In Health: Eye Resolution


Dr. Cameron Javid

In Health: Eye Resolution

There are several age-related eye conditions that everyone should be aware of. We interviewed five local experts to discover the
latest in diagnosis and treatments.
By Elena Acoba | Photography by James Patrick

If you don’t need regular vision correction, and you stay healthy, you’re likely to have few eye problems until your 40s, when age-related conditions start to emerge.
In your older years you can expect hardening of the lens (presbyopia), clouding of the lens (cataract) and debris from aging of the vitreous (floaters). “Those three conditions will happen to every human being if they live long enough,” says Cameron Javid, M.D., an ophthalmologist with Retina Associates.
Glaucoma, macular degeneration and retinal detachment also become more common in older people.
Some of these conditions and diseases can be delayed with a healthy lifestyle. That includes eating foods high in antioxidants and omega-3 fatty acids, exercising, stopping tobacco use and controlling diabetes, high cholesterol and hypertension.
Protect eyes by wearing sunglasses, washing eyelids weekly with baby shampoo to remove bacteria and avoiding sleeping with contacts on.
Getting eye exams throughout one’s life, starting at preschool age, provides baseline information. Having annual exams after 40 will reveal vision and eye changes that you won’t immediately notice.
See an optometrist or ophthalmologist any time you experience abrupt changes, especially vision loss or eye pain. Waiting can lead to severe and permanent vision loss.
Dr. Javid and other Tucson-area eye care professionals discuss some of the age-related conditions you’ll want to monitor to protect your sight.

Macular Degeneration
“Macular degeneration is the leading cause of permanent visual loss among people aged 65 and older,” says Dr. Javid.
It’s possible that people have symptoms well before vision loss begins. That’s why it’s important to have a regular exam of the macula — a bundle of light-sensing cells for sharp, central vision. “We often discover macular degeneration before the patient is aware of any symptoms.”
What eye care professionals look for are yellow deposits (drusen) under the retina. They develop as you age, but a large amount is concerning.
The disease, also called AMD, can develop in only one eye. You may not notice symptoms because the good eye will compensate for the other’s poor vision.
A way to catch a problem is to look at something linear, like the slats of horizontal blinds, through one eye. If you see a bend in the slat, visit a doctor, says Kelly A. Moffat, O.D., an optometrist with Cornea Associates.
Patients also can get a grid printed on a card for self-examinations.
As AMD progresses, you may first notice blurred vision, which can worsen to blind spots in your central visual field and finally large areas of blindness in central vision.
Remaining vision can be preserved if the disease is caught early enough.
For the onset of dry AMD — when macular cells deteriorate — a cocktail of over-the-counter vitamins and antioxidents called AREDS or AREDS2 can slow the progression, says Jeff Maltzman, M.D., FACS, a surgeon with Fishkind, Bakewell & Maltzman Eye Care and Surgery Center.
In wet AMD, abnormal blood vessels grow and leak, damaging retinal tissue and accelerating vision loss. Lasers or drug injections are used to blunt or destroy abnormal blood vessels.
In the last few years many new therapies have been under investigation.
Dr. Javid has patients in eight clinical trials. One involves a drug that can slow the progression of dry AMD, while others are testing oral medications, eye drops and liquid drugs to treat wet AMD.

“There is no cure for macular degeneration,” Dr. Javid says. “Once you get it, you cannot stop it. You cannot reverse it. The goal is to kind of outlive it.

Dr. Ajay Sanan

 

Cataracts
One of the best ways to avoid getting cataracts is “not getting older,” quips Leslie Weintraub, O.D., an optometrist with Catalina Eye Care.
Put another way, live long enough and your eye lenses will lose their clarity. That causes glare, cloudiness and color distortion in your vision.
Health and family history dictate when you’ll develop cataracts, says Ajay Sanan, M.D., at Pima Eye Institute PC. He’s seen new cataracts in people in their 40s and in a 100-year-old woman.
“There’s a whole spectrum on how cataracts evolve,” he says.
There is no cure for cataracts, but studies show you may delay its onset by eating a diet with antioxidant-rich vegetables, taking lutein and protecting eyes from ultraviolet light.
Eye drops and oral drugs, except for antioxidant supplements, do nothing to avoid or treat cataracts, Dr. Sanan says.
Cataracts may never affect your vision or they can cause issues right away. Eye health professionals suggest surgery when the condition affects your lifestyle.
Dr. Weintraub suggests that night vision is an important part of that consideration. “Although you may be legal to drive because you can see those large black letters (in a test),” she says, “in the real world that’s not how things are. We don’t have 100 percent contrast.”
Cataract surgery has come a long way, says Dr. Maltzman. “Modern cataract surgery is a relatively safe and extremely effective outpatient procedure,” he adds.
Technology is moving quickly to improve results through new surgical techniques and replacement lenses.
Lens replacements can correct for almost the entire spectrum of vision impairment: near, far and multiple distances with or without astigmatism.
Lasers provide more precision in surgery, although there is some question as to whether it creates better outcomes. Dr. Weintraub sees less inflammation in recovery.
And new tools now allow surgeons to perform cataract and glaucoma procedures in one surgery.
Every year offers new lens technology and refined surgical equipment, says Dr. Sanan.

Glaucoma
Glaucoma, which robs people of sight from optic nerve damage, will sneak up on you.
Age-related glaucoma (primary open-angle glaucoma) “is a painless, symptomless disease that often goes unrecognized and untreated until significant damage is done,” says Dr. Maltzman.
That’s why it’s important to get regular checkups starting at age 40.
Glaucoma is a build-up of fluid in the eye that can create pressure and damage to the optic nerve. Its first symptom is peripheral vision loss. In this progressive disease, vision loss continues from the edges until it seems you are looking through a tunnel and ends with complete blindness.
“It changes the nerve over time,” Dr. Moffat says. “We may watch it for years before we can tell if that nerve is changing or not.”
The common test is to determine eye pressure with a tonometer; one type blows a puff of air into the eye.
“It is important to understand that this alone is not enough to diagnose or rule out glaucoma,” says Dr. Maltzman. Some people with the disease don’t experience elevated pressure.
An exam of the optic nerve while the eye is dilated is the best way to find the disease, he says. Another way to detect glaucoma is with optic nerve scanners.
Medications that reduce eye pressure are the first line of treatment for this incurable disease. Marijuana has shown promise, says Dr. Sanan, but a prohibitively large amount would have to be consumed to be effective.
Laser surgery (trabeculoplasty) to clean out the canal that drains fluid also is an effective procedure.
If neither adequately reduces eye pressure, traditional surgery to create a bypass of the clogged canal (trabeculectomy) is done. This also is an effective treatment, but complications could last months.

Dr. Leslie Weintraub


Stents have been used for some time to open drainage canals. This year a new version has hit the market that may work better for some patients.
Stents can delay the need for a medication regimen that some patients find hard to maintain. A new technique allows surgeons to remove cataracts and implant stents in the same surgery. “The goal here is, as part of the cataract procedure, we implant a device in the eye to make it a little bit easier to reduce eye pressure,” says Dr. Sanan.
Another move toward better surgical treatment is a procedure similar to a trabeculectomy, but with no external cutting that could lead to complications.
“For the first time in decades, ophthalmologists will have a number of different surgical options,” says Dr. Maltzman. “It will no longer be a one-size-fits-all approach to this disease.”

Retinal Detachment
Commonly, your retina may detach because something else in your eye is moving — the vitreous. Vitreous gel that fills 80 percent of your eye shrinks and liquefies over time, creating clumps and debris that you see as floaters.
The vitreous eventually may separate from the retina, which sends information to the optic nerve. A small number of these separations create tears in the retina. A tear can cause the retina to be pulled from its normal position, called a retinal detachment.
If not treated in time, this retinal detachment can cause vision loss.
A sudden increase in floaters, flashes of light or both need immediate attention to rule out or deal with retinal detachment.
A vitreous detachment does not require further action, but eye care professionals want to do several exams to make sure no retinal tears occur.
A retinal tear can be closed via laser in the office. A retinal detachment needs surgical repair.
“Once we confirm the diagnosis, we schedule you for prompt surgical intervention for the same day or next day,” says Dr. Javid.
The reason for the urgency is that once the retina is detached, it’s not getting the blood, nutrients and oxygen it needs. Cells start to die and vision is lost.
Today’s microsurgical instruments allow doctors to make tiny incisions into the eye to suck out the vitreous and reattach the retina. No sutures are needed. “The system that has become smaller allows for less invasive treatment with faster recovery and less discomfort,” says Javid.

Floaters
Floaters are bits of debris in the vitreous, a gel that shrinks, liquefies and becomes stringy with age. People who are very near-sighted tend to get more floaters, and sooner, than others.
People with diabetes or who have had cataract surgery also are more prone to developing floaters.
“In and of themselves they are not that much of a concern,” says Dr. Moffat. After a while the brain ignores them and they tend to settle out of your line of sight.
A sudden increase in floaters can indicate a retinal detachment and should be addressed immediately.
You may notice floaters more often in settings with bright background light, such as during outdoor activities or computer use. Wearing sunglasses and reducing the brightness of computer monitors can lessen their appearance.
If floaters start to greatly affect your lifestyle, talk with an eye care professional. High-risk surgery to drain the vitreous will remove the floaters. “This is only performed in rare cases where floaters are extensive and adversely affecting one’s visual function,” says Dr. Maltzman.
Laser surgery to zap floaters is a controversial procedure. Both Drs. Javid and Weintraub say it is currently “not considered the standard of care.”  TL