Seeing Clearly Now
Protecting Your Eyesight
Illustration by Stephen Sauer
Don Whitten has seen plenty of things in his 77 years. But for the past decade or so, his vision wasn't as clear as it should have been. "My eyes felt kind of gravelly, and I had difficulty at night driving," he says. As a delivery person for the Prescription Center in Concord at the time, reading the addresses for the deliveries on his route sometimes proved to be difficult. "I had known for years that I would face cataract surgery eventually, but it was during a routine eye exam that my doctor said that it was finally time."
Cataracts is one of the "big three" eye conditions that seniors face, along with glaucoma and macular degeneration, says Dr. Eliot Foley, an ophthalmologist and retinal specialist with Concord Eye Care. He should know: Three out of four of his patients on any given day are senior citizens.
"Cataracts are the clouding of the natural lens inside the eye, and probably the most common eye problem that you might see in an eye doctor's office in this age range," he says. In fact, according to the National Eye Institute, by age 80, more than half of all Americans either have a cataract or have had cataract surgery.
"Their symptoms might be trouble seeing street signs or long distances, generally blurry vision, sometimes a glare - particularly with oncoming lights," says Dr. Foley. "Often they don't necessarily know they have a cataract but they know that their eyes aren't seeing that well so hopefully they'd call in and we can have it checked out."
As common as cataracts are, they are also extremely treatable. Surgery involves removing the cloudy lens and replacing it with an artificial lens. Last June Whitten underwent the procedure, which he said was "fantastic."
"There weren't any big fireworks or anything, but I used to have to wear glasses all the time, now I only need them to read. And my vision is 20/20."
Unlike cataracts, glaucoma is a "silent disease" and seniors don't necessarily know that they have it, says Dr. Foley. It is often associated with high blood pressure in the eye that can rob you of peripheral vision in its early stages and central vision in much later stages if left untreated, he adds. "It's not reversible. We can only slow it down once we diagnose it."
Glaucoma seems to increase with every decade of age, he adds, "so we see more of it in people who are in their 60s, 70s, 80s and up." And because it's a disease that you wouldn't necessarily know you have, he says, screening is important. "We screen a lot of patients for glaucoma because of certain features that they may or may not have. That doesn't mean that they have it, but we test it a lot more than we diagnose it, which is good." Treatment for glaucoma generally includes eye drops and lasers, and under some harder cases, surgery.
Macular degeneration is also a condition that primarily affects seniors 65 and up. The macula is the part of the eye that you use for fine detail vision, says Dr. Foley, such as reading or making eye contact with somebody. Macular degeneration is probably the most common form of acquired legal blindness above the age of 65, he adds.
"Patients who have macular degeneration might have trouble reading or threading a needle," he says. And while some seniors may chock up these symptoms simply to the aging process, Dr. Foley says that shouldn't be the assumption. "It's not necessarily 'normal' to have trouble with your vision as you get older," he says. "It's more common but that doesn't mean it's normal."
In laymen's terms, there are two forms of macular degeneration: wet and dry. The dry form is an age-related phenomena for which vitamins can be somewhat helpful, says Dr. Foley. Although it's not currently reversible, he adds, lots of research is being done and "in all likelihood dry macular degeneration is ultimately going to be treated with gene therapy." With wet macular degeneration, patients get blood vessels that grow beneath the retina and then they bleed and the bleeding causes the vision loss. "That's treated with ocular injections and that's pretty successful at stabilizing and even improving a patient's vision if we treat it early."
The eye is very vascular in structure, says Dr. Foley. "In fact, pound for pound, the retina needs more blood flow for its weight than any other tissue for it to function normally - and that includes the brain," he says. Because it requires such a high oxygen flow, it's also very sensitive to alterations in oxygen levels. "This is why people with diabetes get eye diseases, and patients who are older who have high blood pressure or other circulatory problems often have problems with their eyes, because your eyes are dependent on a high amount of circulation."
So how do you keep the windows to your soul bright, clear and streak-free? Dr. Foley recommends a heart-healthy, well-balanced diet with lots of green leafy vegetables, such as spinach and kale. Working out goes along with a heart-healthy lifestyle and benefits not only your ticker but your peepers too.
Along with diet and exercise, there is another major factor that seniors can do to improve the health of their eyes, according to Dr. Foley: "Don't smoke." Smoking is the most modifiable risk factor, he says. "Smoking can cause cataracts, and increases your chance of macular degeneration."
Patients sometimes ask him if supplements are beneficial. For patients with normal eye examinations, "you can take a vitamin and that's fine," he says, but he adds that there's not a lot of evidence that it will be helpful if you have normal, healthy eyes. "It probably wouldn't hurt you though," he's quick to add. However, in patients with macular degeneration, the antioxidant vitamins (such as vitamins A, C, E, as well as lutein and zeaxanthin) are known to be beneficial. "It may also be just as helpful to eat a healthy diet rich in fruits and vegetables, don't smoke and wear sunglasses in bright light." Generally speaking, at age 65 and up he also recommends having an eye exam at least once a year.
And the last helpful hint? "Don't get older. That's what I always tell patients, and I always get a laugh out of them from that."
A Simple Test
Developed in the 1940s by Marc Amsler, a Swiss ophthalmologist, the Amsler Grid is a simple test that can alert you to any changes in your vision. It's like a piece of graph paper with a dot in the center. Cut out the grid and stick it to your refrigerator to make it easy to remember to test yourself every day. Stand about 14 inches away and while covering one eye at a time, look at the dot. One of the first signs of macular degeneration can be wavy, broken or distorted lines or a blurred/missing area of vision. If you notice a change, get in touch with an opthamologist.
Another way to easily test your vision is by simply looking at your face in the mirror every morning. Cover your left eye with your hand and focus on your face. Then switch, covering your right eye with your hand so you're looking at your face with the left eye. If you notice any central blurring or missing parts, contact your eye doctor.