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 Healthy Steps to Healthy Vision
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Vision impairment is one of the most feared disabilities. Although
it is believed that half of all blindness can be prevented, the number
of people in America who suffer vision loss continues to increase.
The leading causes of vision impairment and blindness in the United States
are primarily age-related eye diseases. The number of Americans at risk
for age-related eye diseases is increasing as the baby-boomer generation ages.
These conditions, including age-related macular degeneration, cataract,
diabetic retinopathy and glaucoma, affect more Americans than ever before.
Disturbingly, the number of Americans with age-related eye disease and the
vision impairment that results is expected to double within the next three
decades. As of the year 2000 census, there were more than 119 million people
in the United States in this age group.
Age-related Macular Degeneration (AMD) is a condition that primarily
affects the part of the retina responsible for sharp central vision. More than
17,465 Arkansans and 1,651,335 Americans have the disease. There are two
forms:
Dry AMD (non-exudative) is the most common form of the disease.
Early AMD involves the presence of drusen, fatty deposits under the
light-sensing cells in the retina. Late cases of dry AMD may also involve
atrophy of the supportive layer under the light-sensing cells in the retina
that helps keep those cells healthy. Vision loss in early dry AMD is usually
moderate and only slowly progressive. Atrophy in late cases of dry AMD can
result in more significant vision loss.
Wet AMD (exudative) is less common, but is more threatening to
vision. It's called wet AMD because of the growth of tiny new blood vessels
under the retina that leak fluid or break open. This distorts vision and
causes scar tissue to form. All cases of the wet form are considered late AMD.
The exact cause of AMD is unknown, but risk factors for the disease include
age (rarely affecting those under age 50), race (Caucasians are most at risk)
and smoking. Research also suggests that long-term diets low in certain
antioxidant nutrients may increase the risk of AMD. Because AMD often damages
central vision, it is likely the most common cause of legal blindness and
vision impairment in older Americans.
Unfortunately, there is no generally-accepted treatment for dry AMD. Laser
therapies to destroy leaking blood vessels can help reduce the risk of
advancing vision loss in many cases of wet AMD. Research has recently shown
that certain doses of zinc, vitamins A and C, and beta-carotene can help
control the advance of late AMD, but appear to have no effect in preventing
the disease in otherwise healthy individuals.
Cataract is a clouding of the eye's naturally clear lens and affects
215,348 Arkansans and 20,476,040 nationwide. Most cataracts appear with
advancing age. The exact cause of cataract is unclear, but it may be the
result of a lifetime of exposure to ultraviolet radiation contained in
sunlight, or may be related to other lifestyle factors such as cigarette
smoking, diet, and alcohol consumption.
Cataract can also occur at any age as a result of other causes such as eye
injury, exposure to toxic substances or radiation, or as a result of other
diseases such as diabetes. Congenital cataracts may even be present at birth
due to genetic defects or developmental problems. Cataracts in infants may
also result from exposure to diseases such as rubella during pregnancy.
Treatment of cataract involves removal of the clouded natural lens. The
lens is usually replaced with an artificial intraocular lens (IOL) implant.
Cataract removal is now one of the most commonly performed surgical procedures
with more than a million such surgeries performed each year. Surgery is not
truly a cure for cataract, however, and its success in controlling vision loss
comes with a price. It is estimated that the federal government spends more
than $3.4 billion each year treating cataract through the Medicare program.
Diabetic retinopathy is a common complication of diabetes. More than
52,278 Arkansans and 5,353,233 Americans suffer from the disease. It affects
the tiny blood vessels of the retina. Retinal blood vessels can break down,
leak, or become blocked - affecting and impairing vision over time. In some
people with diabetic retinopathy, serious damage to the eye can occur when
abnormal new blood vessels grow on the surface of the retina.
In general, the longer someone has diabetes, the greater the risk of
developing diabetic retinopathy. Eventually, almost everyone with
juvenile-onset diabetes will develop some signs of diabetic retinopathy. Those
who develop diabetes later in life are also at risk of diabetic retinopathy,
although they are somewhat less likely to develop advanced diabetic
retinopathy. Research suggests that the risk of diabetic retinopathy can be
reduced through careful control of blood sugar. Laser treatment, called
photocoagulation, has been shown to reduce the risk of sight loss in advanced
cases of diabetic retinopathy.
Glaucoma, which affects some 22,925 Arkansans and 2,227,485 Americans,
is a disease that causes a gradual degeneration of cells that make up the
optic nerve which carries visual information from the eye to the brain. As the
nerve cells die, vision is slowly lost, usually beginning in the periphery.
Often, the loss of vision is unnoticeable until a significant amount of nerve
damage has occurred, for this reason, as many as half of all people with
glaucoma may be unaware of their disease.
The exact cause of primary open-angle glaucoma, the most common form of the
disease, is uncertain. Elevated fluid pressure within the eye (intraocular
pressure) seems related in some way to all cases of glaucoma. The majority of
cases of glaucoma exhibit intraocular pressure outside normal limits at some
time. However, even those cases with apparently normal pressure seem to
benefit from treatment aimed at lowering pressure.
Most cases of glaucoma can be controlled and vision loss slowed or halted
by treatment. Medications, laser treatments and surgery can be used to lower
intraocular pressure. However, any vision lost to glaucoma cannot be restored.
Unfortunately, glaucoma cannot be prevented. Factors that increase the risk of
glaucoma include age, race, diabetes, eye trauma, and long-term use of steroid
medications.
Refractive errors are the most frequent eye problems in the United States.
They are optical defects that result in light not being properly focused on
the eye's retina. Nearsightedness (myopia) and farsightedness (hyperopia) are
the most common refractive errors. People with myopia see near objects
clearly, while distant ones are blurred. People with hyperopia experience just
the opposite – distant objects are clear while near ones are blurred.
Other common refractive errors include astigmatism (uneven focus) and
presbyopia (age-related problem with near focus). Fortunately, almost all
refractive errors can be corrected by eyeglasses or contact lenses. Refractive
surgery is now another alternative for correcting problems such as myopia,
hyperopia and astigmatism. However, the surgical procedures are not without
some risk and the long-term effects of many of these procedures are still
unknown.
How Often To Have an Eye Exam
The American Academy of Ophthalmologists recommend the following exam schedules:
Children- Screening for eye disease by trained personnel
(Pediatrician, Ophthalmologist, etc).
- Newborn to 3 months
- 6 months to 1 year
- 3 years (approximately)
- 5 years (approximately)
Adults- Comprehensive (includes dilatation, glaucoma pressure test, etc.) medical
eye exam by an ophthalmologist.
- Once a year between ages 20 and 39
- Ages 40 to 64, every two to four years
- Ages 65 and older, every one to two years
Some factors may put you at increased risk for eye disease. If any of these
factors applies to you, check with your Ophthalmologist to see how often you
should have a medical eye exam:
- Developmental delay
- Premature birth
- Personal or family history of eye disease
- African-American heritage (African-Americans are at increased risk for
glaucoma)
- Previous serious eye injury
- Use of certain medications
- Certain diseases that affect the whole body (such as diabetes or HIV
infection)
Eye Injury Prevention
More than one million people suffer from eye injuries each year in the
United States. Ninety percent of these injuries could have been prevented if
the individual had been wearing appropriate protective eyewear (with "ANSI
Z87.1" marked on the lens or frame).
- In the house. When using household chemicals, read instructions
and labels carefully, work in a well-ventilated area and make sure to point
spray nozzles away from you. Many chemicals are extremely hazardous and can
permanently destroy the surface of your eyes, resulting in blindness.
- In the workshop. Think about the work you will be doing and wear
protective eyewear to shield your eyes from flying fragments, fumes, dust
particles, sparks and splashing chemicals. Many objects can fly into your
eyes unexpectedly and cause injury.
- In the garden. Put on protective eyewear before you use a
lawnmower, power trimmer or edger and be sure to check for rocks and stones
because they can become dangerous projectiles as they shoot from these
machines.
- In the workplace. Wear appropriate safety eyewear for your job.
Many of the thousands injured each day didn't think they needed eye
protection or were wearing eyewear inappropriate for the job.
- Around the car. Battery acid, sparks and debris from damaged or
improperly jump-started auto batteries can severely damage your eyes. Keep
protective goggles in the trunk of your car to use for those emergencies and
everyday repairs.
Prevention is the first and most important step in protecting your eyes
from injuries, so be sure to protect your eyes with appropriate protective
eyewear. If you do experience an eye injury, seek medical attention promptly.
What To Do If an Eye Injury Occurs
If you do sustain an eye injury, immediately see an Ophthalmologist or
visit the nearest emergency room right away. A serious eye injury is not
always immediately obvious, even if the injury seems minor at first. Delaying
medical attention can cause the damaged areas to worsen and could result in
permanent vision loss or blindness.
- Do not rub the eye. If any tissue is torn, rubbing may cause more
damage.
- Shield the eye from pressure or rubbing action by taping or securing the
bottom of a foam cup or similar type of shield against the bones surrounding
the eye (brow, cheek and bridge of nose).
- Do not apply ointment or medication to the eye. These medications may
not be sterile and could make the eye area slippery, which could slow the
physician’s examination.
- To treat cuts or punctures to the eye, bandage the eye without any
pressure and seek emergency medical care immediately. Do not attempt to wash
the eye or remove any object stuck in the eye. A paper cup held over the
injured eye can help protect it until you can get to your doctor or
emergency room.
- In case of a chemical burn to the eye, immediately flush the eye with
clean water and seek emergency medical treatment right away.
- To treat a blow to the eye until professional help is available, gently
apply small cold compresses to reduce pain and swelling. Don't apply any
pressure. Remember that even a light blow can cause a significant eye
injury. If a black eye, pain or visual disturbance occurs even after a light
blow, immediately seek medical attention.
- To treat sand or small debris in the eye, use eyewash to flush your eye
out. Do not rub the eye. If the debris does not come out, lightly bandage
the eye and seek medical attention.
- Avoid giving aspirin, ibuprofen or other non-steroidal,
anti-inflammatory drugs. These drugs thin the blood and may increase
bleeding. Also, the pain associated with an eye injury is often excruciating
and a non-prescription medication may not help. Do not delay help by waiting
for a painkiller to take hold.
Source: National Eye Institute, National Institutes of
Health and American Academy of Ophthalmologists
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