Another study has been published, further validating the benefits of exercise, this time on the rate of progression of visual field defects among glaucoma patients.
"Although exercise lowers intraocular pressure (IOP), is it helpful in slowing down visual field progression in open-angle glaucoma? This intriguing question was studied by Yokota et al who recruited 24 patients with primary open-angle glaucoma (POAG) or exfoliation glaucoma. They were divided into two groups by a single self-reporting questionnaire: “Do you have habitual exercise more than 30 min per week?” Based on their answers, patients were classified into the exercise or non-exercise group. The mean deviation (MD) of the Humphrey Field Analyzer (HFA) Swedish interactive threshold algorithm (SITA) standard 24-2 program (Carl Zeiss Meditec Co., Ltd., Tokyo, Japan), IOP, and visual acuity was then retrospectively reviewed for 3 years. Results revealed that the exercise group had a mean IOP of 14.8 mm Hg using a mean number of 2.5 anti-glaucoma drugs, whereas the non-exercise group had a mean IOP of 13.3 mm Hg using a mean number of 2.2 anti-glaucoma drugs. The non-exercised group also experienced faster visual field progression. The MD slope in the exercise group was +0.20 dB/year versus −0.53 dB/year in the non-exercise group. Univariate logistic regression models revealed that higher IOP and habitual exercise reduced the visual field defect progression risk.
Exercise can reduce IOP by causing changes in colloid osmotic pressure, increases in plasma osmolarity and blood lactate, and decreases in blood pH. In contrast to the Early Manifest Glaucoma Trial showing that higher IOP was a significant predictor of visual field loss, Yokota’s paper showed that higher IOP was related to slower visual field loss. Yokota et al hypothesized that the decreased visual field loss in the active exercise group was due to better ocular perfusion pressure. The authors postulate that the inability of regular exercise to decrease IOP in this study was due to the small sample size.
The limitations of Yokota’s paper were that it was retrospective, had a small sample size, and, although the MD slope was used to analyze visual field defect progression, different results might have been obtained if point-wise event or visual field index analyses were used instead. I agree with the authors that a large-scale prospective cohort study is needed to clarify the relationship between exercise and glaucomatous visual field defects. In the meantime, to those patients who ask me what else can they do to slow down optic nerve damage (other than taking their medications and keeping their appointments with me), I will give them the gist of Yokota’s paper: do 30 minutes of habitual exercise daily." - Joseph M Ortiz, MD
Several years ago, the American Journal of Optometry reported on a study by the VA Hospital in Kansas City that demonstrated that people who regularly exercised were significantly less likely to develop macular degeneration. In their study, the correlation was stronger than what was expressed by diet or the counter correlation of tobacco consumption. What is regular exercise? In their study, for 30 minutes, more than three times a week and it was only necessary to be vigorous enough to elevate the rate of respiration. Heck, I get to breathing hard, just turning compost! The point is that exercise isn't just for your heart or your weight; nope, it's good for your eyes, it's good for all of you.
This is a single slice of an Ocular Coherence Tomography (OCT) scan of a left macula. It is flawless. The macula is the part of your retina that you use to read with, to look at fine details and central vision with. The center of the macula is called the fovea and the center of the fovea is the foveola. This scan is of 6 mm of tissue with a resolution is 3.5 microns. (A blood cell is about 8 microns.) Usually, the evaluation of the different layers is easier via grey scale but in this scan the different layers are so very clear and the color rendering is more compelling. The OCT has software that allows me to view the scans in three dimensions, take anterior to posterior isolations of particular layers and compare them against a normative, age matched database. Macular degeneration, holes, anomalous vitreomacular adhesions, plaquenil toxicity, glaucoma and diabetic retinopathy are just a few the conditions that I evaluate and/or treat incorporating this technology. This particular scan is a transverse section performed in my office using the Zeiss Cirrus 4000, on my daughter, Miranda. What does yours look like? Through October, we will be performing a complimentary OCT scan with your examination to introduce you to the technology and give us an opportunity to brag about the benefits. I'll even give you a copy of it, if you'd like.
In my previous posting, I stated that "it's about technology" and while that's true and I do appreciate technology, the reason I practice optometry is because I enjoy the opportunity to help people to see better. If the technology doesn't improve or preserve the quality of vision, then the value of that technology is difficult to justify. This is a constant process of consideration for all doctors who must make evaluations of the many technologies that are available to us for the evaluation and management of everything from refractive errors to cancer. For instance, my practice has invested in ocular coherence tomography (OCT) and frequency doubling technology (FDT) in order to allow us to better evaluate the eyes for diabetic retinopathy, plaquenil toxicity, manage diseases of the macula and treat glaucoma, all with a high degree of precision that was unavailable just a few years ago. We chose to incorporate these technologies into our practice in order to provide the best care for our patients and because these conditions are the most common causes of vision threatening disease. It's truly valuable.
Fortunately, most people don't need these kinds of technologies in order to see well. They need a pair of glasses. But in order to see our very best, we need the best lenses and the best lenses are made by Hoya Vision. They have improved the quality of vision that many people experience via the incorporation of high order mathematics to reduce aberrations inherent in progressive addition (PALs) as well as single vision lenses. Hoya Vision is about technology. They are the leader in the science of spectacle lens designs (iD), lens materials development (Phoenix) and lens coatings (EX3). HOYA is the only manufacturer with double surface technology. We have chosen to make these lenses available to our patients because I believe that they're the best and the positive responses I have been seeing from my patients that have converted to these lenses reinforces that conviction. It gives me great satisfaction to hear someone exclaim how clear their vision is with their new glasses! I feel that same pride that I'm sure Dr. Cook enjoyed, when he pulled back the curtains to the window and let me experience my first pair of glasses and I exclaimed, "The trees have leaves!"
Hoya Vision is valuable technology for your vision.
A story from my childhood.
When I was ten, my mother noticed that I was unable to read the signs inside the Sears department store, in which she worked, at 21st and Yale in Tulsa. I’ll tell you more about my mom, another day. I remember it kind of caused her some anxiousness because as soon as possible, she took me to Dr. Phillip Cook, THE optometrist, in my home-town of Collinsville. As some of you know, I enjoy telling this story because it had such an impact on my life and I share it, occasionally. Dr. Cook very carefully examined my eyes (I thought it was fun!) and his refraction determined that I was near-sighted and needed some glasses. Probably a week later, we returned to Dr. Cook’s office and he presented me with my new eyewear. These weren’t just any glasses, either. Some of you might actually be old enough to remember glasses like my first pair. I think the brand was probably “Indestruco” or something similar because they were virtually unbreakable black nylon frames. Perfect for a ten year old boy living in the country. And they were uhhg-lee. They were ugly in 1969. Today, they’re “retro cool”. Regardless, Dr. Cook had this huge, floor to ceiling, twenty foot long window in his reception area that looked out onto Main Street which had recently been “beautified” by the planting of trees in the sidewalks. Dr. Cook took me to the front of his office, drew back the curtains and instructed me to look across the street. I was amazed and reported that, “The trees have leaves!” Of course I knew that the trees had leaves but for however long, I hadn’t been able to see the individual leaves from any distance away from the trees. If it sounds kind of dramatic, I’ll bet that was just the effect he was going for because it worked! I think my mom was about to cry she was so relieved and at the same time, perhaps, embarrassed that she had somehow allowed her first born baby to be so neglected. Dr. Cook just chuckled but I’m sure he was proud of the impact that his professional care had made on both of us.
But that’s not why I became an optometrist.
That’s another story.
Next week, I'll explain why this story is relevant to you. It's about technology. It's about Hoya.
I got an email a few days ago from Chris Hazell, the founder of The Call Collective http://thecallcollective.com/. It moved me and inspires me and I wanted to share it to a wider audience. Well, a little bit wider, anyway. I hope you'll take a few minutes to read it and maybe take a look at his blog, FB, etc.
Why is God so Demanding of Us?/ CHRIS /
From a very young age we’re taught the value of accruing knowledge, relationships, popularity and success—a storing up and clutching onto good things that can help us sail effectively toward a happy life. We’re groomed not to dispense of anything we own or acquire that has value, but instead to cultivate it, protect it, hold onto it with tireless resolve. What we have and collect—our education, gifts and talents, intellect, possessions—we are expected to use strategically to our advantage. We become hoarders so we can navigate the world and be victorious within it.
From a rational vantage point, it makes complete sense. It seems an absolutely necessary mindset to have in order to be successful in the world. These things, in their goodness, can point to God and allow for happiness. When I review the many good things in my life—my family, group of friends, job, health, home in San Diego, access to delicious food at will—sometimes I’m met with an overwhelming sense of comfort and contentment. For me, such a realization invites me to thank God, acknowledging that such things can work as refreshment on life’s journey. These moments, as good and nourishing as they can be, though, also have the capacity to dim my reliance on God. I can easily take comfort in the things around me, becoming resistant in handing them over to God should he ask for them.
Take, Lord, and receive all my liberty,
my memory, my understanding
and my entire will,
All I have and call my own.
You have given all to me.
To you, Lord, I return it.
Everything is yours; do with it what you will.
Give me only your love and your grace.
That is enough for me.
St. Ignatius of Loyola, The Suspice
This prayer from St. Ignatius is one of the most difficult prayers to say. I can muster the effort to rattle off the words, half-heartedly and with shallow earnestness, but to pray them from the heart—to say and mean them in their fullest—is very difficult for me. I don’t know if I’ve ever been able to say those words and truly mean them. There is something inside me that tears when I say them, tempting me to rein in the words.
If we scramble to store up things in this world without a firm anchoring to God we begin to ironically lose these things anyways. Our memory can be held captive by regret and denial. Our understanding can become clouded, darkened by the ceaseless motion to grasp at our own notion of happiness. And our liberty and will—the very vehicles that allow for our freedom and autonomy—can become enslaved to anxiety, worry and fear. We can replace our authentic selves—children loved by God—with a composite of excess possessions and shallow accomplishments. We may only become what we earned, what we were given by others, what the world says we are after a stringent accounting of our “assets.” The whole becomes buried by its parts.
An article in Psychology Today, “Is the Intense Pressure to Succeed Sabotaging Our Children?,” examines the stress placed on children to do well academically. The article serves as a somber warning against the unmitigated pressure placed on many students today to gain admittance to a good college in order to set themselves up for a successful career and life. Tragically, a failure to meet such a lofty goal can sometimes even result in suicide.
“There are so many alternative roads to happiness and fulfillment beyond acquiring wealth and driving a fancy sports car. Why do so many people in our society put a premium on the superficial value of material possessions and status symbols? Everyone knows that friends, family, being healthy, and having a sense of purpose are ultimately the most important things in life and the keys to fulfillment.”
This article only highlights stress placed on students in regard to their schooling. Of course, this same mindset that idolizes a harrowing drive toward success spans across all ages and facets of our culture.
Yet, Christianity stands athwart the blinded quest to accrue and collect. It speaks instead of returning back to a childlike state of dependence, offering up all we own to a loving Father. It calls for a radically different way of understanding our identity and place in the world.
But how can we expect to give away our liberty, memory, understanding and will? Aren’t those the very things that constitute our unique being? They are the crux of our identity, the intersecting of those four aspects of our person literally makes us who we are—and give us the capacity to procure a self-directed and happy life. St. Ignatius’ prayer calls to mind the hard-to-swallow words of John the Baptist: “[Christ] must increase; I must decrease.” Some in our culture may be familiar with the phrase—reading it and repeating it with a feathery understanding. However, entering into a state of decrease—a state of relinquishing our freedom, gifts and very identity—for the sake of God is a monumentally countercultural thing. Of course, the God we proclaim does not exist within a zero sum paradigm. Our loss, for the sake of him, is never truly a loss. It becomes a gain. And as we concede our identity—at least the one we’ve clumsily crafted for ourselves—we learn that he puts the pieces of who we are back together in the right order. We begin to see ourselves as we are: we begin to see we are worthy simply because God says so, emphatically.
The question still remains: why do many of us struggle to pray and mean the words of TheSuspice? If we trust that God will reward us one hundred fold, then where is the holdup? If I’m honest, it’s still a problem of trust. And when I do manage to say the words and mean them, as much as possible, I still struggle to allow God to do with my offering what he wills as opposed to what I will. I can be guilty of assuming that if I give up my understanding, then I’ll receive back my understanding times one hundred in return. It becomes a conditional relinquishing. I’ll do that God, only if you do this.
Of course, maybe he will reward us as we hope, and we can be certain by our faith and understanding of God that he will bless us in some way (as the phrase goes, God will never be outdone in generosity), but the blessing may not come in more understanding. That may only come in the life after this one. Or perhaps, it may come in the form of a deeper faith that doesn’t always question God’s ways—not a blind, irrational faith, but one that accepts the limits of human understanding and the lack of clarity to see what God is really up to.
Although we do not give everything to God and ask for nothing; we still always ask for his love and grace. We find that when we understand what it is we’re asking for, the eternal love of an infinite God and his manifestation in our lives, the exchange is quite unequal—infinitely so. We offer what measly gifts we can to God, measly gifts that we cling onto with furious might at times, in exchange for the whole of God’s being.
St. Ignatius’ prayer remains an invitation to let God bless us even more than he already has. In giving ourselves to him, we allow him to use us as he needs—as his divine instruments, his loving children. It may be in the way we had hoped, or it may come through suffering, but regardless, it will come with tremendous blessings. And as we all know, sooner or later, we all do give up our liberty, understanding, memory and will at that hour of death. The question then becomes, as Henri J.M. Nouwen reminds us in his book, The Only Necessary Thing: Living a Prayerful Life, this: When we do lose them and have nothing left to offer to God, will we stand before him with open hands of trust, or clenched fists of fear?
I am so afraid to open my clenched fists!
Who will I be when I have nothing left to hold on to?
Who will I be when I stand before you with empty hands?
Please help me to gradually open my hands
and to discover that I am not what I own,
but what you want to give me.”
Henri J.M. Nouwen, The Only Necessary Thing: Living a Prayerful Life
This post was first published at Bishop Robert Barron’s Word On Fire blog.
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We saw our first patients at our new location on Rambling Oaks in Norman, today. And yes, it was very exciting. Fittingly, one of the very first patients was a patient that I first met in Midwest City who has followed me to Crossroads and to Moore and now in Norman. We didn't have my diplomas hung, the art work is still on the floor and we didn't have any frames to sell. There were boxes in the hallways, some not yet opened and some that need to be saved for "our next move". But everyone was so happy for us and telling me how successful we will be. I think I'll praise the Lord if we just pay our bills. I'm sure we'll praise the Lord if we go broke and wind up getting visited by a representative of St. Vincent de Paul but I'm confident that if it weren't God's will for us to be where we are, we'd be doing something else. God loves us. He knows us and cares about our individual lives and I believe that whatever comes our way, we will be made better prepared to experience his beatific vision. "The Little Flower", St. Therese of Lisieux, advocates, "Bloom where you're planted." We've been planted at 1120 Rambling Oaks Dr., Norman Oklahoma.
St. Therese, pray for us.
On March 31st, 2016, I closed my office in Moore Oklahoma. I realize this has caused inconvenience for some of my patients and for that, I apologize. It's my fault. I had time before, when I had decided that I wasn't going to renew my lease with LensCrafters, to set up a new location. Instead, I allowed myself to be persuaded that an associate/partnership opportunity was going to be forthcoming that would obviate that necessity. I shouldn't have relied upon that but instead made provisions in case a plan B became necessary. But I didn't. That's what happened and why I have been unavailable, since the end of March until now. A covenant in my lease agreement agreement stipulated that I could not practice within five miles of the 19th Street in Moore office, next to LensCrafters. Therefore, on April 12th I will take possession of the office space located at 1120 Rambling Oaks Drive, in Norman. It's a nice office and 6 and a half miles from the Moore location. I admit to some trepidation in taking on the endeavor of establishing a full service, private practice at this time. (read: not just providing professional services but selling glasses as well) I don't think this is necessarily the best of times to be opening up a new business.
In regards to LensCrafters, I can't say enough good things about the people at the Moore location. Tina, Kathy, Mark, Craig, Chris and Rebecca are all very pleasant, dedicated professionals who did excellent work and made my life and practice more enjoyable, at that location, than it could possibly have been without them. I honestly believe that my experience is in distinct contrast to some of the stories I've heard from ODs at other locations. They will be formidable competition.
While I have been in practice in the central Oklahoma area as well as living in Norman for 31 years, I have not practiced in Norman since 1986. I have some very loyal friends who have followed me to all the different locations from which I have practiced. Thank you all very, very much. I recognize that many of you will not find it necessary or convenient enough for you to follow me to my new office. I regret that. For those of you who decide to continue to see me in Norman, I sincerely hope that I can continue live up to your expectations for professional care.
Thank you for your patience!
Jay Johnson, OD
I have been providing primary vision care since my graduation from Northeastern State University College of Optometry (now known as, Oklahoma College of Optometry) in 1984. I have recognized my status as a Child of the living Lord, Jesus Christ since 2013. Previous to that, I was my own shepherd.