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Lewes, Delaware
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September 2, 1994     Cape Gazette
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September 2, 1994

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30 - CAPE GAZETTE, Friday, September 2 - September 8, 1994 Health & Fitness Macular degeneration is the seq:on,00 leading cause of blindness the elderly By Kerry Kester "Macular degeneration is proba- bly the most common cause of legal blindness," said Dr. Fred Cook, an opthamologist at Robin- son Eye Associates in Lewes. "It's a very common problem. It and glaucoma are the two major caus- es of legal blindness, especially in people over age 65." However, ear- ly detection can help some patients keep their sight longer. .The dis- ease, said Cook, affects Dr. COOK central vision, but it usually allows for some peripheral vision. "It's like having a black spot in the center of your vision," he explained. "Most who are severely affected are in their seventies and eighties." The disease is a result of spots appearing on the retina. The retina is that part of the eye that "sees" and sends "pictures" to the brain, through the optic nerve, for inter- pretation. Near the optic nerve is the macula, which according to Cook, is about the size of a pin. "That's where we have our read- ing vision and our area for fine detail work," he said. The periph- eral retina is responsible for allow- ing peripheral vision. "Macular degeneration," said Cook, "is the normal wear and tear on the reti- na." There are two primary types of the disease. One is atrophic, or dry, and the other is wet macular degeneration. "The atrophic type is the more common type," said Cook. With it, the spots that appear on the retina force the mac- ula to work harder, and it can become thin and stop working altogether. With wet macular degeneration - the more severe, type of the disease - abnormal blood vessels develop beneath the retina, causing fluids or the ves- sels to bleed. Vision loss occurs immediately when the fluids leak or the blood vessels leak. With the atrophic type of the disease, vision loss is usually more gradual, often developing over a period of years, Cook said. Some people are more at risk than others for developing the dis- ease. "Age is really the main risk factor," said Cook. "There is a family component, too. Some of the family component may be due to fairness of skin. There have been studies on identical twins. Sometimes they'll get very similar degrees of macular degeneration. Use the Amsler grid to test eyesight for signs of macular degeneration: 1. Wear your reading glasses, 2. Cover one eye. 3. Look at the center dot and keep your eye focused on it at all times. 4. While looking directly at the center, and only at the center, be sure that all the lines are straight and all the small squares are the same size. 5. If you should notice any area on the grid that becomes distorted, blurred, discolored, or otherwise abnormal, please call your eye doctor right away. 6. Do this test for each eye separately. Copies of the grid are available at Robinson Eye Associates in Lewes. (The Amsler grid and instructions are taken from "Macular Degeneration", produced by the Retina Research Fund.) "Exposure to ultra violet light may be a risk factor too." He said that the disease is more commonly found in those with fair skin and blue eyes. "It's very unusual for African Americans to get it." He said that additional risk factors could include elevated cholesterol, high blood pressure, and cigarette smoking. Early detection can help many patients retain at least some vision for a longer period of time, Cook said. "If it's detected early, laser surgery can be used to cauterize Continued on page 32 Good eating habits series begins Sept. 17 A new and unusual ten-week program to help instill good eating habits will begin Saturday, Sept. 17 at the Quakertown Counseling Center, 1500 Savannah Road, Lewes. According to Jane Burkhardt, Ed.D., a licensed clinical psychol- ogist, the new program, ACE (for Alternatives to Compulsive Eat- ing) is designed for everyone who is struggling with problems of weight, body image, health and fitness. The program will take ten weeks and will include cooking and serving a low calorie, low fat and low cholesterol meal at each meeting. One of the co-leaders of the group, Carole Lutness, of Out- reach Counseling Services, has sustained a 140-pound weight loss for four years as a result of chang- ing her eating habits. Individualized plans for each participant will include a food and exercise program, counseling regarding the emotional compo- nents of compulsive overeating, development of a support system and tools for success. The ACE course will be held from 5 to 9 p.m., and the cost of the program is $486, which includes a personal screening evaluation. Most insurance is accepted. Sliding scale, based on need, may be arranged. For more information call 645-9694. aeq :king relief from common foot problems The emphasis on an active lifestyle for the middle-aged and beyond places stress on parts of the body, starting with the feet. Walkers and runners of all ages are familiar with the benefits of foot orthoses to relieve foot ail- ments, as well as the ankles, knees and hips. A properly fitted orthotic bio- mechanically manages the foot by assisting normal motion at heel strike throughout the gait cycle. Orthotics are manufactured in a variety of designs and materials, but the goal remains the same: proper mechanics of the foot from heel strike through toe-off in motion. Two common foot types fre- quently requiring foot orthoses are the over-pronated foot or pes cavus (rigid, high-arched) foot. Appearing normal when seated, the overpronated foot shows flat- tening of the medial arch when standing. The ankles roll medially (inward) and the big toe turns out- ward. The shoes of over-pronated feet tilt toward each other when HEALTH TOPICS Jack Morris placed on a flat surface and viewed from the rear. APes cavus foot shows a rigid, high arch even during weight-bearing. Many cus- tomers refer to a high in-step, but pes cavus feet have pronounced high arch under weight-bearing, and an inverted hind foot. A famous case of pes cavus feet was Bill Walton of UCLA and NBA basketball fame, who had numer- ous stress fractures of the feet dur- ing his pro career. A variety of common foot ail- ments occur from these foot types such as plantar fasciitis, bunions, neuroma and hammer toes. Plantar fasciitis refers to an inflammation of the plantar (bot- tom) surface or covering of the foot. Arch fatigue and/or generalized soreness, particularly noticeable when rising in the morning, may indicate this condition. Over-pronation lowers the arch putting stress on the plantar sur- face of the foot; the pes cavus foot places the plantar fascia under ten- sion. Doctors may prescribe anti- inflammatory medication, stretch- ing exercises and/or orthotics to relieve plantar fasciitis. Bunions are commonly blamed in shoes witli narrow toes, although the over-pronated foot with resultant forefoot instability is a common cause of bunions. In motion, the over-pronated foot rolls off the forefoot and first metatarsal, abducting the big toe and creating excessive force on the medial area of the hallux (big toe) joint. Some people with rigid pes cavus develop bunions over years of shock and jarring to the forefoot area. Neuroma is a sharp pain or numbness between the third and fourth toes. The over-pronated foot creates excessive pressure in that area in a shoe compressing the nerves; the pes cavus foot may develop neuro- ma as a result of excessive shock and force in the forefoot area. Hammer toes curl upward and usually are flexible, indicating unstable feet. Stabilizing the foot with an orthotic will aid in relaxing the tendons and straightening the toes in some mild cases. Casting the foot and fabricating a positive mold, then formulating a custom orthotic from the mold is the standard in manufacturing orthotics. However, there are many over-the-counter orthotics available in thermoplastic material or leather, which are less costly to the user. In some cases, the over-the- counter model may be used as a trial to see if the patient benefits from this device and may be a can- didate for the custom made model. The non-custom device may be altered or wedged according to the individual's needs. If you are suffering from a foot condition and think that you may need some help, come in and talk to me. We may be able to guide you to an inexpensive comfort aid for foot pain. We stock insoles, arch supports, heel supports, heel spur cushions and orthotics in standard sizes. Frequently, customers are sur- prised to see the variety of inex- pensive products on the market. Custom foot orthotics are the med- icine for many foot ailments, but there are options. New technology and materials constantly bring new devices on the scene for relief from common foot problems. (Jack Morris owns and oPerates Morris Shoes on Kings Highway in Lewes. For more information, call 645-9431.)