Talking Vision 737 Week Beginning 15th of July 2024

Published Jul 17, 2024, 1:30 AM

Sam is joined by Dr Brian Ang, an ophthalmologist and glaucoma specialist who is campaigning for proactive glaucoma care, a series of strategies to lower the risk factors and prevent the onset of glaucoma.

You'll also hear from Peter Greco later in the show, he catches up with Andrea Summerell from the NSW electoral commission, and the ways in which voters who are blind or have low vision can cast their votes safely and accessibly in upcoming the local government elections.

From Vision Australia this is talking vision. And now here's your host Sam Colley.

Hello, everyone. It's great to be here with you. And for the next half hour we talk matters of blindness and low vision.

I could see my colleague every week, but that doesn't alter the fact that I'm still at risk of getting glaucoma. It just helps me detect it earlier. So I wanted a way where I could naturally reduce my risk of getting glaucoma. So one of the best ways of doing that, in my opinion, is through the things we put in our body, especially if that could help to modify the risk profile.

Welcome to the program. This week we hear from ophthalmologist and glaucoma prevention specialist Doctor Brian Ng. He caught up with me to chat about proactive glaucoma care and some ways that glaucoma can be prevented. That conversation is coming up right around the corner, so make sure to stay tuned. Then later on in the program, you'll hear from Peter Greco. Peter is on the show to chat with Andrea Summerill from the New South Wales Electoral Commission, all about the upcoming New South Wales local government elections and the ways that voters who are blind or have low vision in New South Wales can cast their vote safely and accessibly, including Braille voting. I hope you'll enjoy this week's episode of Talking Vision. Doctor Brian Ng is an ophthalmologist based out of the Eye and Ear Hospital in Melbourne, whose research and practice specialises in the proactive treatment of glaucoma through aspects such as sleep, diet, stress management and exercise. But he also has quite a bit to say about the role that good nutrition and in particular vitamins, can play in eye health and glaucoma prevention. Brian, welcome to Talking Vision. Thanks so much for your time.

Well, it's a real pleasure to be here, Sam. Thanks for inviting me. Looking forward to it.

Now we're here to talk today about proactive glaucoma care, Brian, a topic that's very close to your heart. Could you tell us a little bit about proactive glaucoma care?

Yeah, absolutely. I really love to. So first and foremost I am an ophthalmologist and I specialize in glaucoma management and cataract surgery. But equally important is the second hat that I wear. And that's as someone who is at risk of developing glaucoma because of my family history. Now I also have a third hat that I wear, which I'll discuss later. But that's as the founder of co-founder of Neutral Vision, but we will touch on that later. With regards to proactive glaucoma care, it simply means proactively managing the risks that contribute to glaucoma damage. And it's about lifestyle, natural, holistic changes that you can implement in your life. And it doesn't have to be difficult, but broadly speaking, it is divided into five categories exercise, stress management, sleep, nutrition and finally neuroprotection with nutritional supplements. So I call these my five key pillars of Proactive glaucoma care. These are simple things that you could implement straight away, and it doesn't have to be difficult to do. But if you start implementing them now, you will see incremental benefits that will be really good for your eyes over the long term.

So those first four components there are the first four pillars. So that's you know diet stress management exercise and sleep. Those I guess on the surface sound quite straightforward. And we can address those all in that bunch. And I'd love to come back to neuroprotection later and go into that in great detail. But what would you say is an aspect of those four pillars that people perhaps haven't thought about that would impact on prevention of glaucoma.

Yeah, that's a great question. So essentially these all achieve different things for the eyes. So with exercise the idea is to improve circulation to not just your body but also your eyes. And it also helps to reduce the eye pressure. So what you want to do is to do at least 30 to 45 minutes of aerobic exercise every day at moderate intensity. Now, with the exercise side, the important thing is with regards to positioning and also strength training. So if you do a lot of weights and you have to exert yourself a lot, you have to be aware that this could increase intrathoracic pressure, which in turn can cause your eye pressure to be elevated. So when you are doing strength training, just make sure that you exhale during exertion so that you do not inadvertently elevate your eye pressure too much and cause problems with regards to positioning. This is more relevant for people who do things like yoga or gymnastics, so head down positioning can increase the eye pressure. And I actually tested this on one of my patients who enjoyed doing head down positions for yoga. And on the surface, when I see her at the usual clinic visits, the pressure is always ten, 11, 12. But as soon as she dipped her head down, the pressure went up to 30mm. Mercury within 10s. So you can still do yoga, but you may have to modify your technique and your position a bit so that you don't have a head down position for too long. So with regards to stress management, now, I feel that stress is very under-recognized as an important cause of ocular related issues. With stress, you can have issues like elevated eye pressure. You can get problems with your retina too. So the idea is that you have to try to manage the stress because I can't tell people, hey, please have no stress in your life. That just doesn't happen. So the key is to have strategies in place to be able to manage this stress. Recognize when you're getting stressed and you want to make sure that you set aside time for yourself where you can actually sit back and take stock of what's happening and ideally, do something for yourself. And one of the best things that you can do to help with stress management is actually meditation. Certain breathing techniques can also help as well. So in terms of sleep, what people don't realize is they think that too little sleep is not good, which is true, but actually too much sleep is also not good either. So you want to aim for the sweet spot of between 7 to 9 hours a day. And if you have sleep apnea, you have to make sure that you get that treated, because those people with sleep apnea and that's not treated, they are about ten times more likely to develop glaucoma than someone who doesn't. The sleep is important because that's when your eyes and your body get a chance to rest, recover, and repair. And in order for this repair process to occur effectively, you need to feed your body and your eyes with the correct nutrients. And this is where nutrition and diet comes into play. Everybody knows what the important things to eat are, so make sure you eat lots of leafy green vegetables, lots of bright coloured fruits and veg fish so that you get your vitamins A, C, E, zinc, magnesium, omegas. But what you eat, it's also not just about putting the certain nutrients in your body, it's also making sure you exclude harmful things in your body too. So try and avoid foods that are highly refined or highly sugary, highly processed. Try and avoid drinking too much alcohol because that's linked with glaucoma and macular degeneration, even coffee. So a recent study has shown that people who are at genetic risk of glaucoma, such as myself, you really shouldn't drink more than two cups of coffee a day, because that actually increases your risk of glaucoma fourfold. So there are few things here about exercise, sleep, stress management, and diet that I think people could implement straight away to help to reduce their glaucoma risk.

There's a lot of things there that make sense. You know, things like cutting out caffeine, cutting out alcohol and fatty foods. I think it's quite understandable. But as you said, that stress element, it's underrepresented. But when people think about it, it does make sense that if your blood pressure increases, your eye pressure increases, especially with such a strong link between eye pressure and glaucoma risk. I think that does make a lot of sense when you think about it for a sec. So that's definitely up there. But as I said before, Brian, I'm very interested to find out a bit more about this fifth pillar. You speak about neuroprotection. What is that?

So neuroprotection essentially means protecting the nerves as you know with glaucoma, what happens is that elevated pressure causes stress to the retinal ganglion cells and your optic nerve, and this causes downstream damage resulting in peripheral vision loss. So we know that eye pressure is the most important risk factor for glaucoma. But at the same time, we also recognize that there are other risk factors that contribute to glaucoma damage. These are what we call non pressure dependent factors. So in the normal clinical environment we tend to focus a lot on reducing eye pressure. But we generally don't focus on the non pressure dependent aspect of glaucoma. And this is what neuroprotection is. It just means you take certain steps to try to protect your retinal ganglion cells and optic nerve from the non pressure dependent risk factors of glaucoma damage.

Now before we continue, Brian, what I want to just quickly find out from you is that millimeters mercury measurement there. People may be unfamiliar with that and how that sort of relates to the eye pressure. So could you briefly go into detail about that for a minute or so.

Yes of course.

So millimeters. Mercury is purely a measure of eye pressure, just like millimeters is a measure of distance. And kilograms is a measure of weight. So in general eye pressure the normal eye pressure ranges from 10 to 21mm. Mercury. So for people who have say advanced glaucoma we would want their eye pressure to be 14mm mercury or less. And in people who are at risk, then maybe we would set a target pressure that's a little bit higher. Like they have to have their eye pressures below 21mm of mercury. So the millimeters of mercury purely is just a way of us measuring the pressure.

In amongst all of this. You have also been the founder of Neutral Vision, and that's where the food and neuroprotection aspects do come into it quite heavily. So tell us a bit about neutral vision and the work you do there.

Yeah.

So what I did during Covid was to look at all the clinical studies that have been published globally over the past 30 years. This was partly because I started becoming a little bit frustrated at our general advice to patients who are at risk of getting glaucoma. Currently, the advice is get your eyes monitored every six to 12 or 24 months. And I think that is really good advice. The only issue for me is that this doesn't actually alter my risk. So for example, I could see my colleague every week. But that doesn't alter the fact that I'm still at risk of getting glaucoma. It just helps me detect it earlier. So I wanted a way where I could naturally reduce my risk of getting glaucoma. So one of the best ways of doing that, in my opinion, is through the things we put in our body, especially if that could help to modify the risk profile. So through looking at these scientific studies, I realized that there are ten key bio cellular mechanisms that contribute to glaucoma damage. And these include eye pressure, which is the most important. But other aspects as well, such as reduced blood flow to the eye, oxidative stress, reduced mitochondrial function. Now, the mitochondria are the batteries of the cells and also elevated homocysteine levels. So these are things that unfortunately we are not able to measure easily in the clinical setting. But the studies have shown that these are important in a way to help to reduce glaucoma risk. So what we did was to identify the ten key eye specific botanical extracts and bioavailable vitamins that could target these ten bio cellular mechanisms of glaucoma progression, and we combine them into one capsule. What I did in the past prior to Neutral Vision was I've been asking my patients to take 8 to 10 different capsules every day for their glaucoma, and I have to give my hats off to them because they actually did it. I know I wouldn't be able to do it because that's a lot for me to take, but I thought if I made it easier by combining everything into one simple, convenient capsule, it would be so much easier for people to protect their eyes and support their eye health, and hopefully reduce their risk of getting glaucoma over the long term.

I've been speaking today with Doctor Brian Ng. Ophthalmologist and glaucoma prevention specialist, here to talk to me about proactive glaucoma care and the best practice for preventing glaucoma. Brian, thank you so much for your time today. It was great to catch up with you and hear all about your work.

Thank you very much.

It was a real pleasure and thank you for being such a wonderful and generous host.

I'm Sam Culley and you're listening to Talking Vision on Vision Australia Radio, Associated Stations of Reading Radio and the Community Radio Network. I hope you enjoyed that conversation there with Doctor Brian Ng. If you missed any part of that conversation with Brian, or you'd love to hear a little bit more later in the week, the full conversation with Brian, including a little bit more about Neutral Vision, will be available as an interview highlight on our podcast feed wherever you get your podcasts. You can also, of course, find the whole show on the Vision Australia Library or through the Vision Australia website at VA radio.org that's VA radio all one word.org. And now here's Peter Greco with Andrea Summerall.

Well, the local government elections in New South Wales are taking place very soon. Let's find out a bit more about them and speak to the executive director for the Electoral Commission in New South Wales, Andrea Somerville. Andrea, lovely to meet you. Thanks so much for your time. Good morning.

Nice to meet you also.

Tell us a bit about the elections then. When are they happening and what are some of the key dates that we should be thinking about? Sure.

The election date itself is on the 14th of September, so it is coming along quite soon. Um, but there are some key dates to to think about in the lead up to Election day. One of those is applications for Braille ballot papers. So for local government elections, uh electors can have uh.

A.

Ballot paper in Braille that's sent to them or is available to collect at a voting center, but applications for those are open now but close on the 5th of August, so that's one of the key dates. The other thing is around early voting options. So some electors will be eligible to vote prior to the 14th of September election day. And that includes postal vote applications. So if an elector wants to vote via post and they are eligible, we'll have applications for those open on the 6th of August and also early voting. So if an elector is going to be out of the area on election day, then early voting will open on the Saturday prior to election day and will have information about where those locations are on our website as they become available.

All right. Now, as far as registering goes, if people are on the electoral roll already, as in, you know, their votes at the last state or federal election, that kind of means they're already registered. Or do you specifically have to register for a local government election? No.

If they are on the electoral roll already and all of their details are correct, so their current address, then they'll be automatically on the roll for local government elections. However, if they had moved since the last election, they need to update their address with the Australian Electoral Commission who maintain the roll. And it's really important that all of those updates are done before the 5th of August to make sure that they're on the roll. Um, because we print those in advance of, of Election Day. So we'll be going out with social media and messages. But the 5th of August is when the polls close for that election. There are still some options for people to update their enrollment in a voting center, but the best way is to get yourself updated and ready. Um, on the electoral roll before the 5th of August and more information about that process is on our website. Elections dot NSW gov.

You will repeat that before we wrap up. What about as far as voting itself goes? Andrew? Is it compulsory? Do we have to vote if we, uh, if we're in New South Wales.

New South Wales, voting for local government elections is compulsory. So everyone who's on the electoral roll must vote on election day or using one of those voting options beforehand. Uh, otherwise, yeah, you will receive a fine if you don't vote. Mhm.

All right. Well then, um, you know to avoid that we know what to do and we just go back to the brow, uh, brow ballot papers. That's a fantastic idea. So congratulations on that. Is this the first time you've done it for a local government election in New South Wales?

We have done it previously for, um, local government elections. At state elections, the timeline is very, uh, short. And that makes it very difficult for us to prepare Braille ballot papers. And because of that, as you would know, that really large upper house ballot paper, it's not something we offer for state elections, but we have for a number of local government elections now are provided braille, and it is a good service for those who, um, you, you know, use that and um, allows them to, as I said, either have the braille ballot paper sent to their postal address or they can collect it from an early voting venue or a polling place on election day.

All right. But you must register to get that. Like, even if you got it last time, you don't automatically get it this time. You must kind of say, yes, I'm here. I want it again.

Correct. Um, unlike the roll that keeps on going, um, and is, uh, ever available to us, that application for Braille, uh, ballot papers must be made every single election. So people should just be really mindful of that closing date of 5th of August and get their applications in now.

All right. And I guess as far as registering to vote goes, Andrew, obviously if you've turned 18 in the last little while or since the last election, you'd have to register to to vote because otherwise your name wouldn't be on there, would that be? Right?

That's correct. So the people who have, as you say, just turned 18, they need to get themselves on the electoral roll, which they can do through the Australian Electoral Commission, and also for people who have, um, become new citizens. Um, also getting on the electoral roll so they will be able to vote for the first time is another really important process and available through the AEC.

Ah, that's very important message. And, uh, that's very good of you to mention that. Just going back to the Brough, uh, ballot papers. So that's just to get the information. You can't vote with those papers. Is that right? You can.

So what will happen? The Braille process is you apply by the 5th of August. And then once we have closed nominations and we know who all of our candidates are, we then prepare our ballot papers. And that's for all of our voters across New South Wales. And at the same time, we'll prepare the Braille ballot papers. So if your area is having a councilor election and even maybe a referendum or a poll, we will prepare those ballot papers along with our partners, Vision Australia, to to have those papers prepared. And then, um, we will if, for example, someone is having them arrive in their postal address, we will then send those packs out and provide the information about how they return those, ballot papers once they've completed them to the returning office, and then they get counted along with all of our other ballot papers. Well, Andrew.

I've got to say, not living in New South Wales, that is a sensational thing for you to be doing. So congratulations on that. As an individual, if I may say, uh, it's me editorializing, but that is a magnificent thing. So well done to, uh, to all those involved with that. That's, uh, a fantastic initiative. Thank you. Now what about as far as on the day though, are there things in place for people to be assisted to vote on the day? Yes.

So on Election Day, in all about, um, voting venues, first of all, on our website, for every venue on election Day, we have information about those venues as to whether they are fully accessible or, um, partially accessible or not accessible. So people can go on to our website and find the venue that's going to meet the needs for them. Now, secondly, people can take another person to assist them, uh, during that voting process or if they don't have someone that they can take along, uh, speak to them. Venue manager. So the polling place manager on the day and seek assistance. And then we have election officials that can, um, help voters, uh, get through that voting process and make sure that they fulfill all their obligations. So there's a few options available there. We also have some assistive tools in the polling place. Uh, we have magnifying sheets that can assist electors with low vision. Um, and we also have services that staff can access. And the election officials can help with that. such as, uh, you know, calling voters can contact us through the National Relay Service, and that's available on Election Day as well.

That sounds fantastic. And certainly making it as much possible as as you can as far as the accessibility goes. Andrea, how important do you think, uh, local government elections are? Because often that's kind of the government where closest to in terms of services we receive.

Correct. So it, um, you know, local government elections, uh, are very important, as you say, particularly for those things that most people are aware of. So, uh, council representatives, you know, they're called councillors. And, um, each council then has a mayor, and it's the council's role to look after the needs of the city and the local community. And so some of those things that they look after that are really important decisions for residents are planning decisions. Um, facilities like libraries, pools, ovals and also your local roads and of course, um, you know, recycling and, and um, rubbish collection, all of those. They have a very, uh, large remit. So voting at a local government election and, um, making a choice about who is going to be your representatives on council is a really important process. And that's why we're kind of encouraging all our voters to make sure they understand when the election is and how they're going to, um, you know, vote during that process.

Fantastic. Well, do you want to kind of wrap it all up for us in a minute or two? Do you want to kind of go through the dates and what people need to do? And I guess we should emphasize that voting is compulsory. So if you'd like to avoid the fine, and I'm sure at the moment we'll all like to be avoiding any extra costs that we need to bear. Um, people should, uh, you know, be as prepared as they can be. So they do vote. Uh, what are some of the key dates we need to look out for?

Yeah, it's really important, as you say, to plan how you're going to vote. Um, not only is it an important process, but as you say, it's compulsory for all electors on on the electoral roll to.

Do.

So. 14th of September. So 14th of September is election day. And that is still when the majority of electors go out to vote at their local polling place. The 5th of August is the date by which braille applications must be made, and also the date by which anyone who needs to update their enrolment details needs to do so with.

The.

Australian Electoral Commission. And then as we go through the voting process, the 6th of August postal vote applications will open. And then on the 7th of September, early voting will commence. But, you know, that's a lot of dates to remember. So I would suggest that the all voters preparing for voting at the election go to our website, Elections.

New.

South Wales gov.uk, our Local Government 2024 event page is now live and has all of those key dates listed, and it also outlines all of the processes by which people can vote. And as we get closer to the election, it will be where voters can find out information about their candidates and the venue information that I mentioned before.

Andrea, thank you so much for speaking to us. It's been a delight. We wish you well.

Thank you very much for having me.

It's Andrea somewhere over there. Who is the executive director for the Electoral Commission in New South Wales. Local government elections coming up very, very soon.

And that's all the time we have for today. You've been listening to Talking Vision. Talking vision is a Vision Australia radio production. Thanks to all involved with putting the show together every week. And remember we love hearing from you. So please get in touch anytime on our email at Talking Vision. At Vision australia.org that's talking vision all. One word at Vision australia.org. But until next week it's Sam Kerley saying bye for now.

You can contact Vision Australia by phoning us anytime during business hours on 1300 847 406. That's one (300) 847-4106 or by visiting Vision Australia. Org that's Vision australia.org.

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