As baby boomers flood the ranks of the 60-and-over crowd, their incidence of chronic health problems continues to rise. Among these are age-related eye diseases, which are predicted to increase by more than 50 percent by 2020 to 43 million cases. Yet a new survey commissioned by the American Academy of Ophthalmology shows that strikingly few Americans—especially those most vulnerable—realize they are at risk for developing serious eye diseases like cataracts, glaucoma, and macular degeneration.
"As we get older, more than half of us will develop some kind of eye disease," says Andrew Iwach, a spokesperson for the American Academy of Ophthalmology and executive director of the Glaucoma Center of San Francisco.
But, he says, "when asked what worries [them], more people were concerned about weight loss and back pain than the possibility of losing their vision." The survey, reported last month, polled 1,200 people nationwide and found that only 11 percent of Americans believe they are at high risk for developing eye disease. And close to one third of seniors, the most vulnerable group, fail to get a yearly eye exam. The survey also found that 75 percent of minority respondents did not know that their ethnicity elevates their risk.
Some age-related eye conditions may be difficult for people to detect themselves and may creep up unnoticed until it's too late to prevent permanent injury. "The problem with glaucoma," says Iwach, "is that the early vision loss occurs in the periphery, which may go unnoticed without treatment, resulting in tunnel vision. And we can't bring back the vision that was lost." Glaucoma damages the optic nerve, the main passageway between the eye and the brain, causing symptoms such as severe eye pain, blind spots, and blurry vision.
Early detection and intervention can also significantly slow down the progression of diabetic retinopathy, the most common cause of blindness among working-age adults. The disease, which sometimes leads to the appearance of specks or spots in one's field of vision, can be prevented by controlling diabetics' blood sugar and blood pressure, says Timothy Lyons, director of the Oklahoma Diabetes Center at the University of Oklahoma. But, he says, "many type 2 diabetics may go undiagnosed [for] years." The delay in diagnosing that condition means that retinopathy can develop before people even realize they should be taking preventive measures.
"Sometimes early treatment with a laser or medications can prevent more severe vision loss," says Thomas Gardner, professor of ophthalmology at Penn State's College of Medicine in Hershey. "This means the patient will require less severe and extensive treatment later on."
Adults with no obvious visual problems or risk factors should have a baseline screening for eye disease at age 40, ophthalmologists say. People with symptoms or risk factors, regardless of their age, should see an ophthalmologist or optometrist to set a schedule for regular eye exams.
Risk factors to look out for include:
• Diabetes: Both type 1 and type 2 diabetics are prone to developing glaucoma, cataracts, and, as the name implies, diabetic retinopathy.
• Family history: Age-related macular degeneration, glaucoma, and cataracts are all partially hereditary, making family history a major indicator of a person's risk. Iwach recommends telling family members if you are diagnosed with any eye disease, since it might encourage them to get screened for the same problem.
• Age: Those 60 and older are particularly prone to macular degeneration and glaucoma, while cataracts are common in people over the age of 50.
• Ethnicity: African-Americans are six to eight times more likely than whites to develop glaucoma, in part because the former have higher rates of diabetes, according to the Glaucoma Research Institute. Latinos, who also have high rates of diabetes, are similarly prone to eye disease. A relatively rare form of glaucoma, known as closed-angle glaucoma, affects Asian-Americans more frequently than other groups.
To educate Americans about eye diseases and publicize prevention and screening advice, the AAO has launched an initiative it calls EyeSmart. The campaign's website, geteyesmart.org, describes symptoms and treatments for the major age-related eye diseases, with visual aids and video simulations of each disease. It also offers a geographically searchable database of ophthalmologists.
Screening is less useful for some eye diseases than for others, says Donald Budenz, associate medical director of the Bascom Palmer Eye Institute at the University of Miami. "There's no way to stop the development of macular degeneration" or cataracts, he says. "People are going to get them whether we screen them or not." Intervention, however, using laser or surgery, can improve these conditions. "There are accepted safety checks that we must do when we get older," says Iwach. "Women know they need to have regular breast examinations at a certain age, [for example]. We need to make sure we don't forget about the eyes."