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The Eyes Have Our Attention One day Alice and Mary were having lunch in their favorite restaurant when Alice complained about the fact that she had to go see the eye doctor again. She was having problems reading the menu despite having bought new glasses just nine months ago. Usually, she only needed new glasses every 2 to 3 years. Mary, who is 55, asked Alice her age. Alice admitted to being at least 10 years older than Mary but would not give her actual age. Mary was concerned about her friend’s sudden visual problems because her own mother had been having difficulty for the past several years. She suggested that Alice make an appointment to see if the doctor could find any specific reason why she needed glasses so quickly. Mary knew there could be several causes for her friends failing eyesight. For instance, cataracts could be forming, Alice could have Glaucoma, or she could have the beginning symptoms of Macular Degeneration. Several weeks later, Alice called Mary to tell her that she had seen an Ophthalmologist and to let her know what the doctor had told her about her declining vision. Alice told Mary that she was originally concerned that she had Glaucoma, which she had heard can cause blindness without any symptoms. The doctor had explained to Alice that Glaucoma could be compared to one’s arm going numb after sleeping on it wrong. Pressure silently builds up inside of the eye and pushes on the optic nerve, which connects the eye to the brain. However, instead of “falling asleep” like one’s arm, there is a gradual loss of vision. The doctor said that some eyes that are more sensitive could have damage even with normal intraocular pressures. If the doctor had suspected Alice might have Glaucoma, then additional eye tests would have been ordered to examine the peripheral vision or the optic nerve directly. The doctor said that if Alice had Glaucoma, it could likely have been controlled by lowering the pressure in the eye through prescription drops, lasers, or even in severe cases with surgery. However, the doctor found that Alice’s eye pressure was fine. Mary then asked Alice about the possibility of Macular Degeneration since Alice’s brother lost his driving privileges because of the disease’s effects. She knew that he had lost his central vision from what is referred to as “wet” changes, though she was not sure what that meant. While Alice’s brother was still able to see to get around his home and was not blind, he described his vision as “looking through grease.” Though Alice said the doctor told her she did not suffer from Macular Degeneration, Alice said that the way the eye doctor described the disease reminded her of her garden. The retina cells that translate light into vision are similar to flowers, in that they need to be adequately nourished and tended to thrive. With “dry” macular degeneration, the cells wither just like a flower that is not watered and fertilized. “Wet” macular degeneration is different in that there is a rapid disruption of the cells from leaking fluid or bleeding which is similar to a flood in the garden from a broken water main. Alice learned that if “wet” macular degeneration is caught early, it can sometimes be treated with a laser to seal the leaky blood vessels or slow the leak. Alice said that to check for Macular Degeneration, the doctor dilated her pupils to evaluate the back part of her eye. The doctor saw some early changes, called Drusen, which are like age spots of the retina. If the Drusen continue to accumulate, they can progress to “dry” macular degeneration. To monitor the Drusen accumulation, Alice was instructed to look at a sophisticated tic-tac-toe like grid called an Amsler grid and to let the doctor know if the lines of the grid became distorted or blurred since such blurring may signal the progression to the “wet” kind. The doctor informed Alice that smoking, hypertension, and one’s family history place people at additional risk for macular degeneration, while a diet rich in leafy green vegetables is protective. Though Alice told Mary that she was not a smoker, she said that she planned to increase her green vegetable consumption as a preventative measure. Alice said the doctor told her that her complaints of decreased vision, trouble seeing road signs, especially at night, and difficulty reading were all classic symptoms of a cataract. A cataract is traditionally described as a darkening or yellowing of the normally clear lens, much in the way a newspaper that is left out in the sun changes from white to yellow. Risk factors for cataracts include excess exposure to ultraviolet light and smoking. In addition, diabetics tend to get cataracts at an earlier age. Alice said that upon examination, the doctor found she did indeed have a cataract. Since the cataract had now progressed to the point that it was interfering with Alice’s daily activities, Alice told Mary that she had decided to have it surgically removed by her Ophthalmologist, a medical doctor trained to perform surgery on eyes. Alice was told that the procedure would be an outpatient operation but that she would not be able to go home alone after the surgery. Alice then asked Mary if she could lend her a hand the following week when she was scheduled to have the operation. Mary, of course, agreed since that’s what friends are for. |
