AOA HANDOUT Aging Eye.pptx (Read-Only)

Transcription

AOA HANDOUT Aging Eye.pptx (Read-Only)
8/14/13
Cosmetic and Health
Related Considerations
of the Maturing
Population
ž 
President, Women of Vision
ž 
Diplomate, Cornea, Contact Lens and Refractive Technology Section, AAO
ž 
Diplomate, American Board of Optometry
ž 
Past Chair, Cornea & Contact Lens Section, AOA
ž 
Past President, Illinois Optometric Association
ž 
IOA Optometrist of the Year, IOA Young OD
ž 
Review of Optometry Top 10 Woman ODs
ž 
NKCI, Chicago Site Director
Consultant, Chicago Blackhawks and Hockey mom
ž 
ž 
Consultant/Speaker for Bausch + Lomb, Alcon, Allergan, CooperVision,
ISTA, husband Jeff McClimans works for Optos
Kristin J. Tarbet, M.D.
ž 
Past President of WOV
ž 
Past Chair of the AOA CLCS
ž 
Past President of Scleral Lens Education Society
ž 
Chief Clinical Editor of Review of Optometry
ž 
Contributing editor for CL spectrum
ž 
GPLI Advisory board
ž 
Fellow, American Academy of Optometry
ž 
Review of Optometry Top 10 Woman OD
ž 
Optometry degree from the University of Alabama at Birmingham
ž 
Residency at the Illinois Eye Institute
ž 
Dr. Reed is a frequent CE lecturer and writer in the areas of ocular
disease management, pharmacology, and nutrition.
ž 
She serves on numerous advisory boards regarding health and wellness
ž 
Board of Directors, Ocular Nutrition Society
ž 
Teacher of the Year 17 times!
ž  American
Board of Ophthalmology
American Board of Cosmetic Surgery - Facial
Cosmetic Surgery
Diplomat American Society of Ophthalmic Facial
Plastic & Reconstructive Surgery (ASOPRS)
1
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2013 –
Anticipated
TFOS
Contact
Lens
Dryness
Report
2007 –
TFOS
DEWS
Report
1995 – Dry
Eye is a
“disorder”
2006 – ITF
Guidelines;
4 Levels of
Severity
2011 – TFOS MGD
Report
ž Osmolarity
¢ 
“central mechanism in the pathogenesis of ocular surface damage”
¢ 
Potentially the single best marker for dry eye disease
¢ 
Measurement possible, but can be hampered by reflex tearing
while collecting sample, need for large volumes of tears,
possibility of evaporation of the sample
²  “Overall,
MGD is an extremely important
condition, conceivably underestimated, and very
likely the most frequent cause of dry eye
disease.”
²  “A lipid deficiency occurred in 76.7% of dry eye
patients compared with only 11.1% of those with
isolated alterations of the aqueous phase.”
²  “MGD is perhaps the most underdiagnosed,
undertreated, and underappreciated disease in
eye care worldwide”
Investigative Ophthalmology and Vision Science (IOVS); March 31, 2011 (by Tear Film and Ocular Surface Society)
(WC Posey, Diseases of the Eye, 1902)
ž  The
Transillumination of
meibomian glands
lipid layer restricts evaporation to 5-10% of tear flow
helps lubricate
¡  Also
(Transillumination image from Dry Eye and Ocular Surface Disorders, 2004)
Obstructive meibomian gland disease
Squamous metaplasia of
meibomian gland orifices
Turbid secretions from
meibomian gland orifices
ž Lid
margin morphology and turbidity of secretions can
be graded to assess disease severity (Bron et al, 1991; Mathers et al,
Inferior streak
tear breakup
Broad streak
tear breakup
1991)
Images from Dry Eye and Ocular Surface Disorders. 2004.
Images from Dry Eye and Ocular Surface Disorders. 2004.
2
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Lid Margin Disease → Definitions
ž Anterior
Blepharitis
Ø Inflammatory
condition of outside portion of the eyelids
secondary to infection, or associated with acne
rosacea or seborrheic dermatitis of the scalp or facial
areas
Ø Often
ž Meibomian
Gland Disease (MGD; Posterior
Blepharitis)
Anterior blepharitis
Ø Tissue
Inflammation of the inside portion of the eyelids
Ø Associated with altered composition of the meibomian
gland secretions, inflammation of local tissue
Meibomian gland disease
ž  Omega
3 Fatty Acid Intake
¡  Consider
¢ 
ž  A
current intake through dietary means
popular first-line treatment
¡  Topical
Steroid QID 2 weeks
to 1 month in Duration
¡  Concurrent dosing of Restasis
(cyclosporine) BID long-term
¡  Drawback?
Healthy Fish (boiled, baked, grilled)
¡  Initiate
And these are only the drops!!
supplements if appropriate
Between 1,500 to 3,000 mg/day is most
appropriate dose.
¢  High “Pharmaceutical Grade” is essential.
¢  Ethyl-Ester vs. Triglyceride form
¢  EPA+DHA ≥ ½ total Omega 3 FA’s
—  (75-80% common in quality supplements)
¢  Maintain with as low as 1,000 mg
¢ 
¢ 
Cost, IOP concerns, Stinging
Concerns, Off-label concerns,
concerns with prior HSK/HZV?
ž  Not
“new” per-say, except in Western culture
standard treatment protocol
ž  Difficult to standardize methodology
ž  No
Doxycycline 50 mg BID (Rosacea)
Tranquil Eyes Warm Compress
ž  Has
had positive results as a complementary
therapy
ž  Balances the autonomic nervous system.
Cholinergic anti-inflammatory effect by enhancing
vagus nerve activity.
Lipisome Spray
Mastrota paddle
Azasite
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ž  The
role of androgens
¡  Promote
lacrimal gland, salivary gland, and meibomian
gland function.
¡  DHEA is important in maintenance of secretory glands,
and in estrogen-deficient individuals, there is a
proportional deficiency in DHEA.
¡  When the estrogen/androgen balance is disrupted,
autoantigens form leading to auto-inflammatory and
auto-immune conditions.
¡  May be the pathogenesis in Sjogren’s Syndrome.
¡  Topical DHEA drops are being used off-label in varying
concentrations with mixed anecdotal results.
ž Products
derived from the
patient’s own blood.
ž Autologus serum
ž Platelet-rich plasma
ž  “A
ž  Anakinra
(Kineret; Amgen, Inc.)
¡  Recombinant
version of human IL-1Ra approved for treatment of
Rheumatoid Arthritis
¡  DED is associated with significant overexpression of
inflammatory cytokines, including interleukin-1 in the eye.
¡  The IL-1Ra suppresses IL-1-mediated inflammation by
completely inhibiting the binding of IL-1a and IL-1b to IL-1
receptor I.
¡  Randomized, double-masked trial. 75 participants received
Artifical tear, 2.5% anakinra, or 5% anakinra
revolutionary way to treat
evaporative dry eye caused by
meibomian gland dysfunction.”
ž  Controlled
heat and massage for
optimized stimulation of the
meibomian glands.
JAMA – Ophthalmology
Reported online 23.April.2013
Contact: [email protected]
ž  Made
in New Zealand by bees that pollinate the
native manuka bush.
ž  UMF (Unique Manuka Factor) determines antibiotic
effectiveness.
ž  Manuka honey used is pharmaceutical/medical grade
and highly sterilized.
4
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ž Tea
tree treatments with 50% lid scrubs or
5% lid massages are effective in eradicating
mites and reducing ocular scurface
inflammation.
ž Multiple Properties
¡  Anti-microbial
¡  Anti-inflammatory
¡  Anti-protozoalAnti-viral
Christine Sindt, OD, FAAO
ž  Replacing
¡  Replace
Make Up
every 3 months
ž  Hand
ž  Lens
Washing
Case Care
¡  Rinse
¡  Wipe
¡  Store
dry
5
8/14/13
ž  Periorbital
skin is only 0.55mm thick, compared to
2mm thick on rest of body
ž  Contributing Factors
¡  Lack
of Sleep
¡  Allergies
¡  Smoking/ Caffeine/ Alcohol
¡  Dehydration
¡  Iron deficiency/ Anemia
¡  Genetics
ž  GP
contact lens wear
cause:
ž  Primary
¡ 
¡ 
levator aponeurotic
disinsertion
presumably due to
recurrent traction on the
aponeurosis during rigid
contact lens removal.
Ophthalmology. 1995 Jun;102(6):
924-8.
Acquired ptosis in the young
and middle-aged adult
population.
Kersten RC, de Conciliis C, Kulwin DR.
ž  Mueller
muscle
degeneration
ž  PREVENTION
ž  Preparation for Lid SX
ž  One
of the most common cosmetic operations
and aesthetic benefits
ž  Long lasting benefits (years)
ž  Fast recovery time (1-2 weeks)
ž  May be covered by insurance
ž  Functional
ž Severe
Dermatochalasis
ž  Caffeine
¡  Tea
bags
ž  White
ž  Night
¡  UV
ž  Lose
eye liner
cream with Vitamin K and retinol
sensitive, should only be used at night
the glitter make up
ž Thinning
of the dermis and atrophy of fat pads
of elasticity
ž Greater visibility of bony landmarks, blood
vessels, wrinkles, and furrows
ž Transverse forehead lines
ž Lowering of the eyebrows
ž Descent of the corners of the mouth
1. Yaar M, Gilchrest BA. Skin aging: postulated
mechanisms and consequent changes in
ž Ptosis of nasal tip
structure and function. Clin Geriatr Med.
ž Loss
2001;17:617-630; 2. Stern RS. Treatment of
photoaging.
N Engl J Med. 2004;350:1526-1534.
.
ž Discuss
patient goals and expectations
facial asymetry
ž Look for brow / eyelid ptosis
ž Document: fissures, margin reflex distance,
ž Evaluate extraocular muscle function
ž Note presence of Bell’s phenomenon
ž Springback test for lower lids
ž Preoperative photos
ž Assess
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ž  Avoid
ž  Need
visual fields – untaped and taped
photos – frontal and side views
ž  Letter of medical necessity
ž  Lower eyelids are not covered
ž  Pseudoptosis
ž  Preoperative
ž  Measure
and mark skin excess
levator function pre-op
ž  Inject 2% Lidocaine with epinephrine
ž  Excise skin and remove excess periorbital fat [ don’t
forget medial fat pad]
ž  Levator advancement if required for ptosis
ž  Close with subcuticular 6-0 prolene sutures
ž  Be conservative with regards to skin excision
ž  Assess
anticoagulants for 10 days pre-op
routine medications
ž  Be prepared for severe bruising and swelling day 2-4
ž  Bruising may persist for 2-3 weeks
ž  No contact lens wear first week
ž  Continue
ž  If
lateral hooding is present OK to extend past lateral
canthus
ž  Minimize
skin excision past lateral canthus in
younger patients
Younger patient
Older Patient
Marking Guidelines
¡  2 cm of skin needed from brow to lid margin
¡  Use the pinch technique
ž  Chill
eyelid skin for 24 hours [ frozen peas ]
No vigorous exercise or heavy lifting
ž  Protect cornea with ointment
ž  Sleep with head at 45 degree angle
ž  Remove sutures at 1 week
ž  No contact lens use first week
ž  Rest!
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ž  Pain
ž  Too
ž  Bruising
[ uncommon ]
and swelling
ž  Itching
ž  Asymetry
ž  Healing issues
ž  Improper skin/fat excision
ž  Too
ž  It
much skin removed
much fat removed
ž  Asymmetric ptosis
OTHER PROCEDURES
ž  Asymmetric ptosis: Levator advancement
ž  Dermatochalasis
is easier to raise a lid crease than lower one
in lower lids with post op ectropion
ž  Hollowing
ž 
Louise A. Sclafani, OD, FAAO
ž 
Kohl used in ancient times for eyeliner
Three Components: Film Formers, Thickeners ( waxes, gums and
clays to “help color stick” and Pigments
¡ 
¡ 
ž 
ž 
ž 
ž 
ž 
Avoid products with “glitter” especially in dry eye
Introduce new products one at a time: avoid allergy
Don’t mix and match: no lip-liner on the eyes
Never tug lashes with curlers, sharp objects
Application Process: Respect the line
¡ 
ž 
ž 
ž 
Concealer… shadow…liner…powder…mascara…
Apply after contact lens insertion/before presbyopic myopes, GPs!
Remove cosmetics @bedtime, rinse removers
Replace mascara q 3 months: don’t “top off ”
ž  AKA;
ž  Infection,
ž  Used
ž  Allergic
¡ 
Micro-pigmentation, Dermagraphics
for cosmetic and medical purposes (vitiligo)
Iron oxides= Black/brown
Ultramarine= blue,
Chromium oxide= green Titanium oxide=white
Active, unable to wear cosmetics
ž  Most
common is eye-liner… eyebrow….lips
are no FDA “approved colors”: Iron oxide is inert,
doesn’t migrate and less likely to cause allergic reaction
than vegetable based products
ž  May reduce wrinkles and break down scar bands
ž  Importance of reputable Services: licensed
ž  There
¡ 
Dermatologists, Cosmetologist, Aesthetician, Nurses, Mac!
ž  Refresher
due to fading from UV, products, skin type
Hepatitis: prevention with disposables
reaction: Avoid black India Ink and Henna
ž  Granulomas and Keloid (especially with removal)
ž  Dissatisfaction w/ appearance- go classic, not trendy
¡  Removal
via dermabrasion and surgery may lighten skin
ž  MRI
: risks vs. benefits of discomfort
ž  Peri-Operative; pain, swelling, bleeding
ž  COST: $400-$800 …. PARA-MEDICAL
ž  Report Adverse Events
¡  FDA
1800-332-1088
Premier Pigment July 2004
8
8/14/13
ž  Fake
or False Eyelashes
ž  SERUMS
¡  Human,
Synthetic, Feather
¡  Self-Application Technique
¡  Removal without damage and Maintenance
ž  “Permanent”
¡  Evening
ž  ACTIVE
Salon Applied
contain just mineral oils. Read order of ingredient
¡  Myristoyl Pentapeptide-17
¡  CITY Lash, OBAGI ElastiLash, Lash Allure MD
Band or Weaved
Complications Example
¡  Potential for damage to natural lash and lid
¡  $300 : last for several months!!
¡  Associated
ž  Boost
RESTING PHASE
60% of lashes in this
phase for 9 mos.
TRANSITION
Programmed
Death 15 days
hair
falls out
anagen
NEW GROWTH
Lasts 1-2 months (scalp=6yrs)
41% lash active (scalp = 84%)
Bulb
Lash Intensifying Serum by Lili Fan, MD
conditioner and patented lipopeptide technology
ž  Anagen phase: Stimulates keratin genes and hair
follicles to stimulate growth
ž  Catagen Phase: Strengthens, Repairs and protects
ž  Prolongs the Telagan phase by conditioning
ž  Only available thru eye care professional
ž  Zoria Mascara Sensitive eyes
ž  A
telogen
catagen
Hair shaft
Dermal papilla
INGREDIENT (OTC)
¡  Many
¡  Individual,
Growing (Anagen follicle)
and CONDITIONERS
conditioner: Vaseline, Baby Oil, Aquaphor
Lash grow .15 mm/day (scalp = .4)
Matrix
51
ž  Treatment for “Hypotrichosis”
ž  Requires a prescription.
ž  .03% Bimatoprost ophthalmic
ž  Applied to base of upper eye lashed
QD to increase
thickness and darkness of lashes
ž  Prolongs Anagen or Growth phase to increase the
proportion of lashes in this phase
ž  Stimulates transition from telogen to anagen phases
resulting in thicker lashes
ž  Increases melanogenesis to increase amount of
Determine why eyes are red and treat it! But for a party or photo…..
ž 
ž 
ž 
¡ 
¡ 
ž 
¡ 
ž 
ž 
Main ingredients: Vasoconstrictors Naphazoline, Saline
Caution for Rebound Hyperemia
Blue Tinting used by film industry uses light absorption properties
of blue dye to eliminate yellow eyes. CAUTION
¡ 
melanin in the follicle to result in darker lash
ž  Results in 12-16 wks, must be continued
ž  SE: pigmentation of lid margin, iris, sting, $$
¡  PAP= Prostaglandin Associated Periorbitopathy
Detox and increase Vitamin A
Cool compresses
Topical OTC drops: Murine, Visine,
OTC- US Formula by Verseo contains the food color blue dye C142051
(stains!) boric acid (astringent/antiseptic), chamomilla recutita extract,
sodium chloride (wash) and malva sylvestris
FRENCH FORMULA COLLYRE BLEU by Laiter contains Methylene
Blue & Naphazoline
Side Effects of Alpha-2 adrenergic agonists
Surgical intervention: I-Brite technique by Boxer Wachler
¡ 
Conjunctival resection
9
8/14/13
Joan Kaestner, MD
¡  Enhance
aesthetic appearance
facial rhytids
¡  Treat volume loss
¡  Address facial asymetry
¡  Augment surgical proceedures
¡  Reduce
Carruthers J, Carruthers A. Dermatol Surg. 2003;29:802-809.
ž Thinning
of the dermis and atrophy of fat pads
of elasticity
ž Greater visibility of bony landmarks, blood
vessels, wrinkles, and furrows
ž Transverse forehead lines
ž Lowering of the eyebrows
ž Descent of the corners of the mouth
1. Yaar M, Gilchrest BA. Skin aging: postulated
mechanisms and consequent changes in
ž Ptosis of nasal tip
structure and function. Clin Geriatr Med.
ž Loss
The Pyramid of Age
2001;17:617-630; 2. Stern RS. Treatment of
photoaging.
N Engl J Med. 2004;350:1526-1534.
.
Reprinted with permission from Cosmetic
Dermatology. 2007;20(11):739-742. ©2007,
Quadrant HealthCom Inc.
Courtesy of Wm. Philip Werschler, MD.
Etiology of Lines and Wrinkles
ž 52.2%
of the population is between 25 and 64 years
of age1
ž Resisting aging is an important value to “baby
boomers”
ž Fillers and Botulinum toxin can restore volume,
reduce dynamic facial lines and improve facial
contour
ž Careful selection of treatment modalities will
maximize patient satisfaction
l  Genetic
factors
l  Photoaging
l  Smoking
l  Underlying
diseases
l  Gravity
l  Muscular
action
1. 
Meyer J. Washington, DC; U.S. Census Bureau; 2001
1. Stern RS. Treatment of photoaging. N Engl J Med. 2004;350:1526-1534; 2. Administration on
Aging. A profile of older Americans: 2003. Washington, DC: U.S. Department of Health and
Human Services; 2003; 3. American Society for Aesthetic Plastic Surgery, Cosmetic Surgery
National Data Bank. 2002 statistics. New York, NY: ASAPS Communications; 2003. Available at:
http://www.surgery.org/press/statistics-2002.php. Accessed August 20, 2004..
10
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Plastic Surgery
PMMA
Implants
Silicone
PLLA
Lasers/Light
Sources/RF
(LLRO)
Peels + MDAB
The best thing that comes out of the bottle
for a cosmetic surgeon”
ž Patient satisfaction is high with low
procedure morbidity
ž Active ingredient is Serotype A
ž Biologic products differ in behavior
ž Used medically since 1989
ž FDA approved for cosmetic use 2001
“
Nonsurgical
Botulinum
Toxin Type A
HA
Collagen
CaHA
Topical
Products
Emerging
Technology
¡  [
BOTOX ]
Courtesy of Wm. Philip Werschler, MD.
ž  BOTOX®
Cosmetic is a purified, natural protein
derived from the bacterium Clostridium botulinum
ž  works by blocking acetylcholine impulses that trigger
hyperactive muscle contractions
ž  over 20 years successful clinical experience in
therapeutic conditions.
ž  BOTOX® FDA approved for
¡  strabismus, blepharospasm, cervical dystonia, hyperhidrosis and
migraine headache, in addition to the glabellar lines
ž  Approved
in over 70 countries
ž  Ongoing studies for a broad range of medical indications
including:
¡ 
Corrugator
Procerus
Frontalis
Orbicularis
Oculi
spasticity, cerebral palsy, back spasm and facial aesthetics
ž  Glabellar
Creases
Rhytids
ž  Frontalis Lines
ž  Depressor Anguli Oris / Mentalis
ž  Perioral Rhytids
ž  Platysmal bands
ž  Crow’s Feet!
ž  Naso-labial Folds
ž  Periorbital
11
8/14/13
ž  Frontalis
- brow ptosis, secondary
dermatochalasis
ž  Glabella - retained corrugator function
ž  Periorbital area – ectropion, diplopia
ž  Perioral area – mouth dysfunction
ž  Asymetry
ž  Transient eyelid ptosis
ž  Avoid all of the above with better understanding
of facial anatomy
ž Nasolabial
ž Marionette
ž Lip
ž Long-lasting
ž Minimal side effects
ž Painless injection
ž No allergy testing required
ž Easy to use/inject
ž Cost-effective (physician and patient)
ž Efficacious on a variety of facial wrinkles
folds
lines
rhytids
creases
ž Glabellar
ž Permanent
ž Natural-looking
ž Non-permanent
¡  Nondegradable
¡  Last
¡  Long-term
¡  Degradable
¢ 
side effects
Granulomas, asymmetry, migration
¡  Must
be removed if effect
is undesirable
¡  Silicone oil, Artefil
less than 24 months
¡  Temporary
¡  Side
effects usually mild
and transient
¡  HA, Radiesse, Sculptra
ž  HA
is a naturally occurring linear polysaccharide
polysaccharide units are largely water soluble
ž  Optimal volume use improves persistence in the skin
ž Important component of the extracellular space1
ž Maintains proper structure and tissue function
ž Maintains volume and viscoelasticity
ž HA concentrations decrease with age
ž Ideal skin-filling agent
ž  The
12
8/14/13
ž  Tear
ž Evaluation
ž  Jaw
ž Selection
trough
line contouring
ž  Brow elevation
ž  Cheek augmentation
ž  Chin augmentation
ž  Nasal tip elevation
ž  Ear lobe reconstruction
of facial anatomy
of treatment areas
ž Selection of product
ž Informed patient
ž Incremental steps in treatment
ž Focus on facial contouring and rejuvenation
ž Combined
use of Botulinum Toxin, Fillers and
Surgical Procedures
ž  Facial
Distortion
Filler Tear Through
ž  Under eye Filler
ž  OverRx frontalis - brow ptosis, dermatochalasis
ž  UnderRx glabella - retained corrugator function
ž  overRx periorbital area - lower lid laxity, no
movement with smile
ž  OverRx perioral area - mouth dysfunction
ž  Avoid all of the above with better understanding of
facial anatomy!
ž  Excess
ž  Define
patient goals
appropriate treatment modality
ž  Reduce facial lines
ž  Restore youthful volume
ž  Retain function and expression
ž  Enhance overall facial contours
ž  Select
ž  OverRx
frontalis - brow ptosis, dermatochalasis
glabella - retained corrugator function
ž  overRx periorbital area - lower lid laxity, no
movement with smile
ž  OverRx perioral area - mouth dysfunction
ž  Avoid all of the above with better understanding of
facial anatomy!
ž  UnderRx
Careful patient selection
Surgical procedures when needed
Balance patient goals with treatment realities
13
8/14/13
Kimberly Reed, OD, FAAO
ž  The
Obvious
¡  Blood
pressure
(Total, HDL, LDL, ratios)
¡  Triglycerides
¡  Blood sugar
¡  Cholesterol
ž  Vitamin
B
D
ž  CRP or AA/EPA
ž  Vitamin
ž  Fat
molecules carry critical nutrients to end-tissues
and cells
¢ 
¢ 
Xanthophylls: Lutein, Zeaxanthin – HDL!!
Other fat-soluble nutrients – LDL or saturated fats
ž  Statins
may lower total cholesterol AND HDL levels
ž  Ensure your HDL is high
ž  Which nutrients, foods, or supplements can help
increase HDL?
ž  Critical
for energy maintenance, proper neuropsychiatric functioning, nails/skin health
ž  Things that drive your B levels down:
¡  Excessive
alcohol intake
digestion issues
¡  Excessive antacid use
¡  Unhealthy GI
¡  Intrinsic
ž  Things
that promote B vitamin health:
¡  Adequate
¡  B12
ž  Arachidonic
ž  What
ž  Essentially
acid to EPA
estimates the omega-6 to omega-3 ratios
ž  “Silent inflammation marker”
ž  Should be about 3:1 or lower
ž  Average American score is about 11:1
ž  High levels indicate more pro-inflammatory than
anti-inflammatory mediators are circulating
ž  It
sleep
injections or supplements
is your vitamin hydroxy-D3 level?
should be AT LEAST 30
ž  Some recommend as high as 50
ž  Supplement: 5000 IU vitamin D for 3 months, then
retest
ž  Why?
¡  Depression,
ž  Skin
diabetes, obesity, bone health, cancer risk
cancer risk vs. adequate vitamin D levels
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8/14/13
ž  Proper
sleep is associated with
¡  Lower
risk of obesity (abdominal)
¡  Lower risk of hypertension
¡  Better nutrient profiles
¡  Higher adiponectin levels
¡  Lower ghelin levels
ž  How
ž  HCG
¡  What
is it?
are the claims?
¡  What is the evidence?
¡  What
ž  Nutritional
drinks and shakes with “nutritional fat
burners” and “appetite suppressants”
much?
¡  7
hours is minimum
¡  7.5 is a better bet
¡  8 is going for the gold
¡  More than 9 starts to produce diminished return
ž  “Healthy”
ž  1
ž  Green
coffee bean?
ž  Green
extract?
tea?
ž  “Too
much coffee is bad for you! Use moderation.”
is no such thing as too much tea, however
you can drink it!”
ž  “The only artificial sweetener that has not been
shown to do harm is Stevia.”
ž  “There
¡  AHA
ž  National
ž  Hoodia?
ž  Raspberry
alcohol consumption
glass of red wine per day for women
Institute on Alcohol Abuse and Alcoholism
position – for women:
¡  LESS
than 2 drinks per day AND
than 7 drinks per week
¡  For men 4/14
¡  Fewer
ž  Please
join us today at our networking event to further
discuss these topics and watch a demonstration of BOTOX
injections, Permanent Liners, Skin Analysis by JNJ. Win a
chair massage & Enjoy refreshments
¡ 
MARRIOTT MARINA BALLROOM E TODAY 4:30-6:00
ž  If
you would like to learn more about these topics, join us
on the WOV Inaugural Cruise Seminar with AEA Cruise
Bahamas Women of Vision Spa Cruise, 1/30-2/3/14, 4 days,
Celebrity Constellation. Ft. Lauderdale, Nassau, Key West, Ft.
Lauderdale. Discover the tranquility of the AquaSpa, one of the
largest, most luxurious spas afloat. From $649pp.
Visit http://optometriccruiseseminars.com/
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