Monday, July 14, 2014

Understanding Vision Problems: Types, Treatments, and Prevention


Protecting and caring for our eyes is critical to our health and well-being. Poor vision affects everything we do, and can be a serious detriment to the healthy lifestyle

of older adults.
  
Baby boomers are more physically active than any previous generation, and a key component to maintaining a physical lifestyle is vision care. Untreated vision loss can affect independence in that it can inhibit activities like driving a car and the ability to perform activities of daily living. Poor vision in older adults has been linked to isolation, depression, and social withdrawal (Pelletier, Thomas, and Shaw 2009). In fact, vision loss is among the top ten causes of disability among adults, even beating out stroke as a cause (Centers for Disease Control 2011). Eye problems can strike at any age, but the occurrence of certain eye conditions increases with age. Although 3 percent of the U.S. population are visually impaired or blind, about 14 percent of those who are sixty-five and older and 23 percent of those who are eighty-five and older report vision problems (Federal Interagency Forum on Aging Related Statistics 2012). The most common eye problems among older adults are presbyopia, cataracts, glaucoma, age-related macular degeneration, and diabetic retinopathy.

Presbyopia

The first eye issue that people in their early forties tend to notice is difficulty reading up close. Even if individuals have never had vision problems before, they are still susceptible to presbyopia. Among those forty-one to sixty-five, for example, presbyopia or difficulty in seeing up close, is the most common vision problem that affects almost everyone (American Optometric Association 2013). Presbyopia is part of a natural aging process that is caused by hardening of the lenses of the eyes. When the lenses become inflexible, the eyes have a hard time focusing on objects, thus creating the need for corrective lenses. Symptoms include the inability to focus up close, holding reading materials farther away than usual, eye strain or fatigue, and headaches. (Mayo Clinic 2011; U.S. National Library of Medicine 2012). Treatment for presbyopia typically involves either non-prescription glasses or prescription glasses or contacts. Many patients will either elect for or need corrective surgery (Mayo Clinic 2011).

Cataracts

Another common eye problem associated with age is cataracts. It is so common that over half of people over eighty either have cataracts or have had surgery to remove them (National Eye Institute 2009). Over time, proteins may build up under the lens of the eye as part of the natural aging process. When this happens, problems such as cloudiness in areas of the field of vision, reduced ability to see color contrast, and/or sensitivity to glare may occur (American Academy of Ophthalmology 2014; Mayo Clinic 2013). Cataracts may even make it appear as though there is a halo around bright lights or headlamps (National Eye Institute 2009). Cataracts may form in one or both eyes and some people may have no symptoms at all. Eventually, cataracts have to be treated with surgery if vision is affected to the point of disrupting enjoyable activities or independence. This is the most common surgery performed in the U.S. and it’s a relatively easy out-patient procedure with a good prognosis (approximately 90 percent of patients report better vision following the surgery) and fast recovery (American Optometric Association 2014; Mayo Clinic 2013). Others who do not require surgery may be able to correct some of the symptoms with prescription glasses, sunglasses that reduce glare, or using brighter lights when reading or working (National Eye Institute 2009). The risks of surgery as well as the benefits should be discussed with an eye care professional.

Glaucoma

Glaucoma occurs when there is damage to the nerve that is responsible for sending visual information from the eye to the brain. This damage occurs when the normal process of regulating eye pressure through fluid creation and drainage becomes irregular (American Academy of Ophthalmology 2014). When the fluid fails to properly drain, pressure builds up in the eye, causing vision problems that include blindness. Although glaucoma tends to be age-related (those sixty and older are more susceptible), it affects certain groups more than others. For example, Mexican Americans and African Americans who are over the age of forty are more likely to be diagnosed with glaucoma (National Eye Institute 2014). Those who have had trauma to the eye or inflammation of the eye, have used certain types of steroids for a long period of time, have had a tumor, or who have diabetes are at risk of developing “secondary glaucoma,” which is distinguished from other types only by its cause (American Academy of Ophthalmology 2014). Glaucoma is sometimes referred to as the “silent thief ” because there are often no warning signs until permanent damage to the eye has already been done. When symptoms do appear, they may include things like severe brow pain, headache, blurred vision, nausea, or spots in peripheral vision (American Academy of Ophthalmology 2014). Eye drops that reduce the pressure in the eye is the most common treatment for glaucoma, although surgery is sometimes needed.

Age-related Macular Degeneration

Age-related macular degeneration is a disease that causes a breakdown of the retina, which leads to a decline in central vision and the ability to see fine detail. The disease is the most common eye problem for those fifty-five and older (Foundation Fighting Blindness 2012). Age-related macular degeneration has two types—dry and wet. Dry macular degeneration occurs when fat and protein deposits accumulate in the retina. Dry is the most common form of macular degeneration affecting approximately 90 percent of those with the disease. Wet is less common and progresses rapidly due to abnormal blood vessels that leak and damage the retina (Foundation Fighting Blindness 2012). Symptoms of both may include seeing a curvy or distorted line when looking at a straight line or blurriness in the central line of focus.

Diabetes and Vision Problems

People with diabetes are more likely than other groups to develop eye problems, with 60 percent more likely to develop cataracts and 40 percent more likely to develop glaucoma. Age and how long a person has had diabetes increases these risks. Diabetics are also at risk for diabetic retinopathy, a group of conditions that affect the retina and vision. People with this disorder are unlikely to notice any symptoms until their vision is permanently affected. Treatment involves laser surgery and when caught early, has a good prognosis (American Diabetes Association 2013).

Preventing Vision Loss 

The vision problems described increase with age. However, that does not mean that they have to lead to vision loss and thus, a change in lifestyle or independence. Many are either preventable or treatable. Below are some recommendations that professionals who work with older adults can give their older clients.

Comprehensive Exams

The key to avoiding vision loss is annual, comprehensive eye exams by a qualified eye care professional (American Optometric Association 2014; Centers for Disease Control 2012). Eye care professionals vary by their level of education and training and by the services that they provide.

Ophthalmologists are medical doctors (M.D.) or osteopathic doctors (D.O.) who have specialized  training in eye and vision care. They are trained to diagnose and treat all eye diseases and conditions, prescribe medications, and perform eye surgery. They also perform comprehensive eye exams, and prescribe glasses or contact lenses.


Optometrists have earned a Doctorate in Optometry (O.D.) They perform comprehensive eye exams, diagnose and treat eyes for both vision an health problems, and prescribe corrective lenses. The scope of care they can provide is determined by state law.

Opticians are technicians who are trained to design and fit eyeglass lenses and frames, and contact lenses, using prescriptions from opthalmologists or optometrists. Opticians have at least a high school diploma (or the equivalent).

Although comprehensive exams can be performed either by an optometrist or by an ophthalmologist, the American Optometric Association (2011) recommends seeing an ophthalmologist by the age of forty to detect vision problems. Although Medicare does not cover comprehensive eye exams, Medicare Part B does cover some preventive and diagnostic services such as a yearly eye exam, and glaucoma and macular degeneration tests (http://www.medicare.gov/coverage/eye-exams.html). (Medicare 2014.)

During the visit, patients should discuss their family history of eye problems because certain conditions are hereditary.

Lifestyle and Diet

Other vision-saving tips include lifestyle and diet changes. When outdoors or playing sports, wear protective eyewear such as ultraviolet ray blocking sunglasses and sports goggles to avoid eye injuries and vision loss. Including more fruits and vegetables (especially green, leafy vegetables) in a healthy diet and managing weight and blood sugar can help reduce the risk of eye disease. Finally, do not smoke. Smoking is related to macular degeneration, cataracts, and other eye disease (American Optometric Association 2014; Centers for Disease Control 2012).

Knowing the different types of eye problems, their symptoms, and above all—prevention—can help maintain healthy aging. And seeing the right eye care professional at the right time is critical. CSAs are in prime position to help their clients identify possible eye problems and to recommend professional and preventative care. •CSA


Lori Moore, Ph.D., is a Research Associate at Florida State University’s Claude Pepper Center. Her research interests include healthy aging and long-term care settings. She has published in peerreviewed journals and presented her research at several academic conferences. She can be reached at ldmoore@fsu.edu.

Understanding Vision Problems: Types, Treatments, and Prevention was recently published in the Spring 2014 edition of the CSA Journal.

Blog posting provided by Society of Certified Senior Advisors 
www.csa.us