and staying connected with others.
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And I think you've made
people feel a lot less alone.
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So thank you for everything that you do.
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Thank you. Wow, we love to hear that.
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Thanks for - Listening. Thank
you. Got something to say?
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00:15:54.620 --> 00:15:58.070
Share your thoughts about this
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00:15:58.070 --> 00:16:00.650
or make suggestions for future episodes.
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00:16:00.650 --> 00:16:02.360
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Send us an email at
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00:16:07.340 --> 00:16:11.600
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00:16:12.620 --> 00:16:15.590
org or leave us a message at
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00:16:15.590 --> 00:16:20.590
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