The Aging Eye and Vision Loss

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Imagine what it is like to have poor vision, especially if you have had good vision all your life. For millions of Americans, this is a reality. New advancements in eye care, however, have contributed to the early detection and treatment of diseases such as diabetic eye disease glaucoma and cataracts. Jacqueline D. Griffiths, MD, of NewView Eye Center, offers insight into the symptoms, treatments and preventative measures for each of these conditions.

*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).

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