Age-Related Eye Diseases That You Need to Watch Out For

Gregg P. Moody, M.D.

The number of Americans aged 65 and older is projected to double from 46 million today to over 98 million by 2060. While we all strive for overall wellness, many overlook the maintenance of their eye health until problems arise. As with any disease, “an ounce of prevention is worth a pound of cure.” This holds especially true for something as precious as your eyesight. Not all changes in visual quality are the result of disease, but there are three conditions that are of utmost importance to be screened for. These are age-related macular degeneration (AMD), glaucoma, and diabetic retinopathy.

AMD is the leading cause of vision loss in people 50 years or older. The macula is the part of the retina that forms your central vision. AMD leads to thinning of the tissue along with the accumulation of proteins called drusen. Sufferers of AMD slowly lose their central vision making you unable to see fine details at near or far. The peripheral vision remains normal. The most common type is called dry AMD which leads to slow loss of vision and, unfortunately, has no treatment available. The other type, called wet AMD, leads to a much quicker loss of vision. There are treatment options for the wet type, but many still lose parts of their central vision. Most people don’t realize they have AMD until their vison is very blurry. This is why it is important to have regular visits with an ophthalmologist. Risk factors for AMD are Caucasian race, age over 50, family history of AMD, smoking, and diets high in saturated fats.

Glaucoma is a leading cause of blindness in all people over 60, but African Americans are at an even greater risk. Glaucoma is a disease that damages your eye’s optic nerve usually due to fluid building up in the front part of the eye. Most types of glaucoma are painless and cause no vision changes at first. After more severe optic nerve damage occurs you may begin to lose parts of your peripheral vision. Blindness from glaucoma can be prevented with early treatment so regular eye exams can be sight saving. Common risk factors are age over 40, African or Hispanic heritage, family history of glaucoma, and long-term steroid use.

People with diabetes can have an eye disease called diabetic retinopathy. This is when high blood sugar levels cause damage to the blood vessels in the retina. These blood vessels can swell, leak, or stop blood from passing through. Like many diseases it often has no symptoms in its early stages. As retinopathy gets worse, you will notice symptoms such as increased number of floaters, blurry vision, fluctuations in vision, or dark spots in part of your vision. Routine eye exams can diagnose retinopathy, and treatments can often protect the eye from the vision-threatening effects of this disease.

The New Age of Cataract Surgery

Gregg P. Moody, M.D.

Cataracts are treated by removing the eye’s cloudy natural lens and surgically replacing it with an intraocular lens or IOL. Although cataract surgery is considered “successful” in 98% of cases, the definition of success has evolved over the last 25 years. Dramatic improvements in IOL technology now give patients a wide range of surgical options making expectation are higher than ever.
Prior to these innovations, many patients undergoing cataract surgery would still need to wear glasses or contact lenses to correct vision problems. These problems are related to astigmatism and/or presbyopia. Astigmatism is an abnormal shape of the cornea (front of eye) and, if left untreated, can cause blurry vision at all distances.
Presbyopia is an eye condition that occurs as part of natural aging. It involves the gradual loss of the eye’s ability to focus on near objects, such as books, menus, computers, or smartphones. Advances in astigmatism-correcting and presbyopia-correcting IOLs offer reduced dependence on glasses to a larger number of patients. This new technology comes with obvious benefits, but not everyone is a good candidate. There are many underlying eye diseases, like glaucoma, macular degeneration, and diabetic retinopathy, that exclude patients from these implants.

Currently, insurance will pay for the surgery, but not the new premium lens. Premium lens fees ranges from $1200 to $1800 per eye. Anyone interested in more details can make an appointment with my office at North Alabama EyeCare by calling 256-233-2914.

You can also find more information on our website at www.northalabmaeyecare.com.

 

Cataracts 101

What is a cataract?
A cataract is the clouding of the natural lens inside your eye. The main job of the lens is to focus light rays into the eye to help us see. As cataracts develop light cannot pass through clearly, causing you to lose some of your eyesight. There are several causes of cataracts, but natural aging is the most common cause by far. Other causes include trauma, cataracts secondary to other medical conditions, or congenital cataracts. By age 80, more than half of all Americans either have cataracts or will have had cataract surgery.

What are the symptoms of cataracts?
Cataracts usually form slowly. You may not know you have them in the earlier stages. Then you might notice vision that’s cloudy, blurry, foggy, or filmy. Other symptoms include problems driving at night due to glare, changes in the way you see color, or double vision in the affected eye.

Can cataracts be prevented?
There is significant controversy about whether cataracts can be prevented. Some studies have suggested certain nutrients and supplements may reduce your risk of cataracts. The largest study showed diets high in vitamin E which is found in spinach, almonds, or sunflower seeds may help reduce the risk. Supplements include lutein and zeaxanthin found in leafy, green vegetables like spinach and kale.

How are cataracts diagnosed and treated?
Your ophthalmologist can examine and test your eyes to diagnose cataracts. When symptoms begin to appear you may be able to improve your vision with glasses or other visual aids. Once your cataracts have progressed enough to significantly impair your vision and affect your daily life, surgery should be considered. Cataract surgery is the most frequently performed surgery in the U.S. with more than 3 million Americans undergoing surgery each year. It is also highly successful with about 90 percent of those having surgery regaining very good vision.

Vision Problems of School Children

Your child’s vision is essential to his success in school. When his vision suffers, chances are his schoolwork does too.

Vision problems are common among school-age kids. According to Prevent Blindness America, one in four school-age children have vision problems that, if left untreated, can affect learning ability, personality and adjustment in school.

School-age children also spend a lot of time in recreational activities that require good vision. After school team sports or playing in the backyard aren’t as fun if you can’t see well.

Warning Signs Of Vision Problems In Kids

Refractive errors are the most common cause of vision problems among school-age children. Parents, as well as teachers, should be aware of these 10 signs that a child’s vision needs correction:

Blurry vision may be interfering with your child’s ability to learn in school. Regular eye exams can detect and correct this and other vision problems.

  1. Consistently sitting too close to the TV or holding a book too close
  2.  Losing his place while reading or using a finger to guide his eyes when reading
  3. Squinting or tilting the head to see better
  4. Frequent eye rubbing
  5. Sensitivity to light and/or excessive tearing
  6. Closing one eye to read, watch TV or see better
  7. Avoiding activities which require near vision, such as reading or homework, or distance vision, such as participating in sports or other recreational activities
  8. Complaining of headaches or tired eyes
  9. Avoiding using a computer, because it “hurts his eyes”
  10. Receiving lower grades than usual

Schedule an appointment with an optometrist or ophthalmologist if your child exhibits any of these signs. A visit with the doctor may reveal that your child has myopia (nearsightedness), hyperopia(farsightedness) or astigmatism. These common refractive errors are easily corrected with eyeglasses or contact lenses.

Eye Exams: How Often?

Children should have an eye exam by no later than 6 months old, then again by age 3 years, and just before starting school.

School-age children need an exam every two years after that if they have no visual problems. If your child requires eyeglasses or contact lenses schedule visits every 12 months.

Frequent eye exams are important because during the school years your child’s eyeglasses prescription can change frequently.

Your eye care practitioner also will ensure that your child has the visual skills required for success in school and sports, such as accurate and comfortable eye teaming, peripheral vision, ease of focusing from distance to near and hand-eye coordination.

Dry Eye Syndrome

Dry eye syndrome is a chronic and typically progressive condition. Depending on its cause and severity, it may not be completely curable. But in most cases, dry eyes can be managed successfully, usually resulting in noticeably greater eye comfort, fewer dry eye symptoms, and sometimes sharper vision as well.

Because dry eye disease can have a number of causes, a variety of treatment approaches are used.

The following is a list of dry eye treatments that are commonly used by eye doctors to reduce the signs and symptoms of dry eyes. Your eye doctor may recommend only one of these dry eye treatments or a combination of treatments, depending on the cause(s) and severity of your condition.

Also, some eye doctors will have you complete a questionnaire about your symptoms prior to initiating dry eye treatment. Your answers to this survey are then used as a baseline, and the questionnaire may be administered again after several weeks of treatment to evaluate the effectiveness of the chosen treatment approach.

Successful treatment of dry eyes requires that you are willing to follow your doctor’s recommendations and that you use the products he or she recommends consistently and as frequently as directed.

Artificial Tears

For mild cases of dry eyes caused by computer use, reading, schoolwork and other situational causes, the best dry eye treatment may simply be frequent use of artificial tears or other lubricating eye drops.

There are many brands of artificial tears that are available without a prescription. The challenge with using artificial tears is not lack of product availability — it’s the confusing number of brands and formulations available to choose from.

Artificial tears and other over-the-counter (OTC) lubricating eye drops are available in a wide variety of ingredients and viscosity (“thickness”).

Artificial tears with low viscosity are “light” and watery. They often provide quick relief with little or no blurring of your vision when you apply them. But often their soothing effect is very short-lived, and sometimes you must use these drops very frequently to get adequate dry eye relief.

On the other hand, artificial tears that have a high viscosity are more gel-like and can provide longerlasting lubrication. But typically these drops cause significant blurring of your vision for several minutes immediately after you apply them. For this reason, these drops often are not a good choice for use during your work day or when you need immediate clear vision for tasks such as driving. Instead, highviscosity artificial tears are recommended only for bedtime use.

Also, the ingredients in certain brands of artificial tears may determine which type of dry eye condition they are better suited for. For example, one brand might work better for aqueous-deficiency dry eyes, while another brand may be more effective for an evaporative dry eye condition.

If your eye doctor recommends that you use one or more brands or formulations of artificial tears, be sure to follow the directions he or she gives you concerning when and how often you use the drops.

Also, do not substitute different brands from those your eye doctor recommends. Using a different brand or multiple brands of artificial tears will make it difficult to assess the success of the dry eye treatment your doctor recommended.

Other Dry Eye Treatment Considerations

Your eye doctor may recommend one or more of the following supplemental measures if any of the conditions below apply to you:

Medication adjustment. Many medicines — including antihistamines, antidepressants, birth control pills, certain blood pressure medications and more — can cause or worsen dry eye symptoms. Even over-the-counter (nonprescription) medications for allergies and other conditions can cause dry eyes.

Be sure to discuss all medications you are taking with your eye doctor if you are experiencing dry eye problems. In some cases, adjusting the type and number of medications you are taking may help reduce dry eye symptoms without causing adverse health effects.

However, never discontinue a prescription medication without first discussing the matter with your physician. If your eye doctor feels an adjustment to one of your medications may help relieve dry eye symptoms, he or she can discuss it with your physician (or have you discuss it with your doctor) to see if such a change is possible.

Treating eyelid conditions. Blepharitis, Meibomian gland dysfunction or other eyelid conditions are often associated with dry eye disease and should be addressed as part of your overall dry eye treatment regimen. For example, if you have blepharitis, your eye doctor may recommend use of an antibiotic and/or steroid ointment or eye drop in addition to daily eyelid cleansing with a non-irritating shampoo.

Discontinuing or reducing contact lens wear. If you wear contact lenses, it can be difficult to tell if an underlying dry eye condition is causing contact lens discomfort or if your contact lenses are causing dry eye symptoms. If you wear contacts, it’s often best to discontinue wearing them (or perhaps switch to daily disposable contact lenses for part-time wear only) while your dry eye treatment is in progress.

Cataracts

What are Cataracts?

A cataract is a clouding of the eye’s natural lens, which lies behind the iris and the pupil.

Cataracts are the most common cause of vision loss in people over age 40 and is the principal cause of blindness in the world. In fact, there are more cases of cataracts worldwide than there are of glaucoma, macular degeneration and diabetic retinopathy combined, according to Prevent Blindness America (PBA).

Today, cataracts affect more than 22 million Americans age 40 and older. And as the U.S. population ages, more than 30 million Americans are expected to have cataracts by the year 2020, PBA says.

Types of cataracts include:

  • A subcapsular cataract occurs at the back of the lens. People with diabetes or those taking high doses of steroid medications have a greater risk of developing a subcapsular cataract.
  • A nuclear cataract forms deep in the central zone (nucleus) of the lens. Nuclear cataracts usually are associated with aging.
  •  A cortical cataract is characterized by white, wedge-like opacities that start in the periphery of the lens and work their way to the center in a spoke-like fashion. This type of cataract occurs in the lens cortex, which is the part of the lens that surrounds the central nucleus.

What Causes Cataracts?

The lens inside the eye works much like a camera lens, focusing light onto the retina for clear vision. It also adjusts the eye’s focus, letting us see things clearly both up close and far away.

The lens is mostly made of water and protein. The protein is arranged in a precise way that keeps the lens clear and lets light pass through it.

But as we age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract, and over time, it may grow larger and cloud more of the lens making it harder to see.

No one knows for sure why the eye’s lens changes as we age, forming cataracts. But researchers worldwide have identified factors that may cause cataracts or are associated with cataract development. Besides advancing age, cataract risk factors include:

  • Ultraviolet radiation from sunlight and other sources
  • Diabetes
  • Hypertension
  • Obesity
  • Smoking
  • Prolonged use of corticosteroid medications
  • Statin medicines used to reduce cholesterol
  • Previous eye injury or inflammation
  • Previous eye surgery
  • Hormone replacement therapy
  • Significant alcohol consumption
  • High myopia
  • Family history

One theory of cataract formation that’s gaining favor is that many cataracts are caused by oxidative changes in the human lens. This is supported by nutrition studies that show fruits and vegetables high in antioxidants may help prevent certain types of cataracts.

Cataract Treatment

When symptoms begin to appear, you may be able to improve your vision for a while using new glasses, strong bifocals, magnification, appropriate lighting or other visual aids.

Think about surgery when your cataracts have progressed enough to seriously impair your vision and affect your daily life.

Many people consider poor vision an inevitable fact of aging, but cataract surgery is a simple, relatively painless procedure to regain vision.

Cataract surgery is very successful in restoring vision. In fact, it is the most frequently performed surgery in the United States, with more than 3 million Americans undergoing cataract surgery each year, according to PBA.

Nine out of 10 people who have cataract surgery regain very good vision, somewhere between 20/20 and 20/40.

During surgery, the surgeon will remove your clouded lens and in most cases replace it with a clear, plastic intraocular lens (IOL).

New IOLs are being developed all the time to make the surgery less complicated for surgeons and the lenses more helpful to patients. Presbyopia-correcting IOLs potentially help you see at all distances, not just one. Another new type of IOL blocks both ultraviolet and blue light rays which research indicates may damage the retina.

Read more on this website about what to expect if you have cataract surgery and how to deal with rare cataract surgery complications.

Also, men should be aware that certain prostate drugs can cause intraoperative floppy iris syndrome(IFIS) during a cataract procedure.