Age- Related Eye Diseases

Blurring of vision and loss of balance are only two of the symptoms reported by my elderly patients in the clinic. These symptoms affect their activities of daily living and makes them less confident to do regular household tasks.

The Philippine National Survey on Blindness conducted in 2004 reported the top ten causes of blindness which include the following:

Cataract. This is the most common cause of visual loss in Filipinos (62.1%) and is very commom in the lederly. Age- related cataracts develop in two ways: (1) clumps of protein reduce the sharpness of the image reaching the retina and (2) the clear lens slowly changes to a yellowish/ brownish color, adding a brownish tint to vision.

Errors of Refraction. This occurs when light rays don't focus on the retina caused by imperfectly shaped eyeball, cornea and lens. There are four types of EOR, myopia, hyperopia, astigmatism and presbyopia.

Myopia- or nearsightedness is caused by long eyeball or steep cornea. Patient sees close objects clearly while distant objects appear blurred.

Hyperopia- or farsightedness is caused by shorter than normal eyeball, causing distant objects to look clear while near objects look blurred.

Astigmatism- or distorted vision is caused by abnormal curvature of the cornea. One area of the cornea may be curved more than the other.

Presbyopia- or aging eyes. The aging lens become rigid and can't change its shape easily thus making it difficult to read at close range.

Glaucoma. This is the third most leading cause of blindness. It shows characteristic optic disc excavation or cupping, visual field defects and elevated intraocular pressure. Glaucoma cannot be cured but if diagnosed early and treated immediately disease progression may be delayed.

Diabetic Retinopathy. This is a complication of diabetes. It occurs when diabetes damages the tiny blood vessels inside the retina. Vision loss is caused by macular edema or blood leak into the center of the eye also called proliferative retinopathy.

Age- related Macular Degeneration. A disease that blurs the sharp, central vision one needs for "straight-ahead" activities such as reading, sewing, and driving.

It has been noted that taking a specific high- dose formulation of antioxidants and zinc significantly reduces the risk of advanced age related macular degeneration and its associated vision loss. It is recommended therefore for the lederly to take 500mg of Vit. C, 400IU of Vit. E, 15 mg or equivalent to 25,000IU of Vit. A, 80 mg of Zinc and 2 mg of Copper once daily.

Not all of these causes of blindness are preventable and curable hence, awareness that something can be done to improve the quality of the lives of those afflicted should be emphasized.

The Diabetes Legacy

Once again, Dr. R. Fernando, an 80 year old diabetologist, staunch believer of treating pre-diabetics aggressively, encouraged us to to do the same in our practice.

In my once a month wellness day in my private practice, I noticed that most of the patients have fasting capillary blood sugar between 103-140. They are either known diabetics or "healthy" individuals. I have always emphasized on strict lifestyle modification.

What convinced me really is the idea that perhaps diabetes is a disease of the lipids and not the sugar or perhaps disease of the heart and consequently dysglycemia. Truth is, most of my patients who developed diabetes, had, in the past, impaired lipid levels and they were not followed up strictly, so that 5 to 10 years after they come to me already with high sugar levels and a coronary problem.

It is a cry for us Family Physicians to move. We may have come 100 years earlier but who knows, what if treating those 90 and above will lower the incidence of diabetes or perhaps delay its onset? Wouldn't it be nice if the world has less diabetics?

This calls for an evidence based research and I will begin in my patients, today and now....!