Blind World


Eye disease could be detected sooner.





February 23, 2004.

By LAURAN NEERGAARD,
AP MEDICAL WRITER,
THE SEATTLE POST-INTELLIGENCER.




WASHINGTON -- Millions of middle-aged and older Americans unknowingly harbor one of three eye diseases that could blind them - diseases that could be detected in time to save at least some sight if they got regular eye exams.


Glaucoma, macular degeneration and diabetic retinopathy all sneak up on their victims, destroying vital eye cells before the person is aware there's anything wrong.


Risk increases with age. Indeed, the government predicts the number of people left blind or seriously visually impaired is likely to double in 30 years as the baby boom generation grays.


The elderly are most at risk of these diseases, but people in their 40s can get them, too.


Yet vision specialists say far too few people get regular comprehensive eye exams - not where you read the "E" on an eye chart, but where your eyes are dilated so the optometrist or ophthalmologist can spot any disease deep inside.


Now, the government has awarded the eye charity Prevent Blindness America a five-year grant to help fight age-related eye disease by funding free screenings for older people around the country. For locations, check http://www.preventblindness.org.


And a coalition of eye doctors and geriatric advocates has begun a campaign to teach people about who's at risk.


Eye exams aside, among the advice: Protect your eyes from sun; don't smoke, which damages eyes, too; and eat lots of vitamin-packed dark, leafy vegetables. Those steps may help prevent these diseases from ever forming, says Northwestern University ophthalmologist Dr. Susan Taub, who chairs the Better Vision Institute.


There are no national figures on how many people over 40 follow guidelines to get a comprehensive eye exam every year or two. Diabetics and others considered at high risk, such as those with affected relatives, are urged to get annual exams. Such exams cost about $125, and insurance seldom pays for middle-aged healthy people.


But some sobering statistics suggest skipping those exams costs vision. Glaucoma, for instance, affects more than 2.2 million Americans, half of whom are unaware they have it, according to the government. Up to a fifth of the nation's 13 million-plus type 2 diabetics already show signs of sight-stealing retinopathy at the time their diabetes is diagnosed, says the American Diabetes Association.


And while 1.7 million Americans have lost vision to advanced-stage macular degeneration, another 7.1 million are at very high risk because the disease has reached intermediate stages without symptoms, says the National Eye Institute.


Worse, a startling study of Medicare beneficiaries last year found that even people already diagnosed with these eye diseases skip exams: Over half had at least one 15-month gap between doctor visits.


Dr. Frank Weinstock, a geriatric ophthalmologist in Canton, Ohio, personally telephones diabetics and other high-risk patients who skip his exams.


"I may not be able to solve your problem, but if I don't see you, I don't stand a chance," he tells them. "I'm not trying to scare you, but you won't notice (vision loss) until it's too late."


The three diseases all blind differently:


-Age-related macular degeneration, or AMD, steals vision from the center of the eye outward.


Age aside, people with light-colored eyes are most at risk, because the sun's damaging ultraviolet rays can penetrate the retina at the back of the eye more easily.


There are two types. In the "dry" form, light-sensitive cells in the macula, the center of the retina, gradually break down. The "wet" form is less common but causes more rapid damage, as blood vessels leak behind the retina.


Patients with intermediate-stage AMD can slow the damage by taking high doses of antioxidant vitamins plus the mineral zinc. Also, laser therapies can seal off the wet form's leakage; there is no treatment specifically for the dry form.


-Glaucoma steals vision from the outside in, with gradual damage to the optic nerve that first destroys peripheral vision.


Here, for unknown reasons, people with darker eyes are most at risk, as are blacks and Hispanics, and diabetics.


Lost vision can't be restored but after diagnosis, eye drops or laser therapy almost always preserves remaining sight.


-Diabetic retinopathy is a diabetes complication in which retinal blood vessels break, leak or become blocked, causing spotty vision. It can affect young people who have had diabetes from birth, but most diabetics are middle-aged or older and retinopathy risk increases with age. Lasers can seal off blood vessels about to harm vision, making close monitoring crucial.




End of article.






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