Of your five senses, which one are you most afraid of losing? If you’re like most people, the answer is your ability to see. Despite this, many people are not conscientious about caring for their eyes and often neglect to visit an ophthalmologist for routine eye exams as they get older. This report focuses on four disorders that pose the greatest threats to vision after age 40: cataract, glaucoma, age-related macular degeneration, and diabetic retinopathy. It will help you determine your risk of developing these disorders, describe their symptoms, and discuss diagnosis and treatment. This report also describes other common eye disorders, including presbyopia, dry eye, floaters and flashes, retinal detachment, and eyelid problems such as drooping upper or lower lids. You’ll also learn why you should have regular eye exams, especially if you have diabetes or a family history of glaucoma; how to recognize the risk factors and symptoms of specific eye diseases; and what steps you can take to prevent or treat them before your vision deteriorates further.
Prepared by the editors of Harvard Health Publications in consultation with Laura C. Fine, M.D., Clinical Instructor in Ophthalmology, Harvard Medical School, and Jeffrey S. Heier, M.D., Clinical Instructor in Ophthalmology, Harvard Medical School. 49 pages. (2012)
The new focus: Specialized replacement lenses
Starting around age 40, the lens in your eye becomes less flexible—a normal part of aging that makes near vision more difficult, especially in low light. Eventually, everyone develops this problem, known as presbyopia, and most people (even those without cataracts) need reading glasses to see well close-up. But several new types of intraocular lenses (IOLs) may reduce or eliminate the need for glasses after cataract surgery for people who have presbyopia, as well as those with astigmatism.
Accommodating. When you switch from gazing at something far away to something nearby (or vice versa), the tiny ciliary muscles in your eye tug on your lenses so they change shape ever so slightly, enabling you to focus near, far, or in-between. This capability, called accommodation, diminishes as the lens stiffens with age. But the ciliary muscles retain their ability to contract and relax. Accommodating IOLs have hinges on the sides, enabling them to change focus, just like the lens in a younger eye. The first accommodating IOL, the Crystalens, gained FDA approval in 2003, and several similar types of accommodating lenses are under development. Overall, these IOLs offer excellent distance and middle vision, but aren’t as reliable for near vision. Eye exercises can help people get used to them, but about half of people who receive them still end up needing reading glasses.
Multifocal. Like bifocals or progressive lenses used in glasses, these IOLs include different areas designed for distance, intermediate, and near vision. But unlike the lenses in glasses, the areas are organized in concentric circles, rather than from top to bottom. The brain and eye figure out which part of the lens to use. One example, the Restor IOL, uses a type of refractive technology to provide focus for multiple distances. The lens has small, concentric circular ridges that permit the eye to change its range of focus. Another lens, called the ReZoom, has five broad zones to provide distance, intermediate, and near vision. The main drawback of multifocal lenses is difficulty in seeing well at night. The tiny ridges can distort bright light, creating more glare and halos.
Toric. These are monofocal IOLs that have been altered to correct for astigmatism. Instead of making limbal relaxing incisions, the surgeon may implant this IOL. The first one, the STAAR Toric IOL, won FDA approval in 1998; a second one, the AcrySof IQ Toric IOL, was approved in 2005. One drawback to these IOLs is the risk that they will rotate out of position, which may require further surgery to reposition or replace the lens.
Companies that make IOLs are refining several other modifications designed to enhance vision. One new category is aspheric IOLs. Unlike traditional IOLs, which are spherical (meaning the front surface is uniformly curved), aspheric IOLs are slightly flatter around the edges. These lenses are supposed to improve contrast sensitivity (the ability to distinguish an object from its background) or to reduce visual aberrations, such as glare and halos. One aspheric IOL, the Tecnis Z9000, is advertised as improving the ability to see in varying light conditions such as rain, snow, fog, twilight, and nighttime darkness.
Many IOLs include filters that block ultraviolet (UV) light, which is known to increase the risk of cataracts and other vision problems. At least one new IOL, the AcrySof Natural, also filters high-energy blue light, which is present in both natural and artificial light and may damage the retina, possibly playing a role in age-related macular degeneration.
What to consider
Only a small percentage—about 6%—of people who have cataract surgery receive one of these specialized lenses. Not everyone is a good candidate; for instance, people with severe macular degeneration, glaucoma, or diabetic retinopathy are not the best candidates. If you have had LASIK surgery (see page XX), choosing the correct IOL can be a challenge, although the newer lenses aren’t out of the question.
Anther consideration is cost: these so-called premium lenses are not covered by Medicaid or most insurance plans, so you will likely pay between $1,500 to $2,500 extra for each eye if you chose a specialized lens. Because there are so many different lenses on the market, it’s difficult to find comprehensive, reliable data about the magnitude of the benefits and risks associated with each. The most common problems with the newer lenses are glare and halos and the continued need for eyeglasses. Discuss your options with your own cataract surgeon.
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The special section, "Choices in cataract surgery" helped clear up my confusion about the choice of replacement lenses. I also found the discussion of dry eye syndrome to be very useful. The report has been expanded and improved since the last version I bought in 2003.
This article on eye health is very informative & understandable. I would like more like it. Thank you and A Merry Christmas to you.
Harvard quality at affordable price; a bargain by any measure. My main interest is dry eyes, which are covered but very briefly. The content is definitely good, but more was wished for. So, if it's dry eyes you are looking for, skip this one. The other topics are covered very well and will not leave you wanting.
An eye-opener of a publication, for me. The optometrist diagnosed cataracts in both my eyes, as well as early AMD. This publication made me aware of the importance of good diet, and keeping off excess sugar and junk food if I wanted to combat the progress of the AMD. The eye specialist confirmed the cataracts, and told me about the options I might have when choosing the monofocal IOL: either clear distance vision, or clear reading vision and glasses for the one I don’t opt for. I showed him p. 16 from The Aging Eye, on accommodating IOLs, and how the new advances include aspheric IOLs. I am having my cataract surgery done when I return from overseas, in 6 months, and in this time issue one problem about purchasing Harvard Publications is highlighted for me. Once we have purchased a document, would it be possible to get free updates on some regular basis? Like the phone apps these days offer? That way a purchaser can keep in touch with recent trends about issues without having to spend more money purchasing an updated document all over again? That would make these publications well worth their money, while without such updates the purchaser has an outdated document in a year or so…
This was very done: It was complete because it covered all the major topics and concerns in detail. And, despite going into specifics (rather than glossing over the top), it was clearly written for a non-medical person to be able to understand. I really appreciate the Harvard publications because, unlike most, they respect the layman enough to actually provide a full explanation rather than the typical over simplified dribble. It was definitely a good read and a good value.
I read the whole booklet carefully, and overall, it is an interesting review of many basic concepts. I was disappointed that it did not discuss biological mechanisms of eye disease causation, and did not consider at all a common age-related disorder, i.e., macular pucker (epiretinal membrane).
This is a very fine report.It focuses on four disorders. But I would like to know a little bit more about uveitis and iritis and how dangerous these diseases can be. Can I have this in an update of this great booklet, please?
Excellent - detailed, informative yet easy to read and understand. Highly recommended!
Tho' I have not yet read the whole booklet, it does seem to be very throrough with good explanations and visuals. It is a good aid to understanding what to know both before and after an eye exam.
It gave me all the information I needed before oing to have my eyes checked.