Reading: You are More at Risk for Eye Issues Than a Man

By the time we hit our 40s and 50s, many of us are trying to be more savvy about preventive health: We schedule our mammograms, visit our dermatologists for skin checks and our ob/gyns for pap smears, and pay annual visits to our primary care doctors, who perform routine blood panels. But unless we need glasses, how many of us regularly check in with an ophthalmologist? 

“Most people will agree that vision is precious, however 80 percent of Americans don’t get regular eye exams,” Adam Katz, MD, my ophthalmologist brother-in-law, tells me. “People think if they can see well, they don’t have an issue, but seeing well doesn’t mean there isn’t a problem. Glaucoma, for instance, has no symptoms until it’s too late to preserve vision.”

Though 1 in 28 adults over 40 in the US suffers from some degree of vision loss (and I’m not talking about the kind that is correctable with reading — or even prescription — glasses), the major vision-threatening eye diseases (including glaucoma, cataracts, macular degeneration, and diabetic retinopathy) go undetected in far too many, simply because people neglect to get their eyes checked. 

When researchers at the Centers for Disease Control (CDC) asked people who had not seen an eye doctor in the previous year why they hadn’t, the number one reason was the lack of health insurance, says Jinan Saaddine, MD, a medical epidemiologist who leads the CDC’s Vision Health Initiative. “But the number two reason was ‘I didn’t need to.’ We need to do better with educating the public about the importance of eye health.”

Because the risk of all of these eye diseases increases with age, the American Academy of Ophthalmology (AAO) recommends that all adults have a baseline comprehensive eye evaluation when they reach age 40, followed by regular ophthalmologic check-ups every one to four years, depending on a person’s age and risk factors. 

Early Detection is Key
With most ophthalmologic diseases, early detection means a better outcome. “Glaucoma, which results in damage to the optic nerve and can lead to irreversible loss of side vision, is the purest example of this,” says Michelle Andreoli, MD, spokesperson for the AAO and an ophthalmologist at the Wheaton Eye Clinic in Wheaton, IL. Glaucoma affects 2.6 million people in the US, according to the CDC, half of whom don’t even know they have it.  But by the time patients have symptoms, Dr. Andreoli says, the damage is already done. 

The eye is a hollow organ, somewhat like a water balloon, she explains. The inside of the eye is fluid filled: The accumulation of too much fluid over time puts pressure on the optic nerve, compressing it and damaging the nerve fibers inside. “You very slowly lose side vision, and your visual field can shrink all the way down until you get tunnel vision — patients only see the very center and lose everything off to the side,” Dr. Andreoli says. This inability to see things to your side, she says, makes it impossible to drive, since you can’t see a car coming up beside you, and difficult to navigate safely in your environment. 

The goal of glaucoma therapy is to lower the pressure inside the eye, using drops, laser, or surgery. This can reverse the damage to the optic nerve, but it can’t restore lost vision. “We’d like to catch our glaucoma patients before they’ve lost any vision,” says Dr. Andreoli.

Other Common Eye Diseases
The cells in the retina — the light-sensitive tissue in the back of the eye — do not divide; we are born with a finite number of retinal cells. In people with age-related macular degeneration (AMD), some of these cells die off faster than they should, eventually compromising central vision, which is not only needed for seeing objects clearly, but is also crucial for tasks like reading, watching TV, or driving. “We’d like to know if patients are losing those cells, a condition known as dry AMD,  because there are vitamin cocktails that can slow that loss,” says Dr. Andreoli. 

Some patients will not just lose those important cells, but as the eye become sicker will develop abnormal blood-vessel growth beneath the retina. If detected early, these vessels can be eliminated through injections or laser treatment. But if left unchecked, these abnormal vessels can start bleeding, leaking fluid into the macula, or center of the retina, and causing severe central vision loss. This is referred to as wet AMD.

The most common cause of vision loss in the United States, cataract — or clouding of the eye’s lens — affects more than 24.4 million people age 40 and over. By the time they reach 75, a whopping half of all Americans will have cataracts, according to the AAO. 

The first symptom of a cataract is difficulty driving at night. Though early detection doesn’t affect cataract treatment or outcome, “knowing a cataract is there provides a springboard for patient education,” says Dr. Andreoli. There are ways to modulate the symptoms of night glare, for example, by wearing glasses with yellow-tinted lenses. Ultimately, the only way to treat cataracts is with surgery, but cataract surgery is a fairly straightforward outpatient procedure, according to Dr. Andreoli. “I tell my patients it’s harder than a mammogram, but easier than getting a tooth pulled.” 

Diabetic retinopathy, a complication of diabetes that leads to bleeding within the retina itself, is a leading cause of blindness. As the blood vessels in the retina continue to bleed inappropriately, parts of the eye may not get enough blood supply, causing tiny strokes in the eye, Dr. Andreoli says. Just as brain cells die when a stroke prevents them from getting the oxygen they need, retinal cells can die as well, leading to vision loss in areas of the retina. 

Regular eye exams are especially important for diabetics, experts say, not just to check for diabetic retinopathy, but because diabetics are also at higher risk for glaucoma and macular degeneration. The problem, says Dr. Saaddine, is that 1 in 4 people with diabetes don’t know they have it. “And 1 in 3 American adults have prediabetes,” she adds “and 90 percent of them don’t know it.”  

A Window Into the Body’s Health
Regular eye exams are not only necessary for preserving eye health: Just by looking at the eye, ophthalmologists can diagnose diabetes and other chronic health conditions like hypertension, carotid artery disease, and blood cancers. Recent studies suggest that eye tests can even pick up early signs of Alzheimer’s disease. “They say the eyes are a window into the soul,” says Dr. Saaddine, “I say they are also a window into your health.” 

What other steps can you take to preserve your eye health? Quit smoking — or don’t start — as smoking has been linked to AMD, cataracts, and glaucoma. Wear sunglasses, since prolonged exposure to sunlight increases the risk of cataracts and AMD. Regular exercise and a heart-healthy diet also benefits eye health — and reduces the risk of diabetes. “If we can prevent diabetes, we can prevent the vision loss associated with the disease,” points out Dr. Saaddine. 

Women at risk
More than 60 million adults in the US are at high risk for serious vision impairment, and as the population ages, that number is only expected to increase. 

The trend toward teleophthalmology — the largest segment of the growing telemedicine market — is likely to make getting eye exams more accessible and more convenient. Dr. Katz and his partner William Mallon, MD, at the Center for Advanced Eye Care in Vero Beach, FL, for example, have created a comprehensive eye-exam kiosk — aptly named Globechek — which they plan to put into public places to encourage more people to get tested. In a pilot study of the kiosk, which will connect to eye specialists remotely, Columbia University ophthalmologist Lama Al-Aswad, MD, detected sight-threatening eye conditions in nearly half of those screened, underscoring the importance of preventive eye exams. 

Women are at increased risk for most of the eye diseases associated with aging, mainly because they live longer than men, and thus are more likely to be affected by these conditions. In fact, according to Dr. Saaddine, women comprise two thirds of the world’s vision-impaired population. They are also more susceptible to other eye-related problems as they age, notes Dr. Saaddine, including dry eye, which is not only a lesser-known symptom of menopause but also a symptom of autoimmune diseases like Sjogren’s syndrome, lupus, and rheumatoid arthritis, all of which are more common in women.

So for now, midlife women in particular would be well advised to add the ophthalmologist to their doctor to-do list.