Date: Fri 01-Oct-1999

Publication: Bee

Author: JAN

Quick Words:

eyesight-Ruggerior

Full Text:

Age And Eyesight: Good Vision For Life

(with photo)

BY JAN HOWARD

Most elderly patients have excellent vision, but as a person ages changes can

occur that will affect his or her eyesight if not evaluated and treated.

Routine light exposure and normal wear and tear eventually affect the eyes.

"It is important to have regular eye exams, and any unexplained visual

symptoms should be referred to an ophthalmologist," Paul Ruggiero, MD, an

ophthalmologist with Danbury Eye Physicians and Surgeons and consultant at

Ashlar of Newtown, said during a Lunch & Learn program on "The Aging Eye"

September 21 at Ashlar.

The program was the first in a series of free seminars for mature adults about

living and aging well that will be sponsored by Ashlar of Newtown once a month

through May.

Dr Ruggiero presented an overview on the changes seniors can anticipate as

they age, described current treatments available, and offered recommendations

for good eye health.

Eye problems are not commonly the cause of dizziness, light headedness or

headaches, he said. These problems should be evaluated by an internist.

Glaucoma

Glaucoma is caused by pressure high enough to cause nerve damage. It may occur

at any age but increases in frequency after the age of 40. It affects two

percent of the population in the United States.

A family history of glaucoma is significant. These people are four to five

times more likely to get glaucoma, Dr Ruggiero said.

There are two types of glaucoma. The first, angle closure, is rarer, and has a

sudden onset of symptoms that may include eye pressure with nausea and

vomiting as well as a slow heart beat.

This condition can be treated almost risk free by laser, Dr Ruggiero said. If

it is not treated, a person can go blind.

Open-angle glaucoma is the most common, Dr Ruggiero said. It causes a gradual

loss of side, or peripheral, vision. Late visual symptoms can cause

irreversible damage.

"Over the last five years there has been an explosion in pharmaceuticals to

treat glaucoma," he said.

Macular Degeneration

One of the factors contributing to formation of cataracts and macular

degeneration is ultraviolet light. Sunglasses help protect the eyes from this

light.

Macular degeneration is damage or breakdown of the macula, a small area at the

back of the eye that allows us to see fine details clearly. When the macula

does not function correctly, there is blurriness or darkness in the center of

vision that can affect both distance and close vision.

There is no cure for macular degeneration, which inhibits a person's ability

to read.

"It affects central fine vision," Dr Ruggiero said. "A person can get to the

point where they can't read at all. There is no great treatment for it."

There may be a familial tendency for macular degeneration, he said, as well as

sensitivity to ultraviolet light.

Magnification can help through the use of glasses or other aides.

A diet rich in green, leafy vegetables, which are high in antioxidants, a

vitamin such as Centrum, and mineral supplements may be of some benefit, Dr

Ruggiero said.

"Nutrition is important plus protection against ultra-violet light," he said.

The two most common types of age-related macular degeneration are "dry"

(atrophic) and "wet" (exudative).

Most people have "dry" macular degeneration, which is caused by aging and

thinning of the tissues of the macula. Vision loss is usually gradual.

"Wet" macular degeneration accounts for about 10 percent of all cases. It

results when abnormal blood vessels form at the back of the eye and leak fluid

or blood and blur central vision. Vision loss may be rapid and severe.

Lasers can be used for leaking blood vessels, but this is not a cure because a

leak can develop somewhere else, Dr Ruggiero said.

Macular degeneration does not affect the eye's peripheral vision, and it alone

does not result in total blindness. People continue to have some useful vision

and are able to take care of themselves.

Cataract

Cataract, the most common problem, is the clouding of the normally clear lens

of the eye. Common symptoms include hazy or blurred vision, glare or light

sensitivity, frequent eyeglass prescription changes, double vision in one eye,

needing brighter light to read, poor night vision, and fading or yellowing of

colors.

Protection against ultraviolet light is important, Dr Ruggiero said.

A person becomes more near-sighted as a result of cataracts, he said.

Lasers cannot be used to remove a primary cataract, he said. Surgery is the

only way to remove the cataract, he said.

Over 1.4 million people have cataract surgery each year in the United States,

95 percent without complications.

The cloudy lens is removed from the eye and in most cases, the focusing power

is with a lens implant. Improved vision is the result in over 90 percent of

cases.

Protection from excessive sunlight through the use of sunglasses that screen

out ultraviolet light may help prevent or slow the progression of cataracts.

Diabetes

Diabetes is a major cause of blindness, Dr Ruggiero said.

The use of laser is beneficial if recognized early. "Eyes must be checked once

a year," he said, or more frequently if your doctor recommends.

Visual loss is caused by retinal blood vessel abnormalities, or diabetic

retinopathy, he said. There is not enough oxygen to the retina, which could

cause a major hemorrhage in the eye.

Floaters

Small specks or clouds moving in your field of vision are called "floaters."

They are tiny clumps of gel or cells inside the vitreous, the clear jelly-like

fluid that fills the inside of your eye.

The floaters occur when the vitreous gel pulls away from the back wall of the

eye, causing a posterior vitreous detachment.

Vitreous floaters usually are not significant, Dr Ruggiero said.

"The vitreous serves no function that we know of," he said.

While floaters look like they are in front of the eye, they are actually

floating inside. What you see are the shadows the floaters cast on the retina,

the nerve layer at the back of the eye that senses light and allows you to

see.

Floaters can be more serious if the shrinking vitreous gel pulls away from the

wall of the eye and causes a tear in the retina.

Torn Retina

And Retinal Detachment

A torn retina is always a serious problem, since it can lead to a retinal

detachment, Dr Ruggiero said. An ophthalmologist should be seen as soon as

possible if even one new floater appears suddenly or you see sudden flashes of

light.

Retinal tears need to be treated with laser surgery or cryotherapy (freezing),

which seals the retina to the back wall of the eye.

A retinal detachment is a very serious problem that almost always causes

blindness unless it is treated.

Retinal detachments require surgery to put the retina back in its proper

position.

Dry Eyes, Watery Eyes

As people age, their eyes become less lubricated, Dr Ruggiero said, and the

tear gland secretes water to compensate for the loss in lubrication.

Dr Ruggiero suggested the use of lubricating drops three or four times a day

to eliminate the dryness and the subsequent tearing.

He said, "Warm compresses may also help."