Doctor My Eyes

The National Eye Institute just released a report revealing that more than a million Americans over 40 are blind, and 2.4 million are visually impaired. These numbers are expected to dramatically increase as the population ages.

However, there is some good news out there.

On The Saturday Early Show, as part of the "Living Better Living Longer" series, Dr. Robert Cykiert talks about the growing number of treatments available to those who suffer vision problems.

Dr. Cykiert is a professor at the NYU Medical School and surgeon at the New York Eye and Ear Infirmary.

The top four common causes of vision problems in older adults are macular degeneration, cataracts, glaucoma and traditional near-sightedness.

MACULAR DEGENERATION: This is the leading cause of blindness in the older population. Typical patients won't begin to notice vision changes until they are 60 or older. Those who suffer this degenerative disease gradually lose sight in their central field of vision, which makes it difficult to drive, read the newspaper or watch TV.

There are two types of macular degeneration: wet (fragile blood vessels under the retina leak fluid or bleed) and dry (a breakdown of cells and supporting tissues in the retina).

Wet macular degeneration is much less common than dry. But there is a new treatment that has successfully stopped the progression of this version of the disease in some people. It involves injecting a drug into the offending blood vessels and then treating them with a laser.

Dry macular degeneration: No cures have been found for this, the common type of macular degeneration. Because patients believe nothing can be done to help them, they often stop visiting their eye doctors. This is a huge mistake, Dr. Cykiert warns. Because macular degeneration effects so many people, the disease is being actively studied and new suggestions for treatment released.

The newest announcement came in October. The National Eye Institute (organized under the National Institute of Health) discovered that a regimen of vitamins, minerals and anti-oxyidents will prevent intermediate forms of the disease from progressing to advanced forms. In other words, it may be that popping a few pills in the morning can stop a person from becoming blind.

The doses required to be effective will not be found in a basic daily vitamin. For instance, the typical daily vitamin includes 60mg of Vitamin C; the study results call for 500mg a day. Dr. Cykiert says that vitamin companies are developing special formulas that reflect the study's findings.

Although no studies yet show that taking the vitamin regimen before signs of macular degeneration appear will prevent the disease, Dr. Cykiert says it can't hurt.

GLAUCOMA is another serious disease that comes with age. When eye fluid does not drain properly, pressure builds in the eye. This damages the optic nerve that carries information from the eye to the brain. Once vision is lost to glaucoma, it cannot be retrieved.

However, the disease's progression can be stopped with new treatments. Eye drops are the most common remedy. When Dr. Cykiert began practice 20 years ago, there was only one eye drop available; the medication caused severe side effects ranging from swollen eyes to depression. Now, there are five different drops, all with minimal side effects.

Using eye drops to treat glaucoma can involve using a combination of each of the drops several times a day. When patients are unable to stick to this strict schedule or experience serious side effects, doctors suggest a laser treatment. The fast, painless laser surgery allows eye fluid to begin draining again. Dr. Cykiert calls it "effective and safe."

In a small percentage of cases, the surgery needs to be repeated six months or a year later. Also, patients who choose surgery run a higher risk of developing cataracts later.

Glaucoma is a genetic disease. If it runs in your family, you should be sure to visit the eye doctor regularly; testing for the disease is now a regular part of all eye exams. The most exciting news on the prevention front is a new blood test that identifies carriers of the gene that cause glaucoma.

CATARACTS: about 20.5 million Americans 65 and older suffer from cataracts, a clouding of the eye's lens. The clouding is a result of aging but can occur in much younger people as well. There is no pain or redness associated with cataracts. In early stages, individuals notice their vision is a little unfocused; this can be corrected with glasses. Eventually, a new prescription won't help.

"Just because you have cataracts doesn't mean you need surgery," Dr. Cykiert explains. "Only if you have problems functioning. If the patient is 85 years old and no longer drives or works, there's really no need for surgery."

According to Dr. Cykiert, almost two million cataract surgeries are performed each year in the U.S, making it the nation's most common operation. The procedure is much easier than many people may realize.

"I've been doing this operation for 20 years, and I thought it was perfect then," Dr. Cykiert says. "Patients were in the hospital two or three days. Now, it's done as an outpatient surgery and takes 15 minutes."

Doctors remove the cataract and replace it with a lens implant, often needing no incisions at all.

"We used to give small injections all around the eye to numb it; now we use eyedrops as anesthesia. We used to patch the eye closed, now we leave it open after the operation. It used to take 7 or 10 stitches, now there's no stitches."

All of these advances mean that patients enjoy a 95 to 99 percent success rate with their cataract surgery, Dr. Cykiert said. Patients can return to work the day after the procedure.

Cataracts typically are not genetic. Evidence shows that exposure to UV light can lead to cataracts. Dr. Cykiert recommends always wearing sunglasses or contacts that block these harmful rays.

NEAR-SIGHTEDNESS: Traditional vision loss also comes with age. In 1995, the FDA approved Laser Vision Correction which uses different methods to change the shape of the eye's cornea. The most common procedure is called LASIK.

Although there are no long-term studies on the effectiveness of the surgery, most patients report being happy with their results. Potential problems include over/under-correction, seeing a glare around lights at night, scarring of the cornea or infection.

The key to avoiding these problems is making sure you are a good candidate for surgery. Dr. Cykiert has an extensive list of requirements/measurements that patients' eyes must meet. He winds up turning away about 25 percent of those who want LASIK because they don't meet these requirements. In general, a good candidate is someone with no other eye problems and whose prescription has been stable for at least two or three years.

Dr. Cykiert believes older adults also can be candidates for this procedure.

"I have several older patients who are very active and tired of wearing thick glasses. If you pick good candidates, the success rate is the same as it is with younger patients."