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Eye injuries and disorders can occur at any time of life, but with age comes a greater incidence of vision impairment. Four conditions are particularly prevalent and collectively affect nearly 26 percent of adults over 40 in the U.S., according to Prevent Blindness America.
To highlight these disorders, the August episode of Physician Focus with the Massachusetts Medical Society features two ophthalmologists from Eye Health Services, a practice of 19 board-certified eye physicians with 10 locations from Boston to Cape Cod that provides a complete range of eye care services for patients of all ages.
Guests for the program are John T. H. Mandeville, M.D., Ph.D., a specialist in cosmetic and reconstructive eye plastic surgery and president of the Massachusetts Society of Eye Physicians and Surgeons, the statewide specialty medical society for ophthalmologists; and Gerri L. Goodman, M.D., a corneal specialist and member of the Boards of Directors of the Massachusetts Society of Eye Physicians and Surgeons and the New England Chapter of the Glaucoma Foundation. They join host B. Dale Magee, M.D., past president of the Massachusetts Medical Society for the discussion.
Here are some highlights from their conversation.
Cataracts are the most common of the four conditions, affecting more than 24 million adults in the U.S. The doctors say most people will experience a cataract, a condition in which the lens of the eye deteriorates, resulting in such effects as blurred or cloudy vision. “When a cataract starts to interfere with the quality of your daily activities,” says Dr. Goodman, “then we talk about cataract surgery.” The only remedy is surgery, a common outpatient procedure that replaces the lens in the eye with an implant. While easily treated in the U.S., this disorder is the primary cause of preventable blindness in the world.
Macular Degeneration occurs when the blood vessels behind the retina begin to leak. Age-related macular degeneration, or AMD, can take one of two forms. The “dry” form, accounting for 90 percent of the cases, progresses slowly and is characterized by deposits that form in the back of the eye. The “wet” form is more serious and can cause sudden vision loss. “The condition is highly correlated with age,” says Dr. Mandeville. “We never see it in those under 50, and it can accelerate at age 65 and older.” “Wet” AMD is treatable with injections; the “dry” form lacks therapies at this time.
Glaucoma is a progressive condition that affects the optic nerve and degrades a person’s peripheral vision. “It can be diagnosed very early with noninvasive tests,” says Dr. Goodman, “and we can customize treatment for individual patients.” Diagnosis and treatments have become much better, she says, so the incidence of blindness from glaucoma is not as high as it used to be. It remains, however, a major cause of irreversible blindness. “You can’t get back the vision you’ve lost,” says Dr. Mandeville, “so it’s important to diagnose it early.”
Diabetic Retinopathy occurs in people with diabetes. It affects the blood vessels in the back of the eye, and can cause multiple problems, including blurring, distortion, or loss of vision due to bleeding inside the eye. The condition is correlated with the amount of time a patient has had diabetes: the longer one has had the disease, the more likely he or she is to get diabetic retinopathy. “Patients should see an eye physician as soon as they are diagnosed with diabetes, and every year after that,” says Dr. Mandeville. It is treatable with lasers and surgery.
Eye injuries and disorders, however, are not restricted to those 40 years or age and older, and the physicians encourage everyone, regardless of age, to visit an eye care professional early if problems or changes in vision occur. Children with a family history of eye problems should be seen early, and everyone up to 40 should have an examination – with eyes dilated to get the best test - at least every two years.
The doctors urge people to practice eye safety. “It’s important to wear safety glasses whenever you’re doing something that could endanger your eyes,” says Dr. Goodman. That includes such activities as sports or working with tools.
Checking your own eyes periodically is also a good idea. “Most people,” Dr. Mandeville says, “don’t realize they may have a problem in one of their eyes until the good eye is covered. The biggest risk factor for damage to one eye is already having damage to the other eye.”
View the above video for more information, including the distinctions among different eye care health professionals, the components of the eye and how it is structure, how to use an Amsler grid to check for macular degeneration, photographs of what vision is like with the above conditions, and treatment options for the major eye disorders.
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MMS/Richard Gulla
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