Do You Have Eyesight Problem?
A high percentage of elderly admitted to hospitals with falls had vision impairment. And their sight problem may be compounding or causing falls.
Studies also indicated that most elderly people with poor vision could have been successfully treated but failed to seek help from eye specialists. This problem was particularly acute in deprived areas.
Globally, the most common age-related eye diseases which can cause low vision are:
- cataract
- age-related macular degeneration
- glaucoma
- diabetic retinopathy
Cataracts
Cataracts occur when the lens of the eye becomes cloudy or opaque. Vision is decreased because the amount of light passing through the lens is reduced.
Cataracts can be treated by removing and replacing the opaque lens with an artificial lens implant. This safe and effective operation can be done as an outpatient procedure. The improvement in vision is immediate.
However, if cataract surgery is delayed for too long, the lens can become hardened and more difficult to remove, and may lead to other complications such as glaucoma. Cataracts can cause blindness if untreated.
Age-Related Macular Degeneration (AMD)
Macula is the small central area of the retina, the light-sensitive tissue that lines the back of the eye. It is responsible for seeing fine details so that we can read, recognize faces, drive, and use a computer.
Macular degeneration causes “blind spots” in the central vision; the straight-ahead vision becomes distorted or missing.
There are two types of AMD. Dry AMD develops when there is ageing or thinning of the macula tissue or a build-up of waste material. The vision loss with this condition is relatively mild, and presently there is no treatment.
The more serious type is Wet AMD which occurs when abnormal blood vessels grow underneath the retina. These vessels leak blood and fluid, which can cause permanent damage to retinal cells. Treatment is by regularly injecting a medicine called ranibizumab (Lucentis) into the eye to prevent abnormal blood vessels from growing.
AMD affects only the central vision. It will not cause complete blindness because there is still a peripheral vision. A person with AMD should get help from a low-vision specialist to maximize using the remaining useful vision.
There are many useful assistive devices and aids which help people with low vision to continue living an independent life.
Glaucoma
Glaucoma is a disease in which rising fluid pressure in the eyeball causes irreversible damage to the optic nerve.
Peripheral vision is lost initially, progressing to tunnel vision if left untreated. Globally, glaucoma is one of the leading causes of blindness.
Glaucoma may be hereditary and more prevalent in certain ethnic groups. It is also more common among people with diabetes and those with previous eye injuries. Since there are few warning signs, it is important to have regular eye tests to detect them early. You should also see a doctor immediately if there is sudden pain in the eye.
Any vision that has been lost cannot be recovered. However, early diagnosis, careful monitoring and appropriate treatment can prevent further damage and limit vision loss.
Glaucoma can be treated with eye drops, oral medicines, laser therapy and eye surgery, or a combination of these methods.
Diabetic Retinopathy
Diabetic retinopathy, a condition caused by damaged blood vessels in the retina, is a complication of diabetes. It is especially prevalent in patients with uncontrolled blood sugar levels over a long period of time. It affects up to 80% of people with diabetes, both type 1 and 2, for 10 years or more.
The damaged blood vessels in diabetic retinopathy become leaky or closed.
In diabetic macular oedema (DMO), fluid leaks out of the damaged blood vessels and accumulates in the macula, leading to tissue swelling and poor central vision. Usually, the peripheral vision remains normal.
In proliferative diabetic retinopathy (PDR), the close blood vessels cause abnormal and very fragile blood vessels to grow on the retina’s surface. This can lead to permanent loss of vision from bleeding into the eye, retinal scarring and retinal detachment.
There is no cure for diabetic retinopathy. However, laser photocoagulation can seal off leaking points and reduce swelling. Vitrectomy, the surgical removal of the vitreous gel containing the bleeding vessels, may help improve vision in advanced PDR. Anti-VEGF, which inhibits the vascular endothelial growth factor, effectively prevents the further growth of abnormal blood vessels.
Regular eye checks are essential for all diabetics so that signs of diabetic retinopathy can be detected as early as possible.
Just like the rest of the body, ageing brings about changes to our eyes and vision. By the late 40s, most of us would experience problems seeing well in dim light, more sensitivity to glare and bright light, presbyopia and so on.
Although these changes are a bit of a nuisance, they are normal for ageing and can be fixed by prescription glasses, sunglasses and light adjustment in the house. However, to prevent vision impairment, as described above, we have to be more proactive about eye care.
Do you have an eyesight problem?
If yes, don’t ignore it. Make an appointment with the eye specialist now.
If not, congratulation! However, start a yearly appointment with the eye specialist.
Further readings:
- Bourne RRA, Flaxman SR, Braithwaite T, Cicinelli MV, Das A, Jonas JB, et al.; Vision Loss Expert Group. Magnitude, temporal trends, and projections of the global prevalence of blindness and distance and near vision impairment: a systematic review and meta-analysis. Lancet Glob Health. 2017 Sep;5(9): e888–97.
- http://www.nhs.uk/Livewell/Eyehealth/Pages/Livingwithlowvision.aspx
- http://www.who.int/mediacentre/factsheets/fs282/en