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Eye diseases are more common than ever

Catching them early can help you avoid vision loss and even blindness

Published: May 2013

More people than ever in the U.S. suffer from age-related eye diseases. The four most common ailments—cataracts, diabetic retinopathy, glaucoma, and age-related macular degeneration—are the leading causes of vision impairment and blindness here. Poor vision not only reduces your quality of life but research has also linked it to more falls, car accidents, and possibly even to a shorter life span.

That’s why it’s vital to have regular screenings to preserve your eyesight. People should undergo a standard eye exam every year or two beginning at age 65. Adults ages 40 to 54 should be screened every two to four years, and those 55 to 64 should be screened every one to three years. You can be tested by an ophthalmologist (M.D.), who specializes in medical and surgical eye problems, or an optometrist (O.D.), a doctor trained to diagnose and treat eye disorders but not licensed to perform surgery. Here is what you need to know about the four major eye diseases.

Cataracts

How a person with cataracts sees the world.

Close to 21 million people in the U.S. age 40 and older have cataracts, according to the Centers for Disease Control and Prevention. Cataracts are cloudy areas in an eye’s lens formed by the clumping of proteins as we age. They can lead to hazy, blurry vision and sensitivity to glare.

Detect it. Expect to undergo a comprehensive eye exam, including tests using an ophthalmoscope, a device used to inspect the retina at the back of the eye, and a “slit-lamp” test, which enables doctors to detect cataracts in the lens. “Just having a cataract doesn’t mean you have to run and have surgery on it,” says R. Linsy Farris, M.D., a professor of clinical ophthalmology at Columbia’s College of Physicians and Surgeons and director of the department of ophthalmology at Harlem Hospital, both in New York City. “If an older person can read and watch TV, they don’t necessarily need to have their cataract removed,” he says. “It’s an individual decision.”

Treat it. A small incision is made on the side of the cornea, and a tiny probe is inserted that emits ultrasound waves to break up the cataract-containing lens so that it can be suctioned and discarded. A permanent artificial lens is then implanted. Because there are several varieties of lenses, you should consult your doctor about which type is best to correct your near or distance vision, and whether your insurer will pay for it.

You may also want to discuss whether the lens implant should be clear or tinted to filter out certain types of light. As clear lenses age they filter out blue light, which has been linked to disrupted circadian rhythms and sleep disturbances in older people, according to a report in the Sept. 1, 2011, issue of the journal Sleep. But there are insufficient data from prospective studies to know whether tinted-lens implants might also be linked to those problems.

Diabetic retinopathy

How a person with diabetic retinopathy sees the world.

The CDC estimates that 5.3 million adults suffer from diabetic retinopathy, which includes damage to the blood vessels in the retina at the back of the eye. In some cases, fragile blood vessels swell and leak into the eye, blurring 
vision. In others, blood vessels grow abnormally on the retina’s surface and leak blood, causing severe vision loss.

Detect it. There are often no early warning signs of diabetic retinopathy. The cardinal symptom, blood leaking into the retina, often happens during sleep. But if you have diabetes and notice spots floating in your field of vision, see your eye doctor immediately because you may need treatment before more 
serious hemorrhaging occurs. That’s why people with diabetes should get a comprehensive eye exam at least once a year, no matter their age. That often includes a fluorescein angiogram, in which a dye injected intravenously is used to identify blood vessels in the retina and detect any problem areas.

Treat it. Laser surgery to stop blood leakage and stabilize vision can reduce the risk of blindness by 90 percent, 
according to the National Eye Institute. Cases of severe bleeding may require surgery, called a vitrectomy, to restore sight, in which doctors insert a small instrument through a tiny incision in the eye to drain the bloody fluid and then replace it with a salt solution. Patients can usually return home the same day. See our comprehensie advice on how to prevent and treat diabetes and our buying guide and Ratings for blood glucose meters.

Glaucoma

How a person with glaucoma sees the world.

About 2.2 million Americans age 40 and older have glaucoma, the second-most-common cause of blindness worldwide after cataracts. Glaucoma is the name for a group of diseases in which fluid builds up inside one or both eyes, increasing the internal pressure and eventually damaging the optic nerve. If left untreated, people with glaucoma slowly lose their peripheral vision. Over time, central vision can also deteriorate.

Detect it. There are no early warning symptoms of glaucoma. That’s why routine screening at least every two years is so important, especially for people at high risk, such as African-Americans over age 40, cigarette smokers, diabetics, everyone over age 60, and those with a family history of the disease. “It’s not just a matter of taking pressure,” Farris says. “It’s also having the eye exam to get a close inspection of the optic nerve in the back of the eye.” Tests for glaucoma commonly include examining your vision, dilating your pupils, measuring your eye pressure, and checking the thickness of your corneas.

Treat it. There is no cure for glaucoma, and lost vision cannot be restored. But if it’s detected early, medicine and laser or surgical treatments may save your remaining vision. Eye drops that reduce eye pressure are the mainstay of glaucoma treatment, according to the January 2010 issue of Treatment Guidelines from The Medical Letter, a nonprofit periodical for health-care professionals. Examples include prostaglandin eye drops such as bimatoprost (Lumigan), latanoprost (Xalatan), and travoprost (Travatan), and the topical beta-blocker generic timolol.

If you need more than one medicine to control the disease, your doctor may prescribe a combination drug such as Combigan or generic Cosopt, which has a beta-blocker combined with another glaucoma drug, lessening the number of drops you need. If drops don’t work, your doctor may use a laser or surgery to control eye pressure.

Age-related macular degeneration

How a person with age-related macular degeneration sees the world.

About 1.6 million Americans age 50 and older have AMD, according to the CDC. There are two forms of the disease: dry and wet. In dry AMD, cells in the macula—the part of the eye involved in sharp, central vision—break down slowly, gradually blurring central vision in the affected eye. In the more severe wet form of AMD, the abnormal overgrowth of blood vessels leaks blood and fluid at the back of the eye, leading to a loss of central vision.

Risk factors for AMD include
smoking, cardiovascular problems, a family history of the ailment, and previous cataract surgery. Daily aspirin use was recently linked with the wet form of the disease, according to a recent study in the journal Ophthalmology. The observation, based on a study of 4,691 people 65 and older, warrants further evaluation, investigators reported. If you take aspirin daily and are concerned about your risk of wet AMD, consult your doctor.

Detect it. Tests include a comprehensive eye exam and an “Amsler Grid” test in which straight lines may appear wavy to those experiencing early wet AMD. Doctors may dilate the eyes and check behind the retina for yellow deposits that have been linked to an increased risk of advanced dry AMD or wet AMD. Patients may also undergo fluorescein angiography to check for leaky blood vessels in the retina.

Treat it. Nothing has been shown to prevent vision loss from advanced cases of dry AMD. But the National Eye 
Institute recommends that people with at least moderate dry AMD take supplements that combine high doses of vitamins C and E and beta carotene with copper and zinc (Ocuvite PreserVision and others) to help delay and possibly prevent the disease’s progression. But the supplements don’t seem to help people with milder AMD. And high doses of those nutrients might be harmful in some cases, so talk with your eye doctor about the benefits and risks.

Wet AMD can be treated but not cured. Doctors use lasers and other techniques to treat the fragile, leaky vessels. Other drugs injected directly into the eye can block the growth of leaky blood vessels, help slow vision loss, and in some cases even improve vision. One such drug, ranibizumab (Lucentis), is approved by the Food and Drug Administration for AMD but costs about $2,000 per injection. The other, bevacizumab (Avastin), is FDA-approved only for treating cancer but appears to work well against AMD and costs only about $50 per injection. Results of a randomized controlled trial with 1,208 patients reported in the May 19, 2011, issue of the New England Journal of Medicine found the two drug treatments had equivalent efficacy. But there was an unexplained increase in the number of people on bevacizumab who needed hospitalization during the study, mostly for infections and stomach disorders.

The researchers said it may have been attributable to chance but called for further studies.
If an eye disease leaves you or someone you care for with weakened vision, ask your eye doctor about accommodations and devices that may enhance the remaining vision. Or ask for a referral to a specialist in low vision and for information on community groups that offer special services.

Medicines that can cause vision problems

The drugs listed below can all harm vision, especially if you’re older or take them for a long time or in high doses. If you routinely take one, make sure you have regular eye exams, and alert your doctor if you experience vision disturbances. Many complications are reversible if they’re detected early.

Drug Used for Effect on vision

Alpha-blockers, such as alfuzosin (Uroxatral) and tamsulosin (Flomax)

Enlarged prostate gland and high blood pressure

Blurred vision and eye pain. If you are undergoing cataract surgery, tell your doctor if you have ever used those medications because they may cause complications during surgery.

Amiodarone (Cordarone and generic)

Heart-rhythm problems

Deposits on the clear outer layer of the eye, disorders of the optic nerve, and increased sensitivity to light.

Bisphosphonates, such as
alendronate (Fosamax and generic) and risedronate (Actonel)

Osteoporosis and Paget’s disease

Blurred vision, conjunctivitis, eye pain and inflammation, and sensitivity to light.

Corticosteroids, such as prednisone

Allergies and
autoimmune disorders

Prolonged use can lead to cataracts, eye
infections, and glaucoma, with possible
damage to the optic nerve.

Digoxin (Lanoxin and generic)

Congestive heart
failure and atrial
fibrillation

Blurred vision, halos around objects, and
yellow or green vision.

Hydroxychloroquine (Plaquenil
and generic)

Lupus, malaria, and rheumatoid arthritis

Blurred vision, difficulty seeing words and letters, halos around lights, irreversible retinal damage, light flashes and streaks, and
sensitivity to light.

PDE-5 inhibitors, such as sildenafil (Viagra) and tadalafil (Cialis)

Erectile dysfunction

Bluish tint to vision, blurred vision, and increased sensitivity to light.

Tamoxifen (Nolvadex and generic)

Breast cancer

Cataracts, decreased color perception, and retinal disorders.

Topiramate (Topamax and generic)

Migraines and seizures

Blurred vision, eye pain, uncontrolled eye movements, and teary or dry eyes.

Editor's Note:

A version of this article first appeared in the monthly newsletter Consumer Reports on Health. 



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