~ Saving, Improving Sight at Middle Age and Beyond

The State, Columbia, S.C., 06-17-05

COLUMBIA, S.C. - Most people expect to encounter some gray hairs at a certain age. A wrinkle here and there. Some aches and pains, as arthritis or old sports injuries take their toll.

But symptoms of aging eyes have a way of sneaking up on people.

What's more, serious ailments such as glaucoma and macular degeneration may develop so gradually that people don't notice symptoms until they have lost much of their vision.

Whether you're cruising along in your career, tackling a midlife crisis or welcoming grandchildren, you'll want to get a good look at what life has to offer at middle age and beyond.

In the case of presbyopia - which has 40-something people struggling to read the fine print - you might need only a pair of "drugstore glasses."

Here's some advice on detecting and dealing with some of the other common age-related eye ailments. Diagnosis will require an exam by an ophthalmologist or optometrist.

Cataracts:

Her cataracts developed gradually, but there was nothing subtle about what Suzanne Chambliss saw when she looked at her ophthalmologist's eye chart about two years ago.

"I couldn't even see the large `E' without glasses," said Chambliss, a 68-year-old part-time bookkeeper from Columbia, S.C.

Cataract surgery - the techniques for which have improved dramatically during the past decade - restored her vision after quick, painless procedures on each eye.

"Frankly, for me it was a piece of cake," Chambliss said.

The clouded lenses of cataracts are "something we're all going to get, assuming we keep having birthdays," said Dr. Cindy Snell, the Columbia ophthalmologist who performed Chambliss' surgery.

Over time, vision can become dull and blurry as the eye's lens becomes cloudy, usually because of clumps of protein that reduce the light that can reach the retina.

An estimated 20 million Americans older than 40 have vision loss from cataracts, a number that will increase as people live longer, said Dr. M. Edward Wilson, chairman of the ophthalmology department (Storm Eye Institute) at the Medical University of South Carolina in Charleston.

"The cataract operation is one of the miracles of modern medicine," Wilson said. "It's so successful ... it would be a shame for anyone to live with vision loss from cataracts."

Diabetes, smoking, obesity, use of steroid medications (such as for asthma) and sun exposure are among the risk factors for cataracts.

Insurance or Medicare generally cover cataract surgery. The current technique uses ultrasound energy to break up and "vacuum" the cataract through a tiny incision. The replacement lens is placed through the same incision, which usually seals itself, Snell said.

Complications such as infection and bleeding are possible. The decision on whether and when to have the surgery will depend on one's vision loss and the level of vision one needs for daily life, Wilson said - greater for a 60-year-old who works at a computer, less for a 90-year-old who mostly watches TV.

For Walter Walker of Columbia, a retired Clemson University professor, "driving at night became quite a problem." Lights seemed to have halos around them, he said.

Walker, 75, had one cataract removed seven years ago and one two years ago, by Dr. Brian Huff of The Eye Center in Columbia.

Walker is an avid gardener, and in between surgeries, he was struck by how brightly colored his flowers looked to the eye with the cataract removed.

Things look brighter in both eyes now, and "I have no problem with night driving," he said.

Perhaps you've heard about the new ReStor replacement lens, which recently won federal approval. They're touted as a miracle treatment for presbyopia, and one that had cataract patients tossing away their glasses after they received them during clinical trials.

According to MUSC, Medicare has just ruled that cataract patients may get ReStor lenses but will have to pay the extra cost, which will vary according to where they get the lenses.

Glaucoma:

If you have regular eye exams, you probably have been tested for glaucoma. Screening is important because glaucoma has no early symptoms, Wilson said.

"You're losing peripheral vision, but most people don't notice that," he said. "It's called the silent thief of sight."

Increased pressure within the eye causes glaucoma. The pressure damages the optic nerve, a bundle of nerve fibers that sends vision signals to the brain.

Glaucoma damage is irreversible, but eyedrops and, possibly, laser surgery may halt progress of the disease, Wilson said.

According to the National Eye Institute, those at highest risk for glaucoma include:

-African-Americans 40 and older.

-Anyone older than 60, but especially those of Mexican descent.

-Anyone with a family history of glaucoma.

-Diabetics and smokers.

Macular degeneration:

Macular degeneration affects about 10 million Americans, is on the increase and is the leading cause of legal blindness in people 65 and older.

In a way, the symptoms of macular degeneration are the opposite of those for glaucoma. Eyesight is impaired first in the center of one's field of vision, rather than around the edges.

The two diseases have ominous similarities, however. Symptoms may occur so gradually that people don't notice them, and treatment can't reverse damage - only prevent it from getting worse.

Age-related macular degeneration, sometimes referred to as AMD, involves damage to an area of the retina called the macula. In the "dry" form of the disease, the light-sensitive cells of the macula break down. Blurred vision can be a symptom.

Dry AMD can develop into the "wet" form of the disease, in which new blood vessels form and break, causing rapid damage. Straight lines may appear wavy. People at risk for developing wet AMD may be advised to look at a grid of lines every day and report any changes in their vision.

Food and dietary supplements rich in antioxidants can help slow the progression of macular degeneration and are especially important when a family has a history of the disease, Snell said.

Other risk factors for macular degeneration include smoking, obesity and diabetes, and white females are especially at risk.

Snell and Wilson mentioned tests of promising new medications for macular degeneration that are injected into the eye. Other treatments include laser surgery and are likely to help only temporarily.

Tula Valassakis, 81, was diagnosed with macular degeneration about two years ago - fortunately, in her right eye only. Driving is more scary and reading is more difficult, said Valassakis, a retired secretary from Columbia.

She has frequent checkups to watch for symptoms in her left eye and is taking dietary supplements for the first time, at her doctor's recommendation.

"It's a devastating disease, but at least I've got one good eye," she said.

Floaters:

Spots and shapes that seem to float in one's vision usually are the result of clumps of protein in the vitreous gel of the eye that create shadows on the retina.

They become more common as one ages, Wilson said. The National Eye Institute says two-thirds of people older than 70 experience floaters, which usually are not serious.

Wilson said that a sudden flurry of floaters and/or flashes could indicate a torn or detached retina. An eye doctor should check them out as soon as possible.

Dry eyes:

They can have a variety of causes - including autoimmune disorders, injury and effect of medication - but dry eyes are increasingly common with age, Wilson said.

A new medication called Restasis represents progress over traditional treatment with artificial tears, he said: Restasis is the first medication that increases the production of tears.

"It's not just a wetting agent," Wilson said. "This actually helps you make more tears."

The prescription eyedrops may take a few weeks to begin working, he said.

Making the most of limited vision:

Even when patients have lost much of their eyesight, special glasses, lights and magnifiers can help make the most of what they have left, eye specialists say.

"I got to where my left eye couldn't see at all," said Louella Grainger, 75, a retired homemaker in Conway, S.C.

At high risk for vision loss because she has diabetes, Grainger began losing her sight about five years ago. She has age-related macular degeneration and has had a cataract removed.

Early this year, Grainger worked with an optometrist at the MUSC Feldberg Center for Vision Rehabilitation. She now uses a hand-held magnifying glass and a magnifying lamp for close-up tasks such as reading her Bible.

"I even threaded a needle for the first time in about four years, she said.

Grainger said she was thankful to be able to read and sew again, but she said with a chuckle that she had had to learn to feel her way around the kitchen.

"It's hard to hold a magnifying glass and cook," she said.

TAKING CARE OF YOUR EYES

Vision difficulties are a normal part of aging, but everyone can do a few things to keep his or her eyes as healthy as possible.

Don't smoke. It increases the risk for many eye disorders, primarily by damaging tiny blood vessels.

If you have diabetes or high blood pressure, keep it under control and have your eyes checked regularly.

Protect your eyes with sunglasses that shield them from ultraviolet rays.

Eat a healthful, balanced diet with plenty of fruits, vegetables and omega 3 fatty acids.

To help preserve vision, especially if you are at risk for macular degeneration, ask your doctor about taking a dietary supplement with special nutrients for your eyes.

Be aware of changes in your vision. Examples: difficulty reading or distinguishing faces, loss of peripheral vision, straight lines that appear wavy and difficulty distinguishing colors.

Sources: Drs. M. Edward Wilson, Cindy Snell and Rick Milne of Columbia, S.C.; "The Johns Hopkins Medical Guide to Health After 50"


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