By Brian Chou, OD, FAAO
June 29, 2016
You’ve learned to identify risk factors that threaten your patients’ sight and overall health, but, in the meantime, what are you doing to safeguard your own well-being?
Most of us are benevolent racial profilers, for example, applying our knowledge that African-Americans are more likely to develop primary open-angle glaucoma,1 Vietnamese are more likely to develop angle-closure glaucoma2 and Scandinavians are more prone to pseudo-exfoliative glaucoma.3 Understanding the greater likelihood of eye disease for at-risk groups heightens our diagnostic sensitivity. Yet in caring for others, the irony is that we may overlook our own well-being, not realizing that we, too, are part of an at-risk group.
Here are some not-so-well-known risk groups which may include you:
Female, Under 40 and Perform Lots of Exams
Work-related physical discomfort is surprisingly common among optometrists.
A large-scale survey of Australian optometrists found that 82 percent of the 416 respondents experienced work-related physician discomfort, most commonly of the neck, shoulder and lower back.4 Optometrists especially at risk were female, young and conducting a high number of consultations daily. These findings are corroborated by a separate survey study in the U.S. which found that ophthalmologists and optometrists had a notably higher prevalence of neck, hand/wrist and lower back pain compared with family medicine physicians.5
These results underscore the importance of workplace ergonomics, which might include adjusting the height of instrumentation and seating, using automated phoropters and minimizing repetitive motions. Also consider enlisting the help of an ergonomics consultant, or obtain a free on-site consultation by OSHA for small-business owner.6 Employed optometrists should not delay in reporting their musculoskeletal disorders to their employer so that ergonomic concerns may be remedied.
If you’re Asian, and drink alcohol, you may be at increased risk for esophageal cancer.
Asians represent 30 percent of applicants to optometry programs for Fall of 2015 entry,7 even though Asians total only 5.6 percent of the U.S. population. Among the East-Asians (Koreans, Japanese and Chinese), 36 percent lack the ability to efficiently metabolize alcohol due to a genetic deficiency in the enzyme, aldehyde dehydrogenase 2 (ALDH2).8 Alcohol consumption by these individuals leads to facial flushing, nausea and tachycardia – collectively known as “Asian flush syndrome.”
There is disturbing evidence that ALDH2-deficient drinkers that consume the equivalent of two beers per day have a six-to-ten times greater risk of developing esophageal cancer as a drinker without this enzyme deficiency.9 If you are ALDH2-deficient – or perhaps you know of a colleague who exhibits facial flushing after consuming alcohol – it’s not a bad idea for you and other ALDH2-deficient individuals to limit your alcohol consumption.
Male & Over 30–and Love Iced Tea
If you’re male, over 30, and drink lots of iced tea, you may be at increased risk for kidney stones.
The consumption of tea has more than quadrupled in the U.S. over the past twenty-plus years, with more than 85 percent of that tea iced rather than hot.10 Many optometrists, like others in the general population, are fond of iced tea. Unfortunately, iced tea, particularly black tea, is rich in oxalates, a chemical compound associated with forming kidney stones.11, 12, 13 Passing a kidney stone can cause excruciating pain, enough to lead most to avoid a repeat performance. It’s not clear how much iced tea is too much, and this may depend on other risk factors including being male and over age 30, a family history of kidney stones, inadequate hydration, obesity and digestive disease.
You’re Overweight, Smoke, Eat Junk and Don’t Exercise
Who doesn’t know these are risks for heart disease, cancer, stroke and diabetes?
While the risk groups mentioned in prior sections are under-recognized, and therefore interesting, it is the usual culprits that exert a greater toll on us: obesity, smoking, poor diet and lack of exercise. These each contribute to a bevy of maladies leading to disability and premature death. Even to most laymen, these risks are well-known. Yet at your next optometric conference, let the wafting smoke from fellow colleagues lighting up outside remind you that we don’t all practice what we preach.
It takes bold and courageous action to change ingrained lifestyle habits. Regretfully, for many, it takes a “wake-up call” like a health scare to compel a new direction in personal health.
I will not belabor the importance of managing weight, smoking cessation, eating right and exercise. They all pose opportunities to invest in our own well-being so that we can continue serving our patients for the years ahead. Good health is a priceless blessing.
How do you avoid neglecting your health, even while keeping a busy schedule? What tips can you pass along to other ODs trying to stay healthy and fit?
Racette L, Wilson MR, Zangwill LM, et al. Primary open-angle glaucoma in blacks: a review. Surv Ophthalmol. 2003 May-Jun;48(3):295-313.
Nguyen N, Mora JS, Gaffney MM. A high prevalence of occludable angles in a Vietnamese population. Ophthalmology. 1996 Sep;103(9):1426-31.
Desai AD, Lee RK, The medical and surgical management of pseudoexfoliation glaucoma. Int Ophthalmol Clin. 2008; 48(4):95-113.
Long J, Naduvilath TJ, Hao LE, et al. Risk factors for physical discomfort in Australian optometrists. Optom Vis Sci. 2011 Feb;99(2):317-26.
Kitzmann, AS, Fethke NB, Baratz KH, et al. A survey study of musculoskeletal disorders among eye care physicians compared with family medicine physicians. Ophthalmology. 2012 Feb;119(2):213-20.
https://www.osha.gov/dcsp/smallbusiness/consult.html (accessed 6-25-16)
Brooks PJ, Enoch MA, Goldman D, et al. The alcohol flushing response: an unrecognized risk factor for esophageal cancer from alcohol consumption. March 24, 2009. PLOS. http://dx.doi.org/10.1371/journal.pmed.1000050
Yokoyama A, Muramatsu T, Ohmori T, et al. Esophageal cancer and aldehyde degydrogenase-2 genotypes in Japanese males. Cancer Epidemiol Biomarkers Prev. 1996. Feb;5(2):99-102.
Prezioso D, Strazzullo P, Lotti T., et al. Dietary treatment of urinary risk factors for renal stone formation. A review of CLU Working Group. Arch Ital Urol Androl. 2015 Jul 7:87(2):105-20.
Syed F, Mena-Gutierrez A, Ghaffar U. A case of iced-tea nephropathy. N Engl J Med. 2015 Apr 2;372(14):1377-8.
Gasi?ska A, Gajewska D. Tea and coffee as the main sources of oxalate in diets of patients with kidney oxalate stones. Rocz Panstw Zakl Hig. 2007;58(1):61-7.