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Queens Chronicle

Fear Of Vision Loss

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Posted: Thursday, August 1, 2002 12:00 am

When it comes to aging, the thing that bothers most middle and older aged people most, after mental or emotional illness, is the fear of becoming blind.

Yet many people don’t realize that with proper vision care, regular checkups and corrective measures, poor eyesight doesn’t have to be inevitable.

Yes, declining eyesight is part of the aging process starting at age 40, says Dr. William Cooper, director of ophthalmology at the New York Hospital Medical Center of Queens in Flushing.

One in six American adults or 13.5 million people age 45 and older say they have some impairment of their vision, according to a survey by the Lighthouse International, which has a branch office in Queens. About 120,000 people are either completely blind or able to perceive only light or dark. Three million say they find it difficult to read regular newsprint.

Eye problems that commonly occur as people age are presbyopia, floaters, dry eyes and excessive tears. After age 40, eyes lose some ability to focus on close objects and to see small print (presbyopia) because the lens loses some of its elasticity as a normal part of aging.

While the condition is not preventable, it can be corrected with glasses, assures Cooper, who runs the hospital’s eye-center, which sees about 6,000 patients, mostly Queens residents, a year.

Floaters, tiny spots that float across your field of vision, can be either normal or a sign of a larger problem if either the number or shape change suddenly or if they occur with light flashes. A doctor should check changes.

Dry eyes occur when fluid from the tear glands decreases and may be treated with artificial tears or eyedrops. Excessive tears may be a sign of nothing more serious than a greater sensitivity to light, wind or temperature. Sunglasses or a brimmed hat can help. It could indicate an eye infection or a blocked tear duct, both of which can be treated.

Some eye diseases occur more often in older people. These diseases attack muscle control, block the passage of light or cause degeneration of structures in the eye. Some of these include glaucoma, macular degeneration, diabetic retinopathy and cataracts.

About three million adult Americans suffer from glaucoma, when fluid pressure builds and damages parts of the eye. It is one of the leading causes of blindness.

Chronic glaucoma, which accounts for 90 percent of cases, appears in middle age and seems to have a genetic component: one in five has a relative who has it. Doctors refer to it as the “sneak thief in the night” because it comes on gradually to steal vision and may be well-established before noticing warning signs such as the need for new glasses, loss of peripheral vision and blank spots in vision.

Procedures for glaucoma screening are brief and painless, and usually involves an air-puff tonometer to check pressure on the eye and peripheral vision testing.

Treatment of glaucoma requires measures to control the flow and drainage of aqueous humor in the eye, restoring the normal balance of inner-eye pressure. Both medical and surgical approaches, including the use of eyedrops, have high rates of success in treating chronic glaucoma when caught early in regular eye exams.

However, in the case of acute glaucoma, if the pressure of excess fluid is not relieved quickly, the result can be blindness.

A cataract is a painless, cloudy area in the lens of the eye that blocks the passage of light from the lens to the nerve layer of the retina at the back of the eye. Cataracts in older adults do not always have to be removed, and sufferers can substitute surgery with eyeglasses, contacts or other vision aids.

With aging, proteins normally found in the lens of the eye are slowly destroyed by chemicals called oxygen-deprived free radicals, causing water to enter the lining of the lens resulting in clouded vision.

Half of all adults 65 to 74 have a cataract, 70 percent for adults over 75. Women, Native Americans and African Americans are at greater risk of contracting them. Smokers and drinkers are also at risk; and those who have excessive exposure to ultraviolet light, although no direct link has conclusively been proven.

Macular degeneration, which comes in wet and dry forms, is the number one cause of vision loss in the U.S. with more than 13 million Americans showing some sign of the disorder. It does not usually occur in people under 55 and is often referred to as age-related macular degeneration (ARMD).

Macular degeneration is scarring of the macula, a spot about 1/16-inch in diameter at the center of the retina. The macular enables you to read, watch television, drive or anything that requires focused, straight-ahead vision. The scarring distorts or obscures part of the central image that the eye transmits to the brain.

The less common wet form, about 5 to 15 percent of cases, involves leaking abnormal blood vessels growing beneath the macula and requires immediate medical attention. This form can be treated with a laser, which cauterizes the blood vessels.

In the dry form of ARMD, tiny yellow deposits develop beneath the macula, signaling degeneration and thinning of the nerve tissue. This result is insufficient circulation, for which there is no treatment at the moment, says Cooper.

Diabetic retinopathy also damages the tiny blood vessels in the retina, the light-sensitive tissue that lines the back of the eye. It does so slowly and there are no warning signs. The only way to detect it is with a dilated eye exam.

People with diabetes are 25 times more likely to become blind than those without diabetes. Diabetic eye disease can cause as many as 25,000 new cases of blindness a year. Nearly half of the nation’s estimated 16 million people with diabetes will develop some degree of diabetic retinopathy, the most common form of eye disease.

Vision loss from diabetes cannot be restored, yet in 90 percent of those who would otherwise become blind, the early detection of the disease, combined with laser surgery when needed, has helped preserve vision. Laser surgery can shrink the abnormal blood vessels caused by retinal retinopathy.

Also, people who keep their blood sugar levels as normal as possible slow the onset and progression of diabetic retinopathy and lessen the need for laser surgery. Diabetics are also at risk for cataracts and glaucoma, as well as a range of other problems including strokes and kidney disease.

To maintain healthy eyes throughout your life, there are several common sense tips to follow: limit amount of alcohol and drink eight glasses of water daily, don’t smoke, exercise regularly, eat a diet high in fruit and vegetables and low in fat, sodium and cholesterol and protect your eyes from sunlight.

Above all, after age 40 get an eye exam every one to two years.

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