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“Dr. Schramm, my eye doctor, told me that I have “little” cataracts, but they are not yet “visually significant”. What does this mean? Is there anything I can do to slow the growth of my cataracts?

31 Jul

Dr. Nathan Schramm, O.D., C.N.S.

“Dr. Schramm, my eye doctor, told me that I have “little” cataracts, but they are not yet “visually significant”. What does this mean? Is there anything I can do to slow the growth of my cataracts?

Cataracts are natural changes found in the lens of the eye located behind the pupil. Unlike other cells of the body that sluff off and regenerate, the lens is made of cells that are the same cells since birth, so they age with you. As you get older, the lens changes color from clear to yellowish or brown. The lens thickens causing the loss of focus for reading. Proteins within the lens can migrate or bind together, causing opacities as you age. That’s why three times more light enters a 20 year old’s eye compared to the average 60 year old!

“Visually significant” refers to eye vision issues that now affect quality of life. Years ago, the cataract needed to be dense or “ripe” to remove it all in one piece through a large incision. Now, the most advanced technology uses a laser to dissolve the cataract. There are only about a hundred surgery centers in the country with this technology.

Symptoms of cataracts include: blurry vision, trouble reading (even with glasses), need for brighter lights to see, difficulty with night driving, loss of contrast sensitivity (unable to see the golf ball on the green), and glare. Risk factors are age, smoking, chronic ultraviolet exposure (sunlight), diabetes, steroid use, and high glycemic load due to consumption of sugar, soda, high fructose corn syrup, etc.

As cataracts progress, it becomes more difficult to see blue colors due to the yellowing of the lens. The painter Charles Monet’s art became more and more blue as his perception of this color diminished.

To slow cataract progression, it is best to limit sun exposure by use of sunglasses, follow a diet high in antioxidants (fruits, vegetables, spices), and discontinue pro-oxidants such as tobacco, monosodium glutamate (MSG), and fried foods.

Foods that may slow cataract progression include: green leafy vegetables, goji berries, green tea, blueberries, and red wine.

In the American Journal of Clinical Nutrition, July 2013, a meta-analysis of 13 studies with 18,999 participants showed that Vitamin E, lutein, and zeaxanthin reduced the risk of age related cataracts.

New advanced cataract surgery can make you less dependent on glasses. Single power and astigmatism lenses can help most people see well for distance vision. Multifocal implants although more expensive, can help you see distance, reading and some intermediate ranges of vision without the need for glasses.

Dr. Nathan Schramm, O.D., C.N.S. is an Optometric Physician and is a Certified Nutritional Specialist. He is in practice with his wife, Dr. Julie Abraham O.D., at various locations throughout south Florida. Dr. Schramm is currently accepting new patients and appointments can be made at (954) 217-2992.

This article does not replace the need for a yearly comprehensive eye exam by a qualified eye care professional.


Dry Eye Disease Dr. Nathan Schramm, OD, CNS

30 Aug

Dr. Nathan Schramm, O.D., C.N.S.Over 3.2 million American women in the United States have Dry Eye Disease which, in severe cases, has been compared to be as debilitating as angina. It is more common in older women, but affects many women in their 40s and 50s. A transient blur to your vision that improves with blinking is usually associated with the beginning stages of Dry Eye Disease. Other signs include burning, tearing, foreign body sensation, and sometimes itching along the edges of the eyes.

Dry Eye is more common in women over 40 due to hormonal changes, poor diet (excess omega-Gs from processed foods, low intake of omega-3’s), contact lens use, dry environment (air conditioner, overhead fan), allergy medication, smoking, cosmetics, rheumatoid arthritis, Sjogren’s Disease, and diabetes.

Every 10 years you live you have a 20% greater chance of developing dry eyes. Fortunately, there is a natural treatment (and prevention) for this problem. For my patients with this condition, I recommend 800-900mg EPA/ 500- 600mg DHA of omega-3’s preferably from triglyceride based (TG) fish oil; blackcurrant seed oil (omega-6) 160mg; and Astaxanthin 4 to 6mg. Along with the many benefits for the heart, brain, joints, hair, skin and nails, omega-3 fish oil can give you better quality tears. In addition, it may reduce your chances of developing wet macular degeneration. Omega-6 fatty acids have been clinically shown to increase tear production. But too much omega-6 can become inflammatory! The proper balance of omega-6 to omega-3 is between 4 to 1 and 1 to 1.

The typical American diet is about 15 to 1-very inflammatory! (There’s a blood test I use that calculates the patient’s ratio and amount of omega- 3’s in the blood.) To balance this ratio, limit vegetable oils (omega 6) from com and soybean, cottonseed and packaged foods, and eat more omega-3 rich foods like salmon, sardines, grass-fed beef, walnuts and flax seeds. A recent study revealed that women with a high intake of omega-3’s compared to those with a low intake had a 20% decreased risk in developing Dry Eye Disease. Astaxanthin is a natural anti-inflammatory and anti-oxidant that is found in red or pink colored fish such as non-farm raised, wild Alaskan Salmon (6 oz. serving contains about 6mg). I recommend Astaxanthin in conjunction with fish oil and blackcurrant seed oil to help quench the inflammatory cascade and to better stabilize the ocular tear film. Preservative- free artificial tears can be used until this combination takes effect. Eyes do not develop this condition overnight, so expect this natural treatment to take one to three months for full effect.

Dr. Nathan Schramm is an Optometric Physician and a Certified Nutrition Specialist. He is in practice with his wife, Dr. Julie Abraham in Weston, Florida.  Drs. Schramm and Abraham are currently accepting new patients and appointments can be made at 954-217-2992

This article does not replace the need for a yearly comprehensive eye exam by a qualified eye care professional.

What Are Floaters? Anything I Can Do To Prevent Them?

11 Jun

What Are Floaters by Dr. Nathan Schramm, O.D., C.N.S.The term “floaters” refers to small deposits or strands of Tissue that move within the jelly material inside the eye. As we age, this material begins to liquefy, causing floaters. Floaters are sometimes described as dust, black spots, spider webs, or insects in your vision. Most of the time they will move with your eyes. Floaters can happen at any age but are usually first noticed in our 20s. About 65% of the population has  large floaters by age 65. People more at risk are older, female, nearsighted, chromium deficient, or have a history of  head/eye trauma, eye surgery, or inflammation within the eye.

Chromium deficiency can increase your chances eightfold of having floaters. A very large percentage of Americans are chromium deficient, with some studies estimating as high as 80%. As we get older, we can suddenly develop a new, large floater called a PVD or Posterior Vitreous Detachment. This causes  you to feel like something moved in your peripheral vision and may cause flashes of light in your side vision. About 8 to  10% of the time a PVD can cause a retinal break. A retinal break can lead to a retinal detachment. Signs of a retinal  detachment can include a dark shade or curtain in your vision, a paprika haze, and/or onset of many new floaters. If you  have signs of a new PVD or detached retina you should see an eye doctor immediately for a dilated eye examination. There  are no eye drops that help floaters. Incisional surgery is only rarely perfomed to remove very large floaters.

Most floaters are benign and after initial presentation your brain will slowly begin to ignore them, especially as they settle  due to gravity. Avoid aspartame (often found in diet soda), it may weaken the retina. Nutrients that may strengthen the  retina include lutein, zeaxanthin, bilberry, and resveratrol, to name a few. Some foods that are good for your eyes include green leafy vegetables, blueberries, green tea, and red wine (in moderation).

Dr. Nathan Schramm, O.D., C.N.S. Is an Optometric Physician and a Certified Nutrition Specialist. He practices in Weston,  Florida. Dr. Schramm is currently accepting new patients and can be reached at 888-781-2020 or via email:

This article is not intended to replace a full eye examination by a qualified medical professional. A special thanks to Dr. Elias C. Mavrofrides, M.D., A vitreoretinal specialist, and Dr. Julie Abraham, O.D., for editorial support.

Detailed Magnetic Resonance Imaging Findings Of Theocular Motor Nerves In Duane’s Retraction Syndrome

11 Jun

Dr. Nathan Schramm, OD, CNSAuthors: Dr. Nathan Schramm, O.D., N.C.S. and others*
Tianjin Medical University, Tianjing, China.



To study the neuroanatomic characteristics of patients with Duane’s retraction syndrome with high-resolution magnetic resonance imaging.


The study included 11 consecutive cases, including five patients with type I, one patient with type II, four patients with type III, and one patient with inverse Duane’s retraction syndrome. The patients underwent magnetic resonance imaging of the brain, brain stem, cavernous sinus, and orbits.


In 10 patients, the abducens nerve (cranial nerve VI) was absent or showed hypoplasia in the brain stem, cavernous sinus, and orbit. However, these findings were not seen in the patient who had inverse Duane’s retraction syndrome. In two children, magnetic resonance imaging showed that the cavernous sinuses were smaller on the affected side. The inferior division of the oculomotor nerve (cranial nerve III) was traced to enter the lateral rectus muscle or had intimate continuity with the lateral rectus muscle in nine patients with type I and type III Duane’s retraction syndrome. In one patient with type III Duane’s retraction syndrome, the oculomotor foramen was significantly larger on the affected side than on the sound side. In the patient with type II Duane’s retraction syndrome, the superior division of cranial nerve III was enlarged and had three branches. In the patient with inverse Duane’s retraction syndrome, the inferior division of cranial nerve III sent two branches to the medial rectus muscle, and the patient had superior oblique muscle hypoplasia.


Neuroimaging findings showed that the absence of cranial nerve VI, hypoplasia in the brain stem, and an extra branch of the inferior division of cranial nerve III to the lateral rectus muscle is the most common presentation of Duane’s retraction syndrome, but not the only one. The aberrant branches likely correspond to the abnormal eye movement seen in patients with this disorder.

Copyright 2009, SLACK Incorporated.
PMID: 19791724 [PubMed – indexed for MEDLINE]
* Other Co-authors: Yonghong J, Kanxing Z, Zhenchang W, Xiao W, Xuehan Q, Fengyuan M, Wei L, Fanghua Z
J Pediatr Ophthalmol Strabismus. 2009 Sep-Oct;46(5):278-85; quiz 286-7. doi: 10.3928/01913913-20090903-05. Epub 2009 Sep 22.

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