Health

It all started with a dizzy spell. Glenn Heath, a career optician, knew exactly what was happening.
The macular degeneration that runs in his family had finally caught up to him. The dizziness was caused by burst blood vessels in his right eye; the immediate result was noticeably obstructed vision.

That was 1988. Since then, my father, Glenn, has lost his central vision in both eyes. He cannot see the faces of his wife, children or grandchildren, and catches only a glimpse of their hair or collar, which is all that his limited peripheral vision allows. His profound vision loss from macular degeneration, along with cataracts and glaucoma, have, in many ways, made his world much smaller. His failing vision has been a loss for our entire family, and my siblings and I know that at least one of us is likely to inherit the disease that struck our father.

Although my dad’s vision is too far gone to restore, new treatments and technologies for age-related macular degeneration (AMD), cataracts and glaucoma offer hope that my siblings and I won’t suffer his same profound vision loss.

A Ray of Light for AMD Sufferers
New intravitreal injectables can now help stop the damage caused by AMD, the leading cause of blindness in persons 50 and older in Western nations. In the "dry" stage of the disease, the macula, the oval area at the back of the retina, will at first start to dry out, leading to slightly blurred vision or the need for more light when reading or looking at things close-up. The more detrimental "wet" stage of AMD occurs when the body creates blood vessels in the macula, designed to replace those that have dried up. But those new blood vessels leak and break. Scar tissue forms around them and can eventually obstruct central vision, leading to the almost-total blindness that my father suffers.

Patients who develop wet AMD "may wake up one day to find a black spot in their central vision, or one minute they can see well, and the next, everything is blurry," explains Dr. Jaclyn Kovach, assistant professor of clinical ophthalmology at the Bascom Palmer Eye Institute in Naples.

Dry AMD is the most common form of the disease, and develops more slowly than the wet type, Kovach says. Although dry AMD does not always lead to wet AMD, Kovach says, "wet macular degeneration is always preceded by dry macular degeneration."

Prior to 2005, wet AMD was treated with hot and cold laser therapies designed to seal broken blood vessels in the macula. But the laser therapy damaged retinal tissue and caused scarring that also obstructed vision. Newer treatments offer monthly intravitreal injections into the eye, which stop the blood vessel leakage from wet AMD. "We are making rapid advancements in prevention and treatment of AMD, particularly the wet type," says Kovach. "[With] these new injectibles, we’re able to improve the patient’s vision, not just keep it from getting worse." Not every patient is a candidate for injections, though Kovach predicts further progress. "Retinal specialists are looking at super-antioxidants, genetic engineering and new medications likely to come on the market in the next few years," she says.

Death, Taxes and Cataracts
It may seem inevitable that if you live long enough, you’re going to develop cataracts, but surgical options offer an opportunity to reverse the disease, says Dr. F. Rick Palmon, medical director of Southwest Florida Eye Care. Cataracts form and progress slowly, and in their first few years are correctable with stronger eyeglasses. It can happen at any age, but most typically develops once people reach their 60s. Once an ophthalmologist can no longer improve a patient’s vision with prescription lens changes, surgery is usually the next step.

In fact, cataract surgery is the most common surgery performed in the United States. During a routine surgery, the clouded corneal lens is dissolved and removed, and a new, synthetic lens is implanted in its place. "The entire procedure takes from five to 15 minutes," says Palmon. "Patients are given topical anesthesia, so they never feel a thing."

Remember those Coke-bottle glasses that post-surgical cataract patients used to have to wear? They’re history. The standard implantable lens now corrects for distance vision, so that most patients just need reading glasses. Even better, today’s implantable lenses can actually correct vision to the point that some patients no longer need glasses at all.

Keeping an Eye on Glaucoma
Like cataracts, glaucoma is not preventable, but it is easy to manage once diagnosed by an ophthalmologist. Glaucoma is caused by the inability of fluid to drain properly from the eye.

Treatment usually includes a combination of eye drops and laser surgery, and for more advanced cases, existing ducts in the eye are used to reroute and drain fluid. The biggest challenge with glaucoma, says Palmon, is early detection. "For the 2 million people in the U.S. with glaucoma, another 1 million don’t know they have it." This underscores the need for annual eye exams, especially after 40.

Although no one is predicting a cure for these common eye diseases just yet, early diagnosis, new treatment options and research on the horizon have the future looking just a little bit brighter.