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From Glaucomamakes fluid (called the aqueous humor) to stay inflated. In a healthy eye, there is a balance between how much fluid stays in the eye and how much leaves it.

In the eye with glaucoma, fluid builds up, causing intraocular pres-sure (IOP) to rise. This pressure eventually damages the optic nerve, the nerve fibers that carry images to the brain.

Tests for GlaucomaThere are several tests for glau-

coma, and Medicare covers 80% of your costs. There is the visual acuity, or 20/20 test, where an eye professional examines how well you see near and far. Another exam is the visual field test, where you are checked for how well you see ahead and to the side.

“A very important test is the tonometry test, which checks fluid pressure inside the eye,” Boles says. Current recommendations define “normal” pressure as falling any-where between 12 and 22 mm HG (millimeters of mercury), with most people averaging 15 to 16 mm HG.

One caution about pressure read-ings. “There is one form of glaucoma called ‘normal-tension glaucoma’ in which the disease exists, but the eye pressure reads normal. We don’t fully

understand the cause,” Boles says. A new diagnostic is optic nerve

imaging. “It’s a major advance for diagnosing glaucoma earlier. It gives a 3-D image of the optic nerve so we can see more clearly if its shape is distorted. That allows us to start treatment sooner so as to minimize any damage,” Boles explains.

Treatment Advances“Broadly speaking, there are

three treatment options for fight-ing glaucoma: medications, laser correction, and surgery. Thanks to advances in the first two, we need to use surgery less often,” Boles says.

Previously medications called beta blockers and alpha agonists were popular but have the potential for significant side effects, especially among older people. “They can cause congestive heart failure, asthma, and excessively low blood pressure, among other problems. More eye

professionals are using a newer class of drugs called prostaglandins, eye drops which have shown minimal side effects,” Boles says.

For laser correction, selective laser trabeculoplasty (SLT) is the more favored procedure for opening the fluid channels of the eye. “With SLT, the laser targets select cells and the laser can be used at lower lev-els. It seems to be much safer and is allowing us to repeat the procedure many times without scarring. That’s good news because many times the channel has to be reopened within one to three years,” he says.

If a surgical procedure requiring an incision in the eye is necessary, a trabeculectomy is often chosen. It allows the patient to discontinue all medications if it succeeds. However, like all surgeries it has risks. Experts suggest talking with a glaucoma spe-cialist to find out when or if surgery is really necessary.

Get Started Now When vision fails, some simple

techniques like removing throw rugs and other obstacles that could trip you, can help. Also check the article on low- and high-tech vision aids for ideas and organizations to help you.

Boles urges everyone to get checked for glaucoma sooner than later. While latest indications are those most at risk are generally over age 60, a family history of glaucoma, are African-Americans (whose risk starts as young as age 35), “I gener-ally tell people to start getting tested annually at age 40. These are simple tests and we can prevent or at least minimize glaucoma’s damage,” he says.

Eye drops for glaucoma reduce pressure in the eye.

doctors could do for AMD, especially in terms of slowing its progress. In 2001, the Age-Related Eye Disease Study (AREDS) announced a new option to slow AMD in people at high risk for developing its advanced form.

Specifically, AREDS recom-mended a new high-dose formula of antioxidant vitamins and zinc. It is a formulation that needs to be discussed with a doctor to see if it’s right for you—especially since the levels are higher than an average multi-vitamin provides.

Laser surgery is a treatment after wet AMD develops, but it is risky and doesn’t necessarily prevent a recurrence. It is generally used only on a small percentage of AMD

patients.Photodynamic therapy is a pain-

less, 20-minute procedure. The doc-tor injects a drug in your arm and then activates it by shining a light into your eye. The drug destroys new blood vessels and slows development of others.

Eye injections are a newer ther-apy. The eye is numbed and drugs called anti-VEGF therapy are inject-ed to block the growth factor causing abnormal blood vessels to develop. You may need several sessions, some-times even monthly, for treatment to be effective.

If you doctor has discovered you have AMD and advised treatment, don’t wait. The sooner you begin, the better your chances of fighting extensive deterioration of your vision.

Want more health information? Visit our free Health Secrets

archives online at www.EricksonTribune.com.

From Macular Degeneration

ALL EYES ON YOUR VISION

Good Health Starts Here Newsletter

Compliments of Erickson Health, an Erickson product

Continued inside

“Vision loss is very common for people over 65,” says Betsy Zaborowski, Psy.D., executive direc-tor of the National Federation of the Blind’s (NFB) Jernigan Institute. The American Foundation for the Blind says 10 million Americans are either blind or visually impaired. Every 7 minutes, someone loses all or part of their sight.

Among older adults, it is esti-mated at least 1.8 million have vision problems that create some difficulty doing basic chores, like dressing, cooking, paying bills, and fun things like traveling and volunteer work. These vision problems also put them at greater risk of falls and fractures.

If you have low vision, you may experience any or all of these prob-lems:

• Blurred vision, which can be caused by cataracts, scars on the cornea, or diabetic retinopathy;

• Loss of central or center vision,

frequently caused by macular degen-eration;

• Loss of peripheral or side vision, most commonly caused by glaucoma or stroke.

Your eye care professional can tell you more about these and other vision-impairing conditions. For now, here are some devices—both low and high-tech—that can help you maintain your independence.

The more basic levelThere are a wide range of devices

that require little, if any, special training. “Consider a radio. You can take it with you to the ball park and listen to the game,” Zaborowski says. Here are a few other ideas:

• Magnifiers—Magnifying devices include those that look like jewelry and are worn around your neck; small hand-held pocket mag-nifiers; spectacles with magnifiers, and ones that fit over a printed page.

Magnifying make-up mirrors are another tool.

• Telescopes—For distant vision needs, hand-held devices for quick reading, like glancing at a sign. For more lengthy needs, like watching a movie, you can purchase a scope that clips onto eyeglasses (which you can remove for hand-held needs) or get bioptic glasses, ones that have the scope embedded. The latter work like bifocals, providing both long and near vision.

• Writing aids—Pens that write in especially bold ink, and templates that fit over your check register so you know where the lines are.

• Audio adapters—“Audio devices, like audio clocks and watches, and talking pill bottles, are among the most popular options we see people using,” says John Paré, a spokesperson for NFB.

“Books on tape are a great way to make the transition as your vision fails,” Zaborowski adds. There are over 100,000 such books available. Not just the latest bestsellers, but also textbooks, histories, science publications, and more. Contact the

Looking for Low- or High-Tech Vision Gadgets

Continued on the back

“Unlike cataracts, in which the recommendation most often is that patients wait until they develop more fully, glaucoma is the exact opposite. You have to start looking for it even before there are symptoms,” says Samuel Boles, M.D.

Boles is a glaucoma-certified ophthalmologist with Omni Eye Specialists and a consulting special-ist at Oak Crest, an Erickson com-munity in Maryland. “Glaucoma is a silent threat. By the time symptoms develop—including blurred vision and halos seen around lights—the damage to your vision has already

occurred,” he says.

A Major Vision ThreatThere are approximately 3 mil-

lion Americans with glaucoma and 65 million cases worldwide. Every year 300,000 Americans are diag-nosed with glaucoma, and one-third of them lose some portion of their vision because of it. At least 5,400 people lose their eyesight completely because of glaucoma every year.

Glaucoma has ten different forms, but 95% of cases are open-angle glaucoma. The eye constantly

Glaucoma: The Silent Thief of Sight

Low vision aids range from simple magnifiers to more technologically advanced devices.

Continued on next page

National Library Service to see if you qualify for free access (also includes musical scores) at 202-707-5100 or nls@loc.gov.

• NFB-Newsline—This service —free to those who qualify and who have a password—reads you the newspaper you choose (or even just one section) over the phone. To regis-ter for this free service, call toll-free, 1-866-504-7300.

• Miscellaneous tools—Includes self-threading needles, large print items like magazines, rulers, and decks of cards, and a pill cutter with built-in magnifier.

And on the high-tech side . . .Computers and vision aids relat-

ed to them have become a big factor in helping people with low vision.

Among your options:• Screen magnifiers—Some

magnifiers fit over your screen. The Information Technology (IT) depart-ment at Charlestown, an Erickson community in Maryland, has a soft-ware program that magnifies text and also has a speech component. It is installed in a computer for resi-dents’ use in the on-site Computer Lab.

• CCTVs—Magnification sys-tems based on closed-circuit cameras produce an enlarged image of text on a TV or computer monitor.

• Screen readers—Reads aloud what’s on your screen—not only computers but now your cell phone as well. One of the most talked about readers is the Kurzweil-National Federation of the Blind Reader. Whereas most read-aloud technol-

ogy can only be used in the home or office, you can take the reader with you, to restaurants for example. “You hold the device over your menu and it takes a picture, then reads the menu to you,” Zaborowski says. It’s not inexpensive right now, but the price is expected to come down as more people start using it. For more information on this reader call toll-free 877-708-1724.

• Braille items—Keyboards with Braille pads, and Braille embossers which provide Braille printouts, are two examples.

There are numerous other options available to you. The NFB has an online store (www.nfb.org) and the Association of Vision Science Librarians has an excellent set of resources online at www.uab.edu/lister/lowvision/.

The odds are you either have heard of, or know someone with, a cataract. This clouding of the eye’s lens happens to almost everyone. By age 80, half of all Americans either have a cataract, or have had cataract surgery. Of the more than 20 million Americans with cataracts, about 17 million are age 60 and older.

“Because cataract development is very gradual, many people don’t realize their vision is being affected. You realize it’s not as sharp, but you don’t think much of it,” says Roland Lascari, M.D., Erickson Health medical director of Cedar Crest, an Erickson community in New Jersey.

Fortunately the days of the old “Coke-bottle glasses” after cataract surgery are long gone. For years now there have been technological advances that might even have you seeing better after cataract treatment than you did before.

What Causes Cataracts?Science still isn’t totally sure what

causes cataract. They are definitely more likely to occur as we age, but why isn’t totally known. Smoking, excessive alcohol use, and prolonged exposure to ultraviolet sunlight are also risk factors.

One of the most common causes of cataracts is medications, especially the corticosteroids, like Prednisone for asthma. There are other drugs—for heart disease, seizures, glaucoma, and cholesterol—that can increase your risk, so check with your prima-ry care doctor or ophthalmologist.

If you are on such medications or have other risk factors, you must have a regular ophthalmological exam. Today, more primary care physicians, like the ones in the Erickson Health network, are trained to do such exams, but not all doctors are. “Following the cataract is a dif-ferent story. That is where you need an ophthalmologist. and sometimes you might even need a retinal spe-cialist,” Lascari adds.

Replacing the LensThere are several types of

cataracts, but the decision for replacement generally rests on one

thing. “The American Academy of Ophthalmology guideline for replac-ing a cataract is when it’s function-ally disabling the person and their quality of life is affected. A surgeon or professional driver may opt for cataract surgery sooner, while some-one else may not be affected by an advanced cataract,” says Douglas R.

Cataract Replacements Keep Getting Easier

From Low Vision Gadgeets

Possible Cataracts Symptoms • Cloudy or blurry vision

• Colors seem faded

• Glare, such as from headlights or lamps

• Sunlight seems too bright

• Poor night vision

• Your eyewear prescription changes more frequently

These can all be symptoms of other eye problems, so what-ever is bothering you, check with your eye professional sooner rather than later.

Lazzaro, M.D., interim chair, oph-thalmology, Long Island College Hospital in Brooklyn.

Cataract surgery involves taking the clouded lens from your eye and replacing it with an IOL, intraocu-lar lens. IOLs generally have one major difference from your natural lens; many don’t adjust to differ-ent distances like reading a book and then looking up at the TV. “There are now accommodating IOLs which are capable of providing adequate vision at both distant and near objects, but they’re still in their infancy,” Lazzaro says.

A newer option is monovision: a distance lens in one eye and a near vision lens in the other. “Try it first with contact lenses and see if you can tolerate it. Some find it too dis-orienting,” Lazzaro says.

In any case, you and your sur-geon should discuss what kind of work you do most. Are you sitting at a computer and need mostly near vision, or are you that driver whose main concern is distances? Such details will have your doctor recom-mend the IOLs prescription. If you spend a lot of time outdoors, perhaps a yellowish IOL with built-in sun-light protection would benefit you.

Whatever you choose, you still might need some type of corrective lens after surgery, but not as strong a prescription as you used to have. Some very nearsighted people report a real thrill in being able to shave or apply make-up for the first time in decades without glasses, thanks to their IOLs!

Types of SurgeryToday the most common pro-

cedure is phacoemulsification (PE)—the cataract is broken into minute pieces by sound waves and suctioned out through a small inci-sion. The complete surgery generally takes between 10 and 30 minutes and the 2.75 mm incision heals much faster and cleaner than the old 10 mm slits.

“If you have a very small pupil or if the cataract is very dense, you may want a larger opening. Then we go back to the older procedure, extracapsular cataract extraction (ECCE) which used that larger opening. But for 90-95% of patients it’s not necessary,” Lazzaro says.

Finally, bear in mind that Medicare does cover cataract sur-gery—but only to a degree. If you want one of the newer lenses or any-thing else deemed “special” you may have to pay for it out-of-pocket.

Age-related macular degenera-tion (AMD) is a leading cause of low vision and blindness in people over 55. The National Eye Institute says 1.8 million Americans over age 40 have advanced macular degen-eration and associated vision loss today, with another 7.3 million at substantial risk for vision loss from the disease. The Institute projects those numbers will double by 2020.

What is AMD?In AMD, a part of the eye

called the macula is destroyed. The macula is what allows you to see fine details and is responsible for sharp, central vision.

AMD causes no pain. Some people recognize the vision loss quickly, but for many it advances so slowly they don’t realize there is a problem until it has made significant progress. And at that point, there is no way to restore the vision loss.

Two Forms of AMDThere are actually two types of

AMD: dry AMD and wet AMD. Dry AMD is a slow process; the light-sensitive cells in the macula

slowly deteriorate. It starts with blurred vision and can progress (in one or both eyes) to a spot obscuring the center of your vision. Dry AMD has early and intermediate stages. Once it’s considered “advanced,” it has become wet AMD.

Wet AMD can occur from an advancement of dry AMD but it can also develop rapidly, on its own. It happens when blood vessels behind the retina leak blood and fluid. The same obscuring of your central vision occurs as in dry AMD, but much more rapidly.

Risk Factors for AMDPeople over 60 are at greater risk

than any other age group. While people considered “middle-aged” have a 2% risk for developing AMD, that risk increases to 30% in people

over age 75. Other risk factors include

race (Caucasians lose vision more often from AMD than African-Americans), family history, and gen-der (women seem to be at greater risk than men). While you can’t change these risk factors, there are two you can change: stop smoking and modify your diet to include more healthful foods, especially green, leafy vegetables and fish.

Treatments to ExploreIt used to be there was little

Green leafy vegetables and fish help protect the health your eyes.

A Different Form of “Wet” and “Dry” Eye

Continued on the back

From Cataracts

Some people recognize the vision loss quickly, but for many it advances so slowly they don’t realize there is a problem until it has made significant progress.