-: You are keeping up with your eye checkup
and you're consistent with your medication,
but do you ever wonder if there's more
that you could be doing at home
to ensure the best possible outcome for your eye condition?
In this episode, Dr.
Sophie Bakri joins us
to share lifestyle choices that can help.
I'm Ricky Enger and this is Hadley Presents.
Welcome to the show, Dr. Bakri. I'm delighted to have you.
-: Thank you so much. Thanks for having me.
-: Yes, we really appreciate it.
I know that a question people often
have is, you know, surely there's more I could be doing.
I feel like some of these things are out of my control,
but you know, maybe there are things
that I really do have some say in that I could be doing.
And before we get into that,
I'm wondering if you could just tell us a bit about
yourself, kind of your background, what you do.
-: So I'm Dr. Sophie Bakri.
I'm a retinal surgeon
and chair of ophthalmology at Mayo Clinic in
Rochester, Minnesota.
I've been in practice for about 20 years
and my practice focuses on diseases of the retina,
so conditions like macular degeneration,
diabetic retinopathy, retinal detachments, macular holes,
epiretinal membranes, retinal vein,
occlusions, and many more.
I've been fortunate to care for thousands
of patients over the years
and one of the things I've learned is
that preserving vision isn't only about treatments
or surgeries, it's also about empowering patients
to make daily choices
that influence the course of their disease.
And that's why I'm really excited about
today's conversation.
-: Absolutely, you are the ideal person for us to be chatting
with about this.
So I know
that every retinal disease is unique,
but I'm sure that there are probably some things
that are just gonna be universally helpful
for people to do.
Can you talk about a few of those
and why particularly those things are
helpful for eye health?
-: Yeah, so there are definitely some universal lifestyle
approaches and many of them apply not
to just stop ophthalmic disease, but general health as well.
I think really the big one is don't smoke smoking, doubles
or triples the risk of vision loss from macular degeneration
and worsens diabetic eye disease.
And there have been many population studies such
as the Beaver Dam eye study
and others that have really shown this very clearly.
So I think the data here is indisputable don't smoke
and also you probably wanna avoid secondhand smoke as well.
The other thing is thinking about diet.
Everybody has a certain number of calories they need
or they'll consume, and within
that you wanna eat a nutrient rich diet.
So in terms of the retina, think about leafy greens.
Fish high in omega threes
and in particular, you know, we think about salmon,
think about colorful fruits.
I always tell my patients, you know, eat the rainbow.
The more colors the better.
And of course colorful vegetables as well and
and have a balanced diet.
So think about eggs as well. Nuts.
And you know, if I was to sum it up, I would just say,
you know, think about a Mediterranean diet so that,
you know, minimizes meat, minimizes sugars
and increases the amount of beans, pulses, vegetables,
fruits, leafy greens.
And of course on the Mediterranean, you know, they eat a lot
of fish and that's a good thing.
-: Yeah, that makes a lot of sense.
-: 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.
-: 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 dos
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?
-: Yeah, so you know with glaucoma
that there are two things with glaucoma.
One is intraocular pressure, right?
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 engaging in moderate aerobic exercise and,
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.
-: 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 gonna have a big impact?
-: Yeah, so with diabetic retinopathy, that's influenced also
by having high blood pressure and cholesterol.
So three things, you know, need
to be controlled at the same time to lower the risk
of progression of diabetic retinopathy.
So it's definitely a partnership
with your primary care doctor.
You need tight blood sugar control,
but obviously, you know, not so tight that you,
that you drop your sugars
and that causes, you know, problems
but you wanna 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 seeing more
and more of my patients have, they link to their phone and
and 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 diet, certainly a Mediterranean diet
as we discussed, that can really help
with cholesterol management.
But some patients need more, they need statins and
and other drugs to lower the cholesterol
and that actually lowers the cholesterol deposits
that we call hard exudates
that happen in the macular in diabetic retinopathy.
And then again, exercise and smoking.
These are just universal things that are good for eyes and
and good for health.
-: 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?
-: 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 AREDS two formula.
Now ARES 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 two
and the original ARES 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 CE beta betacarotene, zinc,
and copper.
And then AREDS two trial modified this
because the betacarotene was found
to increase lung cancer risk in smokers and former smokers
and the high dose zinc sometimes, you know,
just caused a tummy upset.
And so yes, that was modified then today would two formula.
And so those were removed
and lutein zeaxanthin were were added.
But one of the most common questions, you know, I get is,
well, shall I continue taking these, you know,
are they working well?
They slow down the disease, you know, they, they don't,
they don't stop it completely and,
and you know, many patients are on it
and then they still get even more advanced macular
degeneration and that 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.
-: 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?
-: 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 benefits really from the intermediate
stage and and beyond.
So, you know, for the earlier stages I recommend a
multivitamin and healthy diet and,
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 gonna make right at the beginning, you know,
is it gonna 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 is really, really important.
-: 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?
-: Yes, so good references.
The societies that we work with in retina,
like the American Society of Retina Specialists for example,
puts out 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 I Smart
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 wanna go to the source
and sometimes you wanna actually look up those articles.
And PubMed, P-U-B-M-E d.com is the National Library
of Medicines online journal repository.
And you can look up there the AREDS two trial
that was published in, you know, 2013
and if you wanna read everything about it, you know,
the wises and, 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,
and often, you know, I'm, 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 wanna be a little bit careful
about where some of the stuff comes from.
-: 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 wanna thank you for stopping
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. Bye.
-: Well, you know, thank, thank you so much
and I really, I just wanna 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 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.
-: Thank you. Wow, we love to hear that.
-: Thanks for - Listening. Thank you. Got something to say?
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