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Photograph by Paul Myers
Roald Didriksen, 89, of Sunnyvale, is a volunteer for 'The Better Part,' a television show produced at De Anza College by Cupertino's senior center. Didriksen underwent cataract surgery four years ago.
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Early detection of problems, new treatments help maintain vision
Estrogen may lower the risk of cataracts in women
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.
"The results of cataract surgery are generally favorable, with restoration of normal or nearly normal vision within a few days", says Dr. Sullivan. "The rate of complications is low, and more than 90 percent of cases result in at least 20/40 vision."
Procedures for cataract removal have been prescribed for hundreds of years. The most dramatic change in technique was in the 1970s, when intraocular lens implants became available, eliminating the necessity for thick glasses or contact lenses. In the future, lenses that can correct both near- and far-sightedness may be possible as well. At present, however, most people with intraocular lens implants still need reading glasses.
The cause of cataracts is not fully known, but experts say that factors associated with the aging process may be to blame. Research indicates that injuries, certain medications, diabetes, obesity and smoking may increase the risk. The condition may be preventable by wearing sunglasses with ultraviolet protection and wearing wide-brimmed hats to shade the eyes from the sun's harmful rays, especially at midday. A recent study suggests that the hormone estrogen may lower the risk of cataracts in women.
We can safeguard our vision so it will serve us well until the last blink by joining the roughly two-thirds of people over 65 who visit an eye doctor annually for early screening, detection and treatment of conditions that can impair vision. An annual eye exam, a well-balanced diet, exercising and protecting our eyes from the sun provide a good formula for maintaining good vision.
(This article is not intended to provide medical advice, which should be obtained directly from a physician.)
Organizations that provide information about vision
American Academy of Ophthalmology
P.O. Box 7424
San Francisco, CA 94120-7424
415.561.8500 or www.eyenet.org
For information on a variety of eye-related diseases and their prevention and treatment, describe your ailment(s) and send a self-addressed, stamped business envelope.
National Eye Institute Information Center
2020 Vision Place
Bethesda, MD 20892-3655
800.869.2020 (for publications)
www.nei.nih.gov
Part of the National Institutes of Health. Provides information packets on a variety of eye ailments, and answers inquiries over the phone. Supports 75 percent of vision research conducted in the United States.
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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Los Gatos, California Since 1881
