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Illustration: Roxana
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Caring for Our Eyes, Windows to the Soul Close your eyes and finish reading this article, without peeking. Close your eyes and keep them closed while you go shopping, or dice onions, or shave. You can't? No sighted person could. But these silly suggestions illustrate why we need to protect those most precious of gifts-our eyes.
As we age, our eyes change, but that doesn't mean that poor eyesight is inevitable. Poor eyesight results mostly from disease, and many of the most common eye diseases that afflict people over 50 can be prevented. This includes cataracts, glaucoma, diabetic retinopathy, and age-related macular degeneration (AMD). In 2001, the National Eye Institute (NEI), a division of the National Institutes of Health, funded a first-of-its kind study of eye disorders in Hispanics living in the United States. The results revealed glaucoma to be the leading cause of blindness among the group studied. The findings also revealed that women were more likely than men to suffer from vision impairment due to cataracts, glaucoma, and diabetic retinopathy. "The study underscores the need for early detection of eye disease among Hispanics," said its author, Jorge Rodriguez, M.D., M.P.H., assistant research professor at the University of Arizona Department of Ophthalmology. Early detection of eye disease, so that it can be treated before irreparable damage occurs, is the best way to preserve eyesight. And the best path to early detection is the path that leads to an ophthalmologist's door. An ophthalmologist is a medical doctor specializing in diseases of the eye, and shouldn't be confused with an optometrist. Optometrists are not necessarily medical doctors. Their main job is to measure eyes and fill prescriptions for eyeglasses, not to diagnose eye disease. To protect your eyesight, know your enemy. Learn the basics about the four most common eye disorders, particularly their warning signs: Glaucoma Your eyeballs have fluid in them. Glaucoma occurs when excess fluid builds up inside the eye, damaging the optic nerve. Left untreated, glaucoma impairs vision and causes blindness. Everyone over age 60 has an increased risk of contracting glaucoma, especially folks with a family history of the disease. According to the NEI, 3 million people in the U.S. suffer from glaucoma, but nearly half of those cases are undiagnosed. In the early stages, glaucoma has no symptoms. Only when it becomes advanced (and less treatable) do people experience a deterioration of their eyesight, especially their peripheral vision. The lack of early symptoms highlights the need for a yearly eye exam. To check for glaucoma, the pupils must be dilated-a simple, painless procedure. Recent advances provide a variety of eye drops and medications that can effectively delay the onset of glaucoma (for those at risk of developing it), and slow the progression of the disease (for those who already have it), if it is diagnosed early enough. If eye drops and medication fail to relieve the pressure, laser therapy or surgery may be used to create a new drainage channel in the eye. "There is no question that early, aggressive treatment of glaucoma can prevent blindness," says Dr. José Pulido, professor and head of Ophthalmology at the University of Illinois at Chicago. Medicare now covers an annual dilated eye exam for individuals considered to be at high risk for glaucoma.
Cataracts Cataracts are a cloudiness in the lens of the eye that painlessly but progressively impairs vision. The extent of vision loss depends on the cataract's location and its density or "maturity." The most common symptom of cataracts is diminished vision, often accompanied by blurred edges or double vision. Some people also experience a "halo effect" in bright light, or a yellow tinge in their vision. At least half of all people over 65 have some form of cataracts. For most patients, doctors cannot pinpoint the cause. There may be multiple causes including smoking, eye x-rays, exposure to strong sunlight, certain eye diseases that cause inflammation, some corticosteroid drugs, the natural wear and tear that occurs over the years, and complications from diabetes. This last cause is particularly worrisome for Hispanics, who suffer from a higher incidence of diabetes than the general population. Most of the time, cataracts are not painful. But they can cause swelling in the lens, and increased pressure in the eye. Initially, stronger lighting and eyeglasses can compensate for the vision problems. If the disease progresses, however, surgery is the only option. The usual treatment is removal of the clouded lens, and replacement with a plastic or silicone lens. Since cataract surgery is the most common procedure in the Medicare population, the question for most people is not whether to have the surgery, but when. "Forty years ago, cataracts were only done when they became very dense and mature. The rule now is that the moment the cataract starts to interfere with daily activities is when you do the surgery," says Dr. Rajesh Khanna of St. Mary's Eye Center in Santa Monica, California. Surgeons also remove cataracts that don't cause vision problems, if they prevent examination or treatment of AMD or diabetic retinopathy. "Unfortunately, there have been instances where patients have been pressured to obtain the surgery too early. As with laser surgery, "cataract mills" offer low-cost-and sometimes low-quality-care," according to Michelle Johnson, spokesperson for the American Academy of Ophthalmology. The bottom line, says Dr. Hal Balyeat, Clinical Professor of Ophthalmology for the Dean A. McGee Eye Institute at the University of Oklahoma: "Don't have the surgery too early. Every person is different. You'll know when it's time." The surgery itself, says Dr. Balyeat, has become fairly simple, and almost always works. Generally it's an outpatient operation requiring only local anesthesia. "In most cases, the patient can resume normal activity the next day," says Balyeat. Diabetic Retinopathy Diabetic retinopathy is the leading cause of blindness among all adults living in the United States. Every diabetic is at risk. An NEI-funded study in 2001 found that 3.5 percent of Mexican Americans were unaware that they were diabetics and that they had diabetic retinopathy. "Go to an ophthalmologist as soon as you are diagnosed with diabetes," says Dr. Pulido. Make sure that the diabetes has not led to diabetic retinopathy, which occurs gradually, over a long period of time. Says Pulido, "If diabetes is poorly controlled, especially if the patient also has high blood pressure, the blood vessels of the eye leak and close off. When they leak right into the center of vision, the retina swells up. As it does, good central vision diminishes. Also, abnormal blood vessels can grow, causing bleeding that can pull on the retina." Dr. Pulido adds that 90 to 100 percent of all vision loss from diabetes is preventable. If you are diagnosed with early stage diabetic retinopathy, the best way to prevent progression is to maintain good control over your blood sugar and blood pressure. Other treatments include lasers, which can diminish leaks in the blood vessels, or surgery. But "once a patient is at the point where surgery is needed, 20-20 vision isn't what we're aiming for," says Pulido. So, early detection is crucial. Macular Degeneration Age-related Macular Degeneration (AMD) is caused by a breakdown of the macula which filters near-UV blue light and protects the retina. AMD appears in two forms. Dry AMD, the common form, slowly destroys macula cells, reducing central vision. People with this condition usually cannot see well enough to read or drive. Wet AMD, the rarer and more dangerous form, causes fragile new blood vessels to grow toward the macula. Eventually, the blood vessels leak, resulting in rapid and severe loss of vision. Possible causes are family history, hypertension, excessive sun exposure, inadequate intake of zinc and antioxidant vitamins, and smoking. "Smoking increases the risk two to fourfold, so people should definitely quit smoking," says Dr. Pulido. There have been many advances in treatment over the last few years and lots of new treatments on the horizon, such as steroids and other antibody therapies, adds Pulido. To reduce your risk of eye disease: Quit smoking, eat fruits and leafy greens, always wear sunglasses outdoors, use an indirect-light reading lamp, get a dilated eye exam annually, and ask your doctor about vitamin supplements. See an ophthalmologist immediately if you have pain in the eyes, loss of, or waviness in, your vision, a "shower of floaters," flashing lights, or any injury to, or object in, the eye. Follow these simple suggestions and you can help ensure that you won't miss seeing a thing, for the rest of your life.
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