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Friday, March 24, 2017

Sight Loss in the Elderly

One in three Americans over the age of 65 will develop some form of vision loss due to an age-related eye problem. Worldwide, 82% of those living with blindness are over the age of 50. This healthcare issue is often not discussed and can be missed by doctors. Part of the problem in detecting it is that some people do not want to admit they are losing their eyesight because they want to avoid dealing with sight loss, embarrassment about age-related decline, or fear of losing their independence.

Why is Vision Loss a Problem for Seniors?

These fears and issues above are real. People with vision loss do have new challenges with independence and vision loss is correlated with depression and an overall decline in health. People with visual disabilities are more likely to also have cognitive decline, strokes, and more falls. Falling is directly related to visual impairment and can result in even more disability – particularly in the elderly. People with visual difficulties also are less likely to be able to drive, cook, keep personal finances in order, clean the house, or exercise.

While “old dogs can learn new tricks,” often times, the visual loss late in life is happening at a time when overall health and energy levels may be lower – meaning that rebounding from this significant loss may be more difficult. In addition, the older we are, the more likely we are to suffer from other significant losses of friends, spouses, etc. The losses altogether can be difficult to overcome from an emotional perspective.

Prevention

Some changes in vision – particularly with regard to focus – are normal parts of aging. But, serious vision loss is not a normal part of aging. The World Health Organization claims that 80% of all visual impairment can be avoided or cured. Knowing this, health experts such as those at the National Commission on Prevention (NCP) agree that we should be checked regularly for vision issues to prolong our healthy eyesight as long as we can. The NCP has identified age-related vision impairment screening among the top ten priorities for prevention for those over 65. Many of the diseases that cause sight loss can be best treated, delayed or prevented when caught early.

Some things you can do to prevent vision loss, beyond getting a regular screening with your annual physical, involve a healthy diet and moderate regular exercise. Also, basic safety like wearing goggles when doing certain chores can prevent injury to the eye. Sun protection like visors and sunglasses can also help protect your eyes. And of course, the universal prevention task is to quit if you smoke! Of course, some risk factors, like heredity and age, cannot be changed.

Types of Age-Related Vision Loss

Visual impairment does not necessarily mean a person is totally blind. The impairment can range from moderate to severe. The most common types of age-related eyesight problems are cataracts, diabetic retinopathy, glaucoma and macular degeneration.

Cataracts

By the age of 80, more than half of Americans will have cataracts. Cataract is very treatable with safe and effective surgery, but worldwide, this is the most common cause of blindness. In the United States, the surgery is readily available; in fact, it is the number one surgery paid for by Medicare each year. While not common in those under the age of 65 – the prevalence increases sharply with age.

Essentially, cataract is when the lens of the eye becomes opaque or no longer transparent. Symptoms include a discoloration of the lens of the eye, blurred vision, and glare. The specific visual loss (peripheral, central, etc.) varies with where the opacities occur. There are different types of cataracts.

The disease usually, but not always, progresses slowly over months or years and the outpatient surgery is typically recommended when the cataract effects visual functioning. The surgery is extremely safe with complications only occurring in less than one percent of the cases. Sometimes, surgery will need to be repeated in 3-5 years.

Studies have not definitively found a way to prevent cataracts, but some suggest that quitting smoking, not drinking heavily, maintaining a proper weight, and eating a plant-heavy diet can all improve your chances of not developing cataracts.

Diabetic Retinopathy

4.4 million Americans over 40 have diabetic retinopathy. It is the leading cause of new blindness in the United States and a leading cause of visual impairment in the elderly. It is an eye related manifestation of diabetes 1 and 2. All people with diabetes are at risk of developing Diabetic Retinopathy (DR). The disease is more likely the longer a person has diabetes, but can be present when first diagnosed with diabetes as well.

DR occurs when the circulation in the eye is impaired. Circulation problems can occur throughout the body when a person has diabetes and there are more problems when the diabetes and blood sugar is not being properly managed. The disease is easier to treat in the beginning stages before permanent damage occurs to the retina. Even if it is advanced, the disease can be treated so that up to 90 percent of patients can retain their visual functioning with treatment.

Symptoms may not show up in the early stages – so regular screenings are very important for all people (particularly those over 65 who have diabetes). At some point past the early stages, a person may notice blurry vision, large dark spots, and small spots and dark strings (floaters). These symptoms may come and go at first and typically involve both eyes.

For those with diabetes, the development and progression of DR may be slowed down or helped by improved blood sugar management as well as managing other issues related to circulation such as hypertension and cholesterol levels. Quitting smoking would also help. Treatment includes injections and different types of surgery.

Glaucoma

Glaucoma is also a cause of blindness and visual impairment impacting over three million Americans over the age of 40. It is the number one cause of blindness for African Americans. Of those who have become totally blind with glaucoma, ¾ of them are over the age of 65.

Glaucoma is called a silent disease because in its most common form, damage can be happening to delicate nerve fibers and optical nerves that send information to the brain without any symptoms. There are several types, but all types essentially involve pressure inside the fluids of the eye.

In the most common form called chronic open-angle glaucoma (COAG), there may be no symptoms at all until visual loss is permanent. In COAG, a person will lose peripheral vision first. This form is gradual. In acute closed or narrow-angle glaucoma, the symptoms will be quite sudden and involve redness and throbbing pain in usually one eye, halos, blurry vision, cloudy vision and dilated pupils.

Because the disease is manageable in its early forms, a person should be checked regularly for eye pressure changes. Certain medicated drops, other medications, surgery, and laser treatments are all possible management strategies for glaucoma and are effective at preventing sight loss. However, treatment is typically a lifelong issue, as the disease does not usually go away. For the sudden onset type of glaucoma, emergency drainage of fluid is typically the treatment.

Doctors do not yet think glaucoma is totally preventable as some risk factors are genetics, being near-sighted, or having had a previous eye injury. Other risk factors include certain medications like steroid medications for things like asthma, chronic nasal congestion, and rheumatoid arthritis.

Make sure to get a glaucoma test every 3-5 years from an optometrist or an ophthalmologist to catch glaucoma early. You should go more often if you have any of the risk factors noted above.

Macular Degeneration

Almost two million Americans over 50 have “advanced” Age-Related Macular Degeneration. “Advanced” is the stage that can lead to severe impairment and loss of vision. There are two types of ARMD – “dry” and “wet.” The dry type is the most common. The wet type is more serious and more likely to lead to serious sight loss.

In the dry form, the macular (part of the retina) simply starts to thin or deteriorate. The wet form is sometimes a complication of the dry form and involves abnormal growth of blood vessels forming in the macula. The macula is responsible for detailed vision.

Symptoms for both types include trouble when seeing details, dulling of colors, difficulty seeing in dim light, blurry or cloudy vision, and a blurred or blank spot in the center of your vision. For wet macular degeneration, there are also changes such as lines becoming wavy, more noticeable blank or gray spots in the central vision, and size and color differences in each eye. Usually, the disorder impacts one eye more than the other, but both are often involved.

While some risk factors are not in our control, such as heredity and age, there are some things we may be able to control. High blood pressure, high cholesterol levels, high inflammation in the body, and smoking are all associated with the worst form of MD.

Summary

In all these cases, early detection and routine eye exams are critical – especially the older we become. An optometrist or an ophthalmologist should perform an eye exam in order to fully assess the health of your eye.

While we cannot control all risks for eye disorders, we can control some. What is healthy for the rest of our body is also likely to help ward off eye problems: quit smoking, control weight, control hypertension and cholesterol, and eat well.

 

  
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