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Eye on the Prize

Maintaining vision for life

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As a natural consequence of aging, many adults will experience a change in their vision. Attributed to a number of factors, including genetics and lifestyle, these changes can vary from mild to extremely severe. Eye health is an important issue that needs to be taken seriously. Just like visiting the dentist on a regular basis for checkups, making an appointment with an eye doctor is equally important, and even more so as you get older.

A recent study conducted by the Canadian Association of Optometrists concluded that “Vision loss is the most feared disability for Canadians (69 per cent) and the prevalence of vision loss in Canada is expected to increase nearly 30 per cent in the next decade. Vision loss has the highest direct health-care costs of any disease with the financial burden of vision loss expected to double, reaching $30.3 billion by 2032. The time to act is now, given that over 75 per cent of vision loss is preventable or treatable.”

Ophthalmologist and vitreoretinal surgeon Dr. Patrick Mitchell explains the majority of eye issues become more prevalent with age. “Many issues are fixable, such as cataracts, but some problems can cause irreversible damage, if left untreated for too long. Examples include glaucoma, macular degeneration or retinal detachments. These conditions are treatable, but outcomes are better if treatment is started early.”

Mitchell sees many different types of cases in his patients. “If the cornea develops serious problems it can sometimes require transplantation with a new one. If the lens becomes a cataract, it can be replaced with a new artificial lens. If the retina develops bad macular degeneration, damage from diabetes or high blood pressure, these conditions are often treated with injections of medication into the eye or laser treatments. The retina can also detach, and if this occurs, usually surgery is required.”

Dr. Riaz Ahmed, optometrist with Mission Eye Care, Centre for Dry Eye and Corneal Disease, echoes Dr. Mitchell’s comments on eye issues related to age. “Perhaps the most concerning of these is glaucoma, a silent and progressive disease with no symptoms until the end stage when almost all peripheral vision is lost. It is caused due to an imbalance between the fluid pressure in the eye and the blood flow into the eye, and results in blindness, if untreated.”

Family genes increase susceptibility, especially with age. “There is often a genetic component, with up to seven times increased risk in those with an immediate family member with the disease,” Ahmed says. “It can only be detected during an eye exam where eye pressure is measured along with examination of the nerve at the back of the eye. If glaucoma is suspected, a number of imaging tests are performed over time to confirm the diagnosis. The good news is that glaucoma can be treated, usually quite simply, using eye drops to lower the eye pressure.”

A more serious type of eye disease for individuals over 50 is macular degeneration. According to Ahmed, fair-skinned, light-eyed individuals are most at risk for this particular disease. Macular degeneration is caused by a buildup of metabolic waste under the central retina, ultimately causing cell death, vision loss and, in some cases, bleeding under the retina. Ahmed cautions, “Smoking increases an individual’s risk of developing this sight-threatening disease by as much as six times. Prevention of this disease is important, since the most common form has no cure.”

Another common, but often ignored, eye condition is known as dry eye. Dry eye affects the front surface of the eye and is extremely common in places like Calgary, where the humidity is generally low.

“With our increasing use of digital devices, we have seen an increase in dry eye over the past few years,” notes Ahmed. “This is at least partially due to a decrease in blink rate that occurs when we are on digital devices. Studies show that the average blink rate drops from 12-15 times per minute down to three to four times per minute when we are concentrating on near tasks.” That means individuals who work with a computer most of the day will be extremely susceptible to dry eye.

Patient Charlotte D. suffers from dry eye, a condition diagnosed after she was experiencing red, itchy eyes causing constant discomfort, especially when wearing contact lenses. After visiting her eye doctor, tests indicated she was not producing the oils necessary to keep her eyes hydrated and healthy. Charlotte was prescribed iLux treatment, which directly target a patient’s blocked Meibomian glands through the application of light-based heat and compression under direct visualization. Charlotte claims, “It worked great because now my glands are producing oil. But I still need to do home care which includes warm compresses and lid massage. I also use eye drops every day for relief when my eyes get dry.”

Cataracts – a clouding of the lens inside the eye – is another common eye condition. As people age, this condition is, unfortunately, inevitable. However, it can be delayed with proper UV protection, such as wearing sunglasses. “UV protection is important, especially in the early years of life. The young eye has almost no protection from UV rays, so sunglasses outdoors for the little ones are important to help prevent this disease later in life,” advises Ahmed.

Mitchell notes there are things people can do to reduce their chances of having eye problems, or at least forestall them. “Smoking is extremely hard on the eyes, as the toxins released into the bloodstream can accelerate macular degeneration and also cause early cataract formation. Smoking cessation and avoiding second-hand smoke are one of the most important steps in preventing eye problems. Eating a well-balanced diet, high in lutein and omega-3 fatty acids, can also help keep the eyes healthier. For patients with moderate or advanced macular degeneration, vitamin supplements can slow the progression of this condition. Reducing UV light and wind exposure, and avoiding eye trauma, are also helpful.”

In the past, an eye exam consisted of several tests to check for blurry vision. Today’s eye exams are much more sophisticated, thanks to advanced technology. According to Ahmed, one in seven Canadians has an undiagnosed eye condition, a statistic largely preventable if more people had routine eye exams.

Modern technology has completely changed eye care over the last few years. “We now have diagnostic imaging equipment that can see and analyze parts of the eye that could not be seen before. This leads to earlier detection and treatment of not just eye disease, but also systemic diseases that can manifest in the eyes,” says Ahmed.

“Opticians, optometrists and ophthalmologists are the main sources of eye care in North America, working together to screen and treat patients. As technology has advanced and treatments have expanded, there has been a growing need for some ophthalmologists to further specialize to provide more complex care. In addition to general ophthalmologists, there are ophthalmologists who specialize in pediatrics, cornea, glaucoma, uveitis, retina, pediatric retina, oculoplastics, orbit and ocular oncology. Calgary is fortunate to have specialists in all of these fields, albeit in limited numbers,” says Mitchell.

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