Low Vision and Losing Independence: What You Need to Know

By Dr. Katia Taba, Personalized Retina Care of Naples

When it comes to vision loss or visual changes, it is imperative that individuals see an ophthalmologist because as we age, low vision can make many daily living requirements that we often take for granted difficult or impossible to accomplish. For example, driving, reading, shopping, financial organization, and medication management all require good eyesight. When the elderly lose vision, they can also become more susceptible to falling and breaking bones. This vision loss and risk factor association is known as visual disability, and it is one of the primary reasons that seniors have to leave their homes and enter into an assisted living facility or depend on caregivers.

Vision loss is not a normal part of aging. To better understand low vision, let us define some aspects of vision. Central vision is responsible for detailed vision that helps us read and recognize faces. Peripheral vision helps us get around and that is what we use to see something “at the corner of our eyes.” Contrast sensitivity makes us distinguish different tones and colors such as milk in a white cup. Depth perception helps us see objects in space.

However, presbyopia is “normal” because as we age, many times the lens of the eye is no longer able to change its shape precisely enough to clearly make out images that are close, like a label on a prescription bottle, small print in a book, or a list of ingredients on a jar of sauce. Presbyopia is near vision loss but can be easily corrected with glasses for near vision. That is not vision loss. With vision loss, vision stays blurry even with the appropriate pair of glasses. That is why if you are losing vision with your pair of glasses, you need to see an eye doctor right away.

Other than presbyopia, vision changes and low vision or a blocked visual field are all signs of a condition that needs to be addressed by an ophthalmologist immediately. It is critical to see an eye specialist to prevent any further vision loss or blindness. The bigger question is if it is not a normal aging process, why do 6.5 million seniors over the age of 55 have some degree of vision loss? To clarify, it is important to review the primary causes of low vision.1

Macular Degeneration
The macula is the central area of the retina that provides the most intricate details of sight. It is an oval area that acquires images that travel through the cornea and lens, and provides visual communication to the brain.

In adults over the age of 50, age-related macular degeneration (AMD) is the leading cause of blindness. It is estimated that more than 10 million Americans have some degree of AMD, and unfortunately, there is still no cure for the disease. But there is a great treatment for some forms of the disease.

In AMD, the macula becomes damaged leading to loss of vision, distortion or the appearance of blind spots in central vision. Although it is a very complex disease and still not completely understood, it can be brought on by both hereditary and environmental factors.

There are two main types of AMD, wet and dry. Typically, AMD starts as the dry type and may progress into the wet form of the disease. Dry macular degeneration is the most common form of the disorder, In some cases, whitish deposits (drusen) adhere to the retina, just under the macula and the drusen weaken and deteriorate the macula causing severe central vision loss and blindness.

Wet macular degeneration happens to about 10 to 20% of the individuals that have dry AMD and is usually caused by blood vessels that leak fluid or blood into the macula. It causes blind spots, blurry vision and rapidly escalates to vision loss.

Macular degeneration has several therapies that prevent the disease from progressing. One of the main treatments is antiVEGF (anti-vascular endothelial growth factor) injection.

Dr. Taba, Ophthalmologist and Retina Specialist explains, “In a National Eye Institute (NEI) study, researchers concluded that before the anti-VEGF injections, 2/3 of wet macular degeneration patients went legally blind within two years of diagnosis. Now, we are able to keep vision 20/40 or better in half of our patients. This reduction reflects on a 20% decrease in long term facilities admission since elderly patients are not going legally blind.”

The conclusion of the study confirmed that antiVEGF injections are a major long-term therapeutic advance for neovascular AMD and it was effective at decreasing blindness and the progression of the disease.2

Diabetic Retinopathy
One in 10 Americans has diabetes, putting them at heightened risk for visual impairment due to the eye disease called diabetic retinopathy. The disease also can lead to other blinding ocular complications if not treated in time. Fortunately, having a dilated eye exam yearly or more often can prevent 95 percent of diabetes-related vision loss.

In both type 1 and type 2 diabetics, high blood sugar is highly involved in damaging the delicate blood vessels in the retina. This damage is called diabetic retinopathy. In diabetic retinopathy, serious complications can cause significant vision loss if left untreated. Sudden vision loss from complications, such as vitreous hemorrhage or tractional retinal detachment are extremely threatening issues that can cause blindness.

Eye exams are critical as they can reveal hidden signs of disease, enabling timely treatment. This is why the American Academy of Ophthalmology recommends people with diabetes have eye examinations annually or more often as prescribed by their ophthalmologist, a physician who specializes in medical and surgical eye care.

Treatment is customized for each eye of each patient and can include all of the following:
Medications to inhibit blood vessel growth, vitrectomy surgery, laser photocoagulation, and blood glucose management.

Glaucoma
Glaucoma is referred as a “Sneak thief of sight” because, unfortunately, there are minimal symptoms associated with the disease and the diminutive indicators can cause up to 40% of permanent vision loss before the person notices any vision changes. Millions of Americans are suffering from a dangerous eye disorder that can rob them of their sight, and nearly 1.5 million of them do not even know they have the condition. Glaucoma is the second leading cause of blindness and can also affect the elderly.

Glaucoma treatment consists of topical medication, different modalities of laser and incisional surgeries to relieve intraocular pressure.

Protecting & Preventing Vision
There are many things we can do to prevent loss of vision. Some of these include:
• Stop smoking
• Wear protective eyewear
• Wear sunglasses
• Control blood pressure
• Control blood sugar
• Exercise
• Reduce sugar and salt intake
• Eat a healthy diet that consists of omega-3 fatty acids, lean protein (avoid red meat) and plenty of fresh fruits and vegetables.

If you are experiencing any changes in your eye health, whether it is blurry vision, pain, impaired vision, or any other visual irregularities, it is imperative that you see an ophthalmologist right away. The earlier disease or disorders are detected, the better the outcome and treatment options are for you.

Personalized Retina Care of Naples provides incomparable diagnosis, medical and surgical treatment for retinal conditions and disorders. Dr. Taba is a Board-Certified Ophthalmologist and is Fellowship trained in surgical and medical retinal diseases.

There are ways to regain your independence and correct low vision. To find out more, or to schedule your appointment, please call (239) 325-3970 today.

Personalized Retina Care of Naples
www.retinanaples.com
3467 Pine Ridge Road Suite 103, Naples 34109

References:
1. American Foundation for the Blind, “Services for Older Persons Who Are Blind or Visually Impaired”, Arlington VA, 2019, afb.org
2. C Wykoff, MD, “5-year CATT data reveal strengths, limitations of anti-VEGF therapy.”, 2016, American Academy of Ophthalmology, aao.org