Sudden vision loss is scary and a reason to see a physician immediately, but other vision problems can develop so slowly that you don't realize there's a problem. That's why it's important to have a comprehensive eye exam done every one to two years, depending on your individual risk factors. "Many people really have no idea that the eye and the brain are so sophisticated that you can have 2020 vision, and still have very serious eye diseases lurking in the eye," says Stephanie Marioneaux, M.D., clinical spokesperson for the American Academy of Ophthalmology. Here are eight common vision issues you should be aware of, along with their risk factors and potential treatment options. Early diagnosis and treatment can often stop vision loss in its tracks.
What it is: Refractive errors are the most common vision impairment among adults between age 19 and 40 and they include myopia (nearsightedness), hyperopia (farsightedness), astigmatism (distorted vision at all distances), and presbyopia (the loss of up-close focusing ability), according to Barbara Horn, O.D., president of the American Optometric Association. All of these issues happen when the eye can’t properly bend light.
The cause: Genetics, age, and gender play a role. Spending a lot of time looking at things up close — for instance, while using a smartphone screen, reading a book, quilting a blanket — can also increase your risk of myopia, which is a growing problem.
What to do: Have your vision checked and then use glasses, contact lenses, or laser surgery to correct errors. The National Eye Institute says 11 million Americans aren’t sufficiently corrected and would see a whole lot better if they were.
What it is: “Diabetic retinopathy occurs when your blood sugar is at such a high level that the glucose molecules damage the blood vessels in the eye, which then leach,” says Dr. Marioneaux. “So everything in your bloodstream, including lipids and proteins, spill into the eyes. Where the leakage of the blood vessels occurs will determine how much your vision is impacted.” With the many cases of type 2 diabetes in the U.S., research shows diabetic retinopathy is the leading cause of blindness in Americans between age 20 and 74. Signs include seeing spots or floaters, blurred vision, having a dark, or empty spot in the center of your vision and difficulty seeing at night.
The cause: Poor control of blood sugar is the root cause. Type 1, type 2, and gestational diabetes can put a person at risk for developing diabetic retinopathy.
What to do: People with diabetes can prevent this complication with strict glucose control. Just because you’re taking diabetes medication doesn’t mean you’re in the clear. “Patients who keep their blood sugar over 100 and their hemoglobin A1C around 7, 100% of them will develop diabetic retinopathy within 20 years,” says Dr. Marioneaux. “Well, 7 is okay for the heart, brain and circulation, but it is disastrous for the eye so ophthalmologists say to keep your hemoglobin A1C under 6.5 and blood sugar between 80 and 100.” If you have diabetes, eat right, exercise, take all prescribed medications, check your blood sugar regularly, and get a yearly dilated retinal exam. Lasers, injections and/or surgery can be effective, but only before the loss of sight, which is why early diagnosis is crucial.
What it is: The macula is a small portion of the retina located on the inside back layer of the eye that helps us see what’s directly in front of us. With age-related macular degeneration (AMD) — the leading cause of severe vision loss and blindness in adults over age 65 — some sufferers may see a gray or black spot in the center, with some vision in the periphery.
The cause: Over time, the macula can develop deposits, causing early (also called “dry”) AMD, the most common type. The “wet” version occurs when the macula fills with leaky abnormal blood vessels. Aging and genetics are most to blame, but smoking and UV exposure also increase your risk.
What to do: “Most people with macular degeneration have the dry form, for which there is no known treatment,” says Horn. “The less common wet form may respond to laser procedures and medication injections, if diagnosed and treated early.” Once you hit your mid-to-late 40s, you should have an eye exam every two years, or annually if you have a family history of AMD. Your doctor will dilate your pupils to look behind them. If early to intermediate AMD is diagnosed, you may be advised to take special vitamins packed with C, E, zinc, lutein and other nutrients to slow down the damage.
What it is: Pressure buildup in the eye can cause damage to the optic nerve over time. Peripheral vision is affected first, but total blindness may eventually result. “Primary open-angle glaucoma often develops slowly and painlessly, with no early warning signs,” says Horn. “It can gradually destroy your vision without you knowing it.” Estimates show more than 3 million Americans have glaucoma and it may become even more common as the population ages.
The cause: “The exact cause is unknown, but for some reason, the passages that normally allow fluid within your eye to drain become clogged or blocked,” says Horn. “The fluid in your eye then builds up and increases pressure on the optic nerve.” Anyone can get it, but age and genetics can up the odds.
What to do: See your eye doc for a checkup — half of sufferers don’t know they have the disease. “Essentially, if you begin to lose vision from the side — your peripheral vision — your brain is so smart that you just move your head and you don’t even notice that your vision is shrinking,” says Dr. Marioneaux. Plus, if it’s only happening in one eye, your brain will use the better image from your other eye. Although physicians can use a test in which a puff of air is blown into your eye for screening, official diagnosis requires a dilated exam to scrutinize the optic nerve as well as other tests. Medicine, lasers and/or surgery can keep the disease from worsening. “The goal of the treatment is to prevent vision loss by lowering the fluid pressure in the eye,” says Horn. “Unfortunately, any vision lost already from glaucoma usually cannot be restored.”
What it is: Proteins in the lenses clump together into clouds, blurring vision. Cataracts can range from a tiny blurry spot to a large opaque area. You may also have difficulty perceiving colors, notice a halo around light, or have trouble seeing at night.
The cause: When people get old enough, almost everyone has a cataract. However, cataracts are occasionally found in younger people, including newborns, says Horn. If you have spent a lot of time in the sun, take steroids, have diabetes, or smoke or drink a lot, your risk is even higher.
What to do: A cataract can be detected during an eye exam with dilation, but you’ll likely notice the aforementioned symptoms first. If your cataract is small, try reading with a magnifying glass and using brighter lights at home and the office, but if it gets bigger, outpatient surgery is an option. “Most patients are excellent candidates for cataract surgery and we have very excellent results,” says Dr. Marioneaux. “We are able to remove that cloudy lens which focuses the light in your eye and we replace it with an artificial lens.”
What it is: Tears protect the eye and help give you crisp, sharp vision, but when a person doesn’t have enough tears to properly lubricate their eyes, it’s difficult to wash debris out and prevent infections from taking hold. Dry eyes can result in blurred vision, a burning sensation, or eyes that feel gritty, scratchy, or irritated.
The cause: “This is an emerging problem,” says Dr. Marioneaux. “It’s based on the evaporation of tears from the surface of the eye, and this happens when you stare, which is what everybody’s doing day in and day out.” Intense watching of screens (like phones, tablets, TVs, and computers) or even driving long distances without blinking can trigger dry eyes. Some medications (including antihistamines, blood pressure treatments and antidepressants), environmental conditions (such as smoke, wind or low humidity), eye surgeries (like LASIK), and medical conditions (including Sjögren’s syndrome, rheumatoid arthritis, diabetes and thyroid issues) can also lead to dry eyes.
What to do: Use the 20-20-20 rule to relax and rewet your eyes: Every 20 minutes, look 20 feet in front of you for 20 seconds. Also, make sure your computer monitor isn’t set so high that your eyes must be completely open to see it. Exposing more of your eyeballs to air speeds up evaporation of moisture. If dry eyes become chronic, see your doctor — he or she may recommend eye drops. “Dry eyes does not lead to blindness,” says Dr. Marioneaux, “but it can lead to compromised function.”
What it is: Bacteria in your eyes can result in redness, itching, swelling, discharge, pain and/or difficulty seeing.
The cause: Bacteria can be introduced to your eye in a variety of ways. Wash your hands often and try to avoid touching your eyes. Old eye makeup can also harbor germs. Contact lens wearers, who may introduce germs as they insert the lenses, are at high risk.
What to do: Toss mascara every three months. Take out contacts at night, even if they’re labeled for long-term wear — sleeping in them ups your risk tenfold because it gives bacteria time to multiply. See your eye doctor immediately as you may need Rx antibiotic drops to fight the infection.
What it is: Dots, circles, lines, and specks get in the way of your vision and seem like they’re floating on top of your eye. However, the interference is actually inside your eye.
The cause: The clear gel behind the eye clumps together, allowing us to see it.
What to do: The gel clumps aren’t usually dangerous, but if new floaters appear suddenly or you see sudden flashes of light or shadows, see your doctor to rule out a retinal tear. Otherwise, leave it be. Your eye and brain will eventually adjust and you’ll stop noticing the floater. Unfortunately, eye drops won’t help floaters disappear.
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