Vision is probably our most important sense, but we often take it for granted. Learn about some common eye problems and the effective treatments now available.
Vision is perhaps the most important of our five senses, but it’s often taken for granted, until problems develop. And they seem to develop at lightning speed as we age.
The most frequent complaints, according to the National Eye Institute, are “refractive errors,” better known as nearsightedness, farsightedness, presbyopia and astigmatism. Most adults over age 35 are affected by one or more of these conditions, which are typically corrected with eyeglasses and contact lenses.
The leading causes of blindness and low vision, according to the Centers for Disease Control and Prevention, Atlanta, are age-related eye diseases such as cataracts, diabetic retinopathy, glaucoma and age-related macular degeneration. Other common eye disorders are amblyopia (lazy eye), strabismus (crossed eyes) and presbyopia (tired, aging eyes.)
The good news is that optometrists and ophthalmologists have been treating eye conditions for decades, with much success. And new, improved treatments continually evolve.
Even when it comes to eye transplants, physicians have more than a century of experience to draw upon, says Dr. Richard Miller, a Rockford ophthalmologist and fellowship-trained corneal specialist who owns Miller Eye Center, 2995 Eastrock Dr.
“The first such transplant was performed in 1904,” Miller says. “It worked! Can you imagine doing that without the medical advances we enjoy today?”
Corneal transplants are the most common of all transplants performed in the United States. They’re highly successful because they require no tissue-type matching, and rejections can usually be readily treated. Such transplants benefit young and old alike.
“Corneal transplants are effective in helping younger patients with scarring from eye injuries or infections, and dystrophies, or hereditary clouding of the eyes,” Miller says. “Older patients need transplants primarily due to the complications of cataract surgery.”
Glaucoma is a serious, common and incurable eye disease that can lead to blindness. When necessary, Miller treats it surgically. Normal intraocular pressure readings range from 10 to 21, but such readings in glaucoma patients may be 30 or higher. Occasionally, glaucoma patients have normal eye pressure, making the disease difficult to diagnose. Miller says patients ages 50 and younger should be screened for glaucoma every two years; after 50, annually.
“Glaucoma is a disease in which higher than normal pressures in the eye slowly cause blindness,” he explains. “First, a patient loses peripheral vision, then, gradually, all vision. About 4 to 5 percent of the population suffers from glaucoma, and it’s even more common among African-Americans.”
Early in the disease stage, treatment typically begins with drops that reduce eye pressure. Secondary treatments may include laser surgery or hospital-based surgery, both of which aim to reduce high pressures.
“The laser surgery is performed in the office, a 5-minute, painless procedure called a trabeculoplasty,” Miller says. “A more involved surgery is a trabeculectomy, in which a hole is made in the white of the patient’s eye. A new modification is a metal implant termed ExPRESS Shunt, which is implanted in the hole and allows fluid to escape and be absorbed by the body.”
Glaucoma can be controlled, but not cured. The condition worsens over time, no matter what course of treatment is used. Most laser or surgical methods yield benefits for 5 to 10 years and may need to be repeated.
What really excites Miller is the future of eye treatment. In the early 1980s, 3M developed a multifocal intraocular implant, using new technologies developed by the Hubble Space Telescope team to overcome image blurring caused by earth’s atmosphere. Available under different brand names, it has an 80 percent success rate in allowing patients to read and clearly see distant objects. Miller has already implanted more than 700 of them.
“We foresee a day, possibly within the next 20 years, when patients will have their lenses replaced at age 20,” Miller says. “They’ll never need glasses or bifocals, or worry about cataracts, for the rest of their lives.”
Given that more than half of all people age 80 and up have cataracts or have had them removed, it’s thrilling to envision a time when this affliction is a thing of the past. Today, surgical treatments with high success rates are available. Left untreated, cataracts slowly cloud vision until people no longer can do the things they want to do.
“Cataracts can stop patients from reading, driving, using computers or enjoying hobbies such as needlework or golf,” says Dr. Masud Malik, an ophthalmologist who treats patients for a wide range of vision concerns, including cataracts, at Malik Eye Institute, 3865 N. Mulford Road, Rockford. “Patients react to cataracts differently. Some want them removed right away, while others are content to wait. Acuity is no longer the sole issue in determining when to surgically remove the cataract. If patients want to wait, and the cataract is not very advanced, we generally give them the option to wait until their lifestyle is affected. It’s important to keep in mind that delaying cataract treatment too long will make removing them more challenging.”
When patients visit, Malik considers whether non-surgical avenues, such as prescribing different glasses, should be the first course of action.
“At the point when surgery is needed, we dilate the eye and examine the patient’s condition closely,” he says. “We look at the back of the eye as well, because some patients have more than one problem going on. We must take everything into consideration before proceeding.”
After assessing test results, Malik reviews with his patient the facts, risks and benefits of surgery. When the patient is ready, Malik takes careful measurements and determines the best way to implement the cataract removal and lens replacement. The technique, called phacoemulsification, is performed on an outpatient basis, either at the surgery center or a hospital.
“The surgery requires no injections, only eye drops and a mild sedative,” says Malik. “I surgically remove the old lens with the cataract and slide the folded new lens implant into place. It unfolds gently and is secured in the same structure that held the old, cloudy lens.”
Patients recover quickly and are generally ready for new glasses in as little as two weeks. In about 30 percent of cataract removal cases, a thin film develops behind the lens, which can affect vision. Malik removes it, in the office, using laser technology.
Most patients who have cataract surgery achieve long-distance vision clarity, without glasses, within days. Patients with astigmatism may require toric lens implants; a toric lens has two different powers in two orientations perpendicular to each other.
Often performed in conjunction with cataract surgery, the limbal relaxing incision, a refractive surgical procedure, may help patients to achieve sharper long-distance vision, by correcting minor astigmatism.
For patients who want to read without glasses after cataract surgery, treatment options are expanding. Multifocal lens implants are one option, Malik says. Two brand-name products on the market are AcrySof IQ ReSTOR by Alcon and TECNIS Multifocal by Abbott. Other options for better reading vision include blended vision treatments and monovision lens implant treatments.
“Most of our patients don’t mind wearing reading glasses, but for those who do, it’s nice to know that there are more options available for them than we had in the past,” says Malik. “I consider it an honor and a privilege for patients to trust their eyes to me. Helping them to see better is a very rewarding part of being an ophthalmologist.”
Indeed, new products and procedures for corrective eye care are impressive, says Dr. Kenneth R. Minarik, a registered optometrist who practices at Northern Illinois Optical, 121 N. Madison St., Rockford. He has followed such advancements closely, ever since he began practicing 30 years ago. He points to improved contact lens technology as one example.
“Back then, most people quit wearing contacts by age 50, because their eyes were too dry,” says Minarik. “Fortunately, the silicon lens arrived in time for the great American baby boomer era. With the new lenses, older Americans can comfortably wear contacts into their 60s and 70s.”
Those people who enjoy very good distance vision for the first 40 to 50 years of their lives may eventually need corrective lenses for improved near vision. Unfortunately, this can compromise their ability to see afar. The best possible situation occurs when patients start wearing glasses or contacts in middle or high school, because they adapt more easily later in life, when they’ve had to wear them since childhood. This eliminates start-up problems that can occur with the sudden need for corrective lenses, such as blurring when the patient looks down, seeing warped edges and angles, and altered depth perception.
“This abrupt need for corrective lenses to focus close-up is called presbyopia, which in Greek simply means old, tired eyes,” Minarik says. “We also call this the Holy Grail of baby boomers, who have never needed glasses and now find it necessary to hang frames on their faces.”
Minarik emphasizes that early and consistent eye maintenance and care are essential, for more reasons than patients may realize.
“You’d be amazed at how often we spot diseases during routine eye exams,” he says. “For example, diabetes is the No. 1 cause of blindness in America. Once a diabetic patient begins bleeding into the eyes, his or her sight is in danger and needs immediate intervention. Sadly, we find any number of patients, including a disproportionate number of men, who aren’t aware they’re diabetic, even though their undiagnosed diabetes has already advanced to the stage that they’re bleeding in their eyes.”
Cancer is another unexpected diagnosis.
“Just because a person sees well doesn’t necessarily mean he or she is well,” Minarik says. “I look for freckles and moles in the backs of eyes. Melanoma is supposedly rare in the eyes, but I’ve found it seven times in the past eight years. It’s extremely dangerous because of its proximity to the brain.”
Along with finding a good eye doctor to conduct regular eye exams, it’s essential for patients to find reputable companies that provide glasses and contact lenses.
“Most people don’t realize that those who make glasses are not licensed in the State of Illinois, while hairdressers are,” Minarik says. “I’ve seen ads for optical businesses that say they’ll keep making the glasses over and over until they’re right. That’s not acceptable. Why should patients have to go through that? Here at Northern Illinois Optical, we’ve been in the business for 62 years and take pride in having the expertise to do it right the first time.”
While everyone agrees that lifelong good eyesight is extremely important, not everyone understands that eye care should start early, whether or not there’s reason to suspect a problem.
A child’s first eye exam should occur between 6 and 12 months of age, says Dr. William Hillmann, a registered optometrist at Primary Eye Care Centers, located in Edgebrook, 1603 N. Alpine Road, Rockford. The American Optometric Association (AOA) encourages eye exams in infancy, as well.
“We look for potential problems developing in an infant’s eyes, so that we can begin to resolve them early,” Hillmann explains. “Even without feedback from the child, we can detect early functional issues, the need for vision correction, and we can identify many congenital diseases, defects and rare tumors. Many of these, when found early, can be treated successfully, preventing long-term vision loss.”
Among the problems a child may face are significant near- or farsightedness, a turning eye, or a congenital cataract which could result in “lazy eye,” or amblyopia.
Hillmann recalls an interesting case that involved a newborn. “The youngest patient I have prescribed contact lenses for was six months old,” he says. “In this case of congenital cataract, we used corrective lenses until the child reached his teens, then we referred him for surgical correction of the condition.”
In cooperation with a national AOA public health program called InfantSEE, Primary Eye Care performs free eye exams on children up to 12 months old. “One in 10 children is at risk for developing functional, physical or vision problems,” Hillmann explains. “But only about 13 or 14 percent of parents report taking their children for eye exams. Parents tend to wait for complaints from their child or their child’s teacher prior to pursuing eye care. Unfortunately, the child usually is unaware that his or her eyesight isn’t normal, so doesn’t complain.”
Often, parents don’t realize their children have sight issues until the children attend school. Professional eye exams go far beyond traditional school eye screenings, which tend to concentrate on distance vision and may fail to identify up to 60 percent of children who have vision problems. Hillmann encourages parents to watch for signs of vision problems.
“Children who sit too close to the television or hold books too close to their faces, squint, complain of sensitivity to light, tilt their heads or rub their eyes a lot are exhibiting symptoms of eye problems,” he says. “They may have short attention spans or poor hand-eye coordination. They also may misbehave or avoid close work.”
These children may be misdiagnosed as having attention deficit or hyperactivity disorders when the underlying problem is actually vision-related.
“The State of Illinois now requires a comprehensive eye examination prior to kindergarten or first grade, or when moving into the state, just as they require physical exams,” Hillmann says. “A comprehensive eye exam as early as possible goes a long way toward correcting and even preventing more severe vision problems in a child’s future.”
The potential for improved eye care appears to be limitless. However, the best end results all begin with consistent eye care and examinations to prevent or treat diseases that erode both vision and one’s quality of life. For those who make the effort to check their vision regularly, the future looks bright indeed. ❚