Vision Changes

Vision Changes

Set Your Sights High

You've booked the corner table at Chez Chic, and it's time to wow the clients from out of town. The sommelier hands you the wine list. You sigh nonchalantly, make a joke about bad California Chablis and open the list with a practiced touch of disdain.

Uh-oh. You can't read it. Your eyes won't focus on the fine print. So much for being nonchalant. You straighten your arms, hold the list a yard from your face and start to squint.

Just like that, you've gone from deal maker to dear old grandma, sitting there reading a large-print version of The Old Farmer's Almanac. What's next--knitting needles, a rocking chair?

It's a fact of life that sooner or later, your vision is going to fade a bit. Nine in ten women between ages 40 and 64 wear glasses or contact lenses to make reading and other close work a little easier.

But don't despair. You may be able to slow the process with regular eye exams, a healthful diet and maybe even some do-it-yourself eye exercises. More importantly, you can take steps now to deal with serious vision problems such as glaucoma, cataracts and macular degeneration that could lead to greatly reduced sight or even blindness.

Up Close and Blurry

Remember all the ladybugs in Mom's old flower garden? You'd pick them up gently and let them crawl on your fingers, holding them right up to your nose and counting the little black dots on their backs.

Try that now. Odds are you couldn't tell a ladybug from a breath mint until it was seven or eight inches from your face. That's because the lenses in your eyes begin to stiffen with age. And the less they bend, the harder it is to focus on something close.

The condition is a form of farsightedness called presbyopia, and it's as inevitable as rain at a picnic. "There's really no way around it," says Richard Bensinger, M.D., a Seattle-area ophthalmologist and spokesman for the American Academy of Ophthalmology. "It's easy to correct, but it means you're probably going to have to wear glasses or contact lenses."

If you do end up needing corrective lenses, the choice between glasses and contact lenses is usually up to you. "In most cases, it's just a matter of preference," Dr. Bensinger says. "Some people like glasses, which they can take off when they don't want them. And some like contact lenses, which allow them to see well without showing people that they need glasses."

Even if you eventually need bifocals, which help correct your vision both near and far, you don't have to advertise it to the world. Doctors have developed blended lenses that eliminate the telltale line across the center of each lens. You could also try bifocal contact lenses, which allow you to change focus as your eyes move up and down. Dr. Bensinger says they can be much more expensive than standard contacts, however, and warns that not everyone can adjust to them.

Your eye doctor might also prescribe so-called monovision contact lenses. You put a distance vision contact in your dominant eye (usually the right) and the reading contact in your other eye. "It's not as hard to adjust to as it sounds," Dr. Bensinger says. "You don't have to consciously adjust to it every time you change your focus." Monovision lenses are made like regular contacts and are less expensive than bifocal contacts, he says.

In addition to presbyopia, spots and floaters may appear more often as you get older. These are little specks or dots that pop up occasionally in your field of vision, then disappear after an hour or a day or more. Dr. Bensinger says they're caused when parts of the clear vitreous fluid that fills your eye get a little stringy or lumpy.

"Usually, it's nothing serious," Dr. Bensinger says. "The spots just drift down out of your vision, and that's it. But if you suddenly see lots of spots or flashes of lights in your eyes, that could be a sign that something more serious is wrong, and you should see a doctor immediately."

And if you live in especially dusty or windy areas, you may be at risk of developing pterygiums, which are fleshy, benign growths around the eyes. These can start growing in your mid-twenties, usually on the sides of your eyes closest to your nose. Dr. Bensinger says they're just a cosmetic problem unless they grow large enough to block your sight. Pterygiums are easily removed with minor surgery.

Taking the Long View

Barring accidental injury, your eyes will probably serve you well right up to your mid-sixties. You may need a new set of reading glasses every few years, but you probably won't notice any serious deterioration of vision.

Still, experts warn that you should never take your eyes for granted. Most serious eye diseases are painless and show no symptoms for years. If you don't get your eyes examined on a regular basis, you may not know how bad things have gotten until it's too late to help. Here are some diseases to watch out for.

Glaucoma. This progressive disease causes 12 percent of all blindness in America. It is marked by increased fluid pressure in the eye, which, over the years, can cause irreversible damage to the nerves that send vision impulses to your brain.

Doctors don't know what causes most kinds of glaucoma, and they don't know how to cure it. Vision lost to glaucoma cannot be restored, but when detected early enough, glaucoma can be controlled. Eyedrops or oral tablets can sometimes help lower the pressure in the eye. If that fails, laser surgery may help unclog the eye's natural drains, allowing fluid to escape and lowering pressure. And if that doesn't work, eye surgeons can create an artificial drain to carry away the fluid.

An estimated three million Americans have glaucoma, and half of them don't even know it. Another five to ten million people have the eye pressure buildup that precedes the disease, and far fewer than half of them know it. The best advice for dealing with glaucoma? Find out if you have it--now. "The earlier this disease is picked up, the better able we'll be to control it," says Carl Kupfer, M.D., director of the National Eye Institute in Bethesda, Maryland. That means regular eye exams, especially if you're at high risk for glaucoma.

Cataracts. Although they usually don't become a problem until you near retirement age, cataracts often start forming much earlier in life, especially if you have ever had an eye injury or have undergone such procedures as radiation treatments, chemotherapy or an organ transplant.

Over the years, the once-clear lens in each eye may turn yellow because of protein buildup. In time, the lens may become milky white and translucent, clouding vision to the point where you need an artificial lens implant. This plastic replacement lens does not flex to focus light, as the original lens did. But with corrective glasses, your vision can be restored quite well. "While we can't yet cure cataracts, we can certainly provide patients with good sight," Dr. Bensinger says.

Cataracts, like glaucoma, may have a hereditary link. So if anyone in your family has had cataracts, you may be at higher risk and should have your eyes examined more often than the standard every three years.

Macular degeneration. This insidious eye disease robs you of your fine visual skills. "In more advanced cases, you would be able to tell that someone was standing in front of you, but you couldn't tell who," Dr. Bensinger says. "You could see there was a bus coming down the street, but you couldn't tell which one, because you couldn't read the sign."

The cause remains unknown, but the condition somehow causes deterioration of the macula, the central part of the retina that's responsible for sharp focus. Unfortunately, there's little hope right now for restoring sight lost to macular degeneration, though laser surgery may help stabilize sight for a time. There is some hopeful news, though: Because macular degeneration strikes people who are over age 60 almost exclusively, you can start now--perhaps with the help of an improved diet--to ward it off before it starts.

Diabetic retinopathy. It primarily strikes people with diabetes and is the leading cause of blindness in people ages 20 to 50. Loss of vision begins to occur when blood vessels in the back of the eye leak, blurring vision and sometimes denying nutrients to the eye.

"If you have diabetes," Dr. Bensinger says, "I cannot urge you strongly enough to have your eyes checked regularly. It can literally save your sight."

Laser treatments can help slow the damage from leaking vessels. But again, help is available only if you get your eyes examined regularly. "Early detection of diabetic retinopathy is even more of a success story than testing for glaucoma," Dr. Kupfer says. If caught early, there's a 95 percent chance you can keep your sight for at least five years, Dr. Kupfer says.

Focusing on Prevention

You can't change your genes, so there's not much you can do about the biggest vision risk factor of all--heredity. Still, here's some advice to give you the best chance of staying 20/20 into the twenty-first century.

Get your eyes checked. Doctors just can't say this enough.

"Regular eye examinations are by far the most important thing you can do to help preserve your vision," Dr. Bensinger says.

If you are between ages 30 and 50 and have no previous eye problems, the American Academy of Ophthalmology suggests seeing an ophthalmologist every three years. If you have a family history of glaucoma or diabetes or are already wearing glasses or contact lenses, your doctor may suggest more frequent visits.

The academy suggests an immediate visit to the doctor for any of the following:

* Sudden vision changes in one or both eyes

* Unexplainable redness

* Seeing a number of spots or floaters or showers of sparks in the corners of your eyes

* Eye pain that won't go away

* Accidental contact with chemicals, especially lye

Hide behind some shades. Sunglasses that block both UVA and UVB rays and visible blue light may help decrease the risk of cataracts, Dr. Bensinger says. Wraparound glasses that cover the sides of your eyes are a good idea, since they shield your eyes completely. And try to wear a hat with a visor to block direct sunlight from your eyes. "Exposure to sunlight drops the age at which you may develop cataracts," Dr. Bensinger says. "So if you're going to be outside, it makes sense to cut that sunlight as much as possible."

Stop smoking. Cancer. Wrinkles. Stinky clothes. Yellow teeth. Emphysema. If you really need another reason to quit, here it is: Cigarette smoking might cause cataracts. A Harvard Medical School study of 120,000 nurses showed that women who smoke 35 or more cigarettes a day have a 63 percent greater risk of developing cataracts.

The reason isn't known, but researchers speculate that smoking may reduce antioxidant levels in your blood, promoting cataract growth.

Try some see-food. The links between diet and vision are still weak. But there's growing evidence that a substance called glutathione may help control the spread of macular degeneration. It's found in fresh green, red and yellow vegetables. Canned or frozen vegetables lose all their glutathione in processing.

Zinc may help, too. Though there's no hard evidence yet, Dr. Bensinger says taking multivitamin supplements containing zinc "is probably not a bad idea, as long as you're not spending too much money on fancy brands."

Antioxidants--vitamins A, C and E plus beta-carotene--showed promise as cataract fighters in the Harvard Nurses' Health Study. A report in the American Journal of Clinical Nutrition claimed that people who eat 31/2 servings of fruits and vegetables every day have a lower risk of cataracts, too.

"Eating a healthy diet may delay the usual aging of the lens and so delay cataracts," says Paul F. Jacques, Sc.D., an epidemiologist with the U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts University in Boston.