Early detection of vision problems is necessary

By Rita Baum

From the time we are born until we shut our eyes forever, our eyes influence how we perceive our world and how we react to those perceptions. A baby first recognizes its mother as a shadowy shape along with a voice and a scent. Over the course of a few days, the shadow gradually becomes a recognizable form.

The significance of these early images never fades. Those who have watched older people surrounded by family members during the last moments of life often notice that the gaze of the dying person passes intently from face to face--perhaps forming a lasting picture to take with them.

Most people consider the eyes to be the most important of our sensory organs. Unfortunately, more than one-third of people over age 65 do not have regular eye exams. As a result, many elders don't learn that they have serious vision problems until significant vision loss has occurred.

The good news is that many cases of age-related vision loss can be prevented or treated with early detection. The most common conditions are cataracts, glaucoma, macular degeneration and diabetes, with cataracts being the most prevalent. Most of these disorders lack any early symptoms but can be detected by regular eye exams and slowed or halted completely with drugs, surgery or both--if they are discovered and treated in time.

Many people begin to notice age-related changes in their 60s or earlier. Around age 50, brighter lighting may be needed for reading, ordinary household tasks and around stairways. It may take longer to adjust to the darkness when entering a movie theater or a tunnel. Reading becomes easier when a book is viewed at arm's length--although this condition (presbyopia) is easily remedied with a pair of reading glasses.

Some eye conditions are not as easy to remedy as presbyopia and can affect quality-of-life and hamper independence if allowed to progress. According to Dr. John Sullivan, an ophthalmologist with the Eye Medical Clinic in San Jose, the only way to discover these conditions is through a comprehensive eye exam with an eye doctor.

A comprehensive eye exam involves determination of the optical power of the eye for the purpose of prescribing glasses or contact lenses (refraction) as well as medical evaluation. Examination of the inside of the eye usually involves dilation of the pupil, which frequently results in temporary blurring.

Once a year, Medicare will cover the medical portion of the evaluation (to the extent that it covers any medical illness), but only if the patient complains of a medical condition. Neither Medicare nor supplementary insurance will pay for the refraction component of a comprehensive eye exam (which involves enlarging or dilating the pupils to enable a better look at the eyes.)

The human eye is an amazing and complex organ that communicates with the brain when stimulated by light rays reflected from objects. Light enters the eye by passing through the cornea and lens, which focuses an image onto the retina--the thin lining on the interior wall of the eyeball. The eye contains muscles that expand and contract to alter the size of the pupil and control the amount of light that enters the eye. The image is processed by the retina and transmitted through the optic nerve to a specialized portion of the brain. The image received by the retina may not be crisp if the lens is not clear and transparent. Lens opacifications or cataracts interfere with the focusing of light onto the retina.

According to Dr. Sullivan, almost everyone over the age of 60 has some sort of opacification within the lens that can be detected on examination. The vast majority of people are completely unaware of these minor aberrations, which are normal changes associated with aging and may or may not eventually become troublesome enough to require treatment. The only treatment possible is surgical replacement of the lens itself. There are no drops or medicines that cure cataracts.

Cataract surgery is only necessary if the clarity of the lens progresses to such a degree that the individual is troubled by the resultant poor vision. "The idea that a cataract must be ripe to be ready for surgery is related to earlier types of surgery and is no longer apropos," says Sullivan. "The patient is the best judge of when to do the surgery, since the determining factor is how well the patient can see."

Cataract surgery is the most frequently performed operation in people over age 65, with 2 million cataract procedures performed each year in the United States. Medicare will usually pay for the surgery if the patient's vision is 20/50 or worse. The surgery is done on an outpatient basis and does not require an overnight stay. The process takes less than an hour and involves replacement of the natural lens with an artificial lens. There are several choices of lens material and design, including lenses that correct both near- and far-sightedness. Most implanted lenses are made of a soft foldable material. Eye surgeons can insert these lenses through an opening so small that sutures are unnecessary.

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Rita Baum, a Los Gatos resident, has a master's degree in gerontology. She has worked in the field of aging for more than 20 years.

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