Red Flags for Eye Disorders in the Elderly

The warning signs for eye disease are not as perceptible as patients and doctors would prefer. That is one of the reasons physicians at the Indiana University School of Medicine Eugene and Marilyn Glick Eye Institute caution people to have annual eye exams after the age of 50.

The risk factors for eye disease are similar to those for all diseases, said Louis B. Cantor, M.D., chair of the IU Department of Ophthalmology and Jay C. and Lucile L. Kahn Professor of Glaucoma Research and Education.

“Family history is the biggest red flag for most eye diseases, others include age and race. African American and Hispanic individuals are at increased risk for diseases such as glaucoma,” he said. “Secondary risk factors for eye disease are near sightedness, diabetes and elevated eye pressure.”

The most common cause of sight problems in the elderly is cataracts, an eye disorder that clouds the eye’s lens, causing vision to become dull and blurry. Age is the primary risk factor for a condition that results in more than one million cataract procedures annually in the United States.

Most people who live into their 70s will develop cataracts in one or both eyes, said Dr. Cantor. The specific risk factors for cataracts include aging, as well as smoking, prolonged exposure to sunlight and prolonged use of steroids.

Macular degeneration affects nearly 25 percent of the population over 65. There are two forms of macular degeneration, dry and wet.

The dry form is caused by pigment changes or age spots in the area of central vision in the retina of the eye. There are few treatments available for this form of macular degeneration except vitamin supplements which may reduce the risk of worsening of the disease in some individuals.

The wet form is caused by the proliferation of tiny blood vessels that develop because of degenerative changes in the retina and leak fluid or blood. This form of macular degeneration can cause severe and rapid loss of vision. Treatment options for this form of macular degeneration include laser treatments or monthly injections of an anti-VEGF drug, which blocks the growth of these blood vessels inside the eye, Dr. Cantor explained.

Risk factors associated with macular degeneration are age, a family history of macular degeneration, and overall health risks such as smoking, obesity, poor diet, high blood pressure and cholesterol.

Damage to the retina in the eye from diabetes is a real threat for those who deal with what is becoming an all too common disease in Americans.

“We have seen an explosion of diabetes in our population,” Dr Cantor said. “It probably has something to do with our sedentary nature and obesity, but there may be other factors as well.” 

Diabetes can damage the small blood vessels, called capillaries, in the eye which results in loss of blood flow to the retina.  These blood vessels can then leak bleed causing severe vision loss that may be irreversible.

Glaucoma, nicknamed the “sneak thief of sight” by some, is the most common cause of irreversible but preventable vision loss in the Western world. Damage to the vision from glaucoma often progresses without any warning signs or symptoms and often before the disease is diagnosed.

“Glaucoma is a very common disease, it affects about 2 percent of the population (only half of whom know they have the disease) and for many years, it was thought to be related only to increased eye pressure. Now we know that glaucoma is a very complex disease, where the eye pressure is certainly important but isn’t the only factor that can lead to damage to the optic nerve in the back of the eye,” said Dr. Cantor. The optic nerve is the computer cable that carries all of the information from the eye to the brain so that we can see.  It is this nerve that is damaged and ultimately can be completely lost in glaucoma, resulting in total blindness.

Dr. Cantor and Alon Harris, M.S., Ph.D., director of clinical research for the Eugene and Marilyn Glick Eye Institute, are conducting a multi-year study, the Indianapolis Glaucoma Progression Study, focusing on vascular (blood flow) abnormalities in glaucoma. This study is the largest to look at what factors besides the eye pressure might predispose glaucoma to develop or get worse, despite treatment to lower the eye pressure.

According to Dr. Cantor, most people begin to experience changes in their vision as they turn 40, and by age 65, one in three Americans will have experienced an eye disorder.

His take-home message for patients: “Don’t take your vision for granted, particularly if you have any risk factors including a family history of problems with vision. Make sure you routinely get comprehensive eye examinations.”

Source: Indiana University