For most of her 76 years, Carolyn was a regular visitor at Philadelphia’s many museums. She also loved gardening and especially enjoyed Saturday afternoon strolls along the tree lined streets of her quiet neighborhood with it’s flower covered lawns and wind chimes.

But in the past several years, her walks have only left her frustrated and worried. On several occasions, she has tripped and fell on the sidewalks made uneven by tree roots. She used to think the uneven pavement was quaint. But she now worries that her eye-sight is failing and may force her to give up some of her favorite activities.

The National Eye Institute, in conjunction with Prevent Blindness America, analyzed the 2010 U.S. Census data and determined that 2.04 percent of the population or 142 million individuals have visual problems that affect every aspect of their lives.

Chances are that if you are affected by cataracts, glaucoma, macular degeneration or the complications of diabetes, you will at some point experience difficulty seeing. Doctors call this condition “low vision,” which can be defined as ever-present visual impairment that cannot be corrected with glasses, contact lenses, medical or surgical treatment.

Some individuals with low vision experience difficulty reading because the print appears to be too small or broken. Others may have problems seeing the face of their watch, cooking or writing their name on the line.

If you are experiencing any of these problems, consult your ophthalmologist or optometrist and make sure you get annual eye exams.

While your eye care specialist will prescribe an appropriate treatment regiment, here are a few tips to help the visually impaired maintain their independence.

1. If you enjoy reading, make sure you have proper lighting. Choose the light that provides the best illumination and make sure it is close to your reading material.
2. While reading, take a break and rest your eyes to prevent fatigue.
3. Talk to your doctor about prescribed reading glasses. Reading glasses purchased from the nearest convenience store usually do not have the necessary optical lenses to provide enough magnification.
4. Consult a low vision therapist who can help with strategies for everyday chores such as cooking, cleaning, writing and scheduling appointments.
5. Seek out vision rehabilitation therapy, which demonstrates equipment, strategies, and techniques that can help individuals complete activities of daily living with increased efficiency, independence and self-confidence.

Kinshasa A. Coghill, M.S. is a Certified Vision Rehabilitation Therapist and a Certified Low Vision Therapist with more than 10 years of experience working with seniors with low vision. More information is available at www.lowvisiontherapist.com. 

For an individual who has served others in different ways, it is only fitting that he found a vibrant home that offers a secure future.

Frank was working at a machine shop when he was drafted in February of 1943. Having volunteered to go airborne, he was stationed in Georgia and eventually transferred to the Philippines.

Following his service, he frequently offered his assistance as a mail carrier and was asked to stay as a regular. “I told my wife when I made regular carrier, we would get married,” he said. “So after I started, we set the date and were married in May of 1948.”

After more than three decades as a carrier, Frank took on a supervising role and eventually retired in 1979. Over the years, his family had grown from his three children to seven grandchildren and one great-grandchild.

Unfortunately, Frank endured the hardships of losing his wife and giving up his keys, having been declared legally blind. For these reasons, he and his family agreed a community that could provide an active environment and allow him to maintain his independence was the best option, and Chandler Hall fit that mold perfectly.

For over a year, he has lived in the Cane Manor House section, where 23 residents have formed a tight-knit community in the homelike atmosphere with a dining, living and family room as well as a covered porch. Like Frank, many of his peers have grown children nearby so that he can host events at the community or venture off-site.

Despite this proximity, his children are grateful for the different levels of available healthcare including assisted living, memory care, home health care and a respite program. Chandler Hall was also one of the first Medicare-certified Hospice providers in Pennsylvania, offering such services to those in the Pavilion and surrounding community.

“It’s a great location and we liked the convenience of having extended care across the street if anything were to happen,” said Frank’s daughter, Janis. “Now he goes there for physicals and eye doctor appointments.”

There is no question that Frank has enjoyed a smooth and comfortable transition to Chandler Hall. Though he loves the prepared meals, he refuses to miss the weekly trip to the grocery store where he freely picks out various items.

He has also had no problem immersing himself in the social scene. “I joined the YMCA here and I enjoy playing trivia games, exercising in the afternoon and watching Phillies games,” he said.

With a prime location near historic Newtown, several amenities and a wide array of services, Frank has everything he could potentially need right outside of his door.

“I am very well satisfied, and the people here are all nice,” he said.

And as the community celebrates its 35th anniversary, Frank is certainly looking forward to his future at his new permanent address.

*Diabetic Eye Disease*
Diabetic retinopathy, the most common of these vision problems, affects five million of the over twenty million Americans with Diabetes. According to Dr. Griffiths, high blood sugar levels associated with diabetes can lead to closure of small blood vessels in the retina which can cause leakage of fluids into the retina and obstruction of blood flow. This can rapidly cause vision loss that can be irreversible in some cases.

In addition, blurred vision may occur when the macula, the part of the retina that provides central vision, swells from leaking fluid. Oftentimes, laser surgery of the retina can help with this leakage. In more advanced cases, however, the disease can progress to frank bleeding and even retinal detachments requiring surgery. Dr. Griffiths says that because there are often no symptoms in the early stages of retinopathy, your vision may not be affected until the disease becomes severe. That is why annual eye exams are the hallmark for diabetic eye care.

Laser treatment has been proven to help reduce vision loss but it will not cure diabetic retinopathy or prevent future vision loss. Along with an early diagnosis of diabetes, diet and exercise can help control your blood sugar, thus reducing the risk of progressive diabetic retinopathy.

Those with diabetes are also at risk for having cataracts at a younger age while being twice as likely to develop glaucoma.

*Glaucoma*
Although 2.2 million Americans age forty and older have glaucoma, only half are aware of their condition due to lack of symptoms. Glaucoma can lead to progressive blindness. The exact cause of glaucoma is unknown.

The optic nerves of those with glaucoma become damaged over time. It is believed that a certain pressure, usually a high pressure, leads to slow progressive damage to the optic nerve, which manifests itself as a gradual decrease in peripheral vision. According to Dr. Griffiths, fluid is made in the eye and must exit the eye at a constant rate. Fluid exits the eye at the angle where the cornea and iris meet. In the more common open angle-glaucoma, the angle that allows fluid to drain is open, but for uncertain reasons, the fluid passes too slowly through the meshwork drain and that creates an abnormal pressure gradient.

Although there is no cure for glaucoma, treatments are available to control it. According to Dr. Griffiths, most doctors use eye drop medications for newly diagnosed glaucoma, but new research findings indicate that laser surgery, which helps open the meshwork that drains fluid is a safe and effective alternative. Newer, once a day eye drops have increased compliance among glaucoma patients and they are quite efficacious. Laser treatments are also very effective. However, if both of these more commonly used treatments fail, surgery is the next option.

While laser surgery has been proven to be effective, its effects can eventually wear off and a second laser surgery may be warranted. Dr. Griffiths says while glaucoma surgery may save vision not yet lost, it does not improve sight. In fact, your vision may not be as good as it was before surgery.

*Cataracts*
Cataracts, affect over 20 million Americans age forty and older. Cataracts are the clouding of the eye’s crystalline lens. This causes the passage of light rays to be scattered leading to blurred vision. Dr. Griffiths says cataracts start out small and initially have little effect on vision. As they grow slowly, they impact vision and the most common signs of visual impairment include sensitivity to light, night glare, double vision in one eye, fading/yellowing of colors and frequent changes in glasses or contact prescriptions. Although normally a part of the aging process, cataracts can also develop from eye injuries, certain diseases, genetics and certain medications in people of all ages.

Cataracts are removed as an outpatient surgical procedure that usually takes fifteen to thirty minutes. Once the crystalline lens is removed, the focusing ability must be replaced with an intraocular lens (IOL). In many cases, this lens can vastly improve distance vision to the point that no glasses are needed for distance tasks. Reading glasses are still required, however, after implantation with a basic IOL. Insurance carriers including Medicare cover the basic IOL as part of cataract surgery.

New developments, such as Multifocal and Accommodating intraocular lens implants, can now afford people great vision at distance, intermediate and near without glasses. According to Dr. Griffiths, there are different manufacturers and types of advanced lenses. ‘Multifocal lenses’ allow quality vision at multiple zones through a series of focusing rings whereas the ‘accommodative lenses,’ move within the eye to give focusing power at multiple distances. Unfortunately, these premium lenses and the services related to them are not covered by insurance plans but they just may be worth the extra expense for patients. Over 90% of patients who choose these premium lenses are spectacle independent. The other 10% only require glasses for certain tasks.

One alternative to premium lenses Dr. Griffiths discusses is monovision, which is a technique where one eye is corrected for distance and one for near. This technique can often be accomplished with the basic lenses. Depth perception can sometimes be affected by this technique however.

Talk to your eye surgeon about the risks, benefits and alternatives of cataract surgery and multifocal implants to see whether you are an appropriate candidate for surgery and to find the best lens that fits your needs. Indeed, not all Ophthalmologists offer Premium IOLs so be sure to inquire about them yourself if the subject is not brought up during your conversation about cataract surgery.

It is important to see your eye care professional regularly for an examination at least every two years. If you have diabetes, it is strongly recommended you have a dilated eye examination at least once a year. If you have Glaucoma, you must see your Ophthalmologist more frequently. The American Academy of Ophthalmology now recommends that everyone have a comprehensive ophthalmic examination at the age of 40 because many eye as well as systemic conditions begin to be picked up at this age. Combined with early detection, the latest technologies and advancements can help control these eye conditions.

Jacqueline D. Griffiths, M.D. graduated from Yale University, earned her medical degree from the University of Michigan and completed her Ophthalmology residency at Georgetown University Medical Center. She is Board Certified and has been in practice for fourteen years. She started her own Ophthalmology practice and laser center, NewView Laser Eye, Inc. in 1999. For more information about Dr. Griffiths, the eye conditions discussed, or any other eye condition, please visit www.newvieweyecenter.com

Other References: American Academy of Ophthalmology (aao.org) and American Society of Cataract and Refractive Surgeons (ascrs.org).