Vision Loss Is Not a Normal Part of Aging Open Your Eyes to the Facts! Everyone's vision changes with age. Some changes are normal; some are caused by age-related eye conditions. Find out the difference. If you are experiencing changes in vision, or you know someone who is, seek help. Visit your eye doctor, search our Help Near You database on www.visionconnection.org to locate an eyecare professional in your area or call (800) 829-0500. Vision Loss Is Not a Normal Part of Aging Page 1 Did You Know? As we age, the quality of our vision diminishes naturally. Most changes typically are not severe, and a new prescription for glasses or a few adaptations, such as improved lighting, may be all that is needed. However, conditions such as macular degeneration, glaucoma, cataracts and diabetic retinopathy can affect permanently the quality of sight for older adults. Open your eyes to the facts: • There is a difference between changes in the aging eye that are normal and those that are not. • Learn what is natural, what is preventable, the possible warning signs and how to get help. • Remember that eye care is important. Only a doctor can detect certain vision changes when you cannot — before symptoms become noticeable. Page 2 The number of people with serious vision problems — uncorrectable vision impairment — is growing as we all live longer. Research conducted by Lighthouse International reveals that one in six Americans age 45 or older — representing 16.5 million people — reports some form of vision impairment, even when wearing glasses or contact lenses. In addition, the prevalence of vision loss increases with age; by age 75, one in four people — 4.3 million — reports some form of vision impairment. We've also learned from our research that the majority of Americans has limited knowledge about vision loss and aging, and assumes — mistakenly — that older adults become visually impaired as a part of the normal aging process. Read on to learn about … • Normal changes in the aging eye — what we all can expect • Tips for keeping your eyes healthy • The four most common causes of age-related vision loss and their warning signs • How vision rehabilitation can help you cope and restore independence • Getting help Vision Loss Is Not a Normal Part of Aging Page 3 Normal Changes in the Aging Eye — What We All Can Expect Losing Focus The most common age-related vision change — presbyopia — happens to almost everyone beginning between the ages of 40 and 50. A natural result of aging, the lens begins to lose elasticity, making it harder to focus vision up close for such activities as reading. But presbyopia can be corrected easily with reading glasses or glasses with bifocal, trifocal or progressive ("no-line") lenses. Declining Sensitivity The lens of the eye also becomes increasingly dense and more yellow with age. These changes may affect color perception and contrast sensitivity. For instance, the color blue may appear darker and harder to distinguish from black. And it may become difficult to tell where an object ends and its background begins, making it difficult to see curbs or steps, for example. Needing More Light As the eye ages, the pupil gets smaller, resulting in the need for more light to see well, along with more time to adjust to changing levels of illumination (going from daylight into a dark theater or dimly lit restaurant, for example). Page 4 Tips for Keeping Your Eyes Healthy Many factors influence eye health. Some, such as diet and lifestyle, can be controlled; others, like aging and genetic predisposition, cannot. But monitoring eye health can play an important role in preventing, or minimizing, vision loss. Here are some general guidelines for protecting your vision: • Schedule routine eye examinations. It's possible to have a serious vision problem and not even know it! Even if you don't notice changes in your vision, some eye diseases have no symptoms in beginning stages. Early diagnosis may save your sight; visit your eyecare professional at least once a year. • Monitor your blood pressure and exercise regularly. Cardiovascular stress, such as high blood pressure, can damage parts of the visual system and lead to vision loss. Work with your doctor to maintain normal blood pressure, a healthy diet and an approved exercise routine. Vision Loss Is Not a Normal Part of Aging Page 5 • Guard your eyes from the sun. Prolonged exposure to the sun's harmful ultraviolet (UV) rays has been linked to cataracts and macular degeneration. Although studies have shown that people with fair complexions and blue eyes may be especially susceptible, everyone spending time outdoors should wear sunglasses with 100% UV- A and UV-B protection, along with a wide-brimmed hat. • Protect your eyes. A scratch, abrasion or other injury to the eye can lead to infection and scarring, which may result in some degree of vision loss. Wear protective goggles when the risk of eye injury is increased; for example, when working with tools, or playing racquetball or contact sports. • Don't smoke! Cigarette smoking has been linked to a number of eye conditions, including cataracts and macular degeneration. Page 6 • Consult a doctor before taking nutritional supplements. Receiving too much, or too little, of some nutrients (zinc or beta-carotene, for example) can affect your health. So eating a nutritious, low-fat diet rich in fruits, grains and vegetables — especially leafy greens — is recommended. If you wish to take vitamin supplements, check with your doctor first, just as you should before taking any supplement or medication. Vision Loss Is Not a Normal Part of Aging Page 7 The Four Most Common Causes of Age-Related Vision Loss In addition to normal changes in vision, older adults may experience eye disorders, health problems or injuries that can permanently affect eyesight —resulting in blurred or distorted images, or the loss of central or side vision. A number of conditions can potentially impair vision; the most common among them are macular degeneration, glaucoma, cataracts and diabetic retinopathy. Impaired vision ranges from partial sight (also known as "low vision") to blindness. Low vision cannot be corrected fully to the normal range by ordinary glasses, contact lenses, medication or surgery. Low vision, however, does not mean "no" vision. And although vision loss may be permanent, much can be done to maximize remaining — usable — vision and improve quality of life through vision rehabilitation. Page 8 But first and foremost, everyone — and most especially, older adults — should have regular eye exams by an ophthalmologist or optometrist to maintain eye health and for early detection of conditions that cause low vision. Macular Degeneration Macular Degeneration in Brief What it causes: central vision loss Warning signs may include: • gradual, spotty loss of detail vision (dry macular degeneration) • sudden and severe loss of central vision (wet macular degeneration) • a need for more light Macular degeneration occurs when the macula — the central part of the retina, which is responsible for detail, color and daylight vision — is damaged. When central vision becomes blurred and distorted, reading becomes difficult, color vision is reduced and there is an increased need for light. Page 9 There are two types of macular degeneration: dry and wet. The dry variety, which is most common (affecting 90% of those with macular degeneration), progresses slowly. And vision changes are much more subtle. When reading, for example, parts of letters may appear to be missing. Straight lines also may appear crooked or wavy (when looking at Venetian blinds, for example). About 10% of people with age-related macular degeneration develop the wet variety, which can come on very suddenly due to leaking blood vessels that have grown in, or under, the retina. The wet type causes severe vision loss and progresses more rapidly than the dry form. A large, dark spot appearing in the center of vision (doctors call this dark area a "scotoma") is typical. If you have a sudden loss of central vision, go to your eye doctor right away! Risk factors for developing macular degeneration may include high cholesterol, untreated high blood pressure, diabetes and smoking, all of which result in poor circulation to the retina; a lack of certain nutrients needed by the retina; excessive exposure to harmful UV light; and a tendency within families. Treatment Options Although there is no cure for macular degeneration, an evolving treatment — photodynamic therapy — may slow the progression of wet macular Page 10 degeneration. Photodynamic therapy uses a special intravenous dye with a laser to seal leaking blood vessels, and several treatments per year may be necessary. The National Eye Institute's recent Age-Related Eye Disease Study also showed promising results for patients in the intermediate stage of macular degeneration who took specified doses of antioxidant vitamins and zinc: they lowered the risk of developing more advanced stages of the disease by approximately 25%. This formula is now on the market, but be sure to check with your doctor to see if it's recommended for you. Glaucoma Glaucoma in Brief What it causes: damage to the optic nerve from abnormally high eye pressure or poor circulation Warning signs may include: • subtle loss of contrast • difficulty driving at night • loss of peripheral vision (late-stage glaucoma) Page 11 Glaucoma is caused by progressive damage to the optic nerve, usually resulting from a buildup of fluid pressure inside the eye. Because there are no obvious early symptoms of glaucoma and it progresses slowly, you may not realize that your field of vision is decreasing. Routine eye examinations and special tests of the visual field are key to detecting glaucoma at an early stage. Early on, glaucoma causes a subtle loss of contrast between objects and their backgrounds — for example, not being able to distinguish the curb from the sidewalk, or missing a step on a staircase. Many people are uncomfortable or afraid to drive at night because of contrast loss, too. When glaucoma progresses, the optic nerve damage causes an irreversible loss of peripheral vision. As the condition can be hereditary, people with a family history are at a higher risk, as are all older adults, African-Americans and Hispanic-Americans. Early detection is critical. Treatment Options Treatment options for glaucoma are always evolving — another reason to visit your eye doctor regularly to screen for the condition. And be sure to ask for a contrast test, which can help identify subtle changes in contrast sensitivity due to the loss of retinal cells. Vision Loss Is Not a Normal Part of Aging Page 12 As a rule, elevated eye pressure can be managed with eye drops, medication, laser treatment or surgery. If detected early, eye drops most likely will be prescribed to control the pressure and prevent peripheral vision loss from advancing glaucoma. Cataracts Cataract in Brief What it causes: cloudy vision Warning signs may include: • vision seems hazy • trouble distinguishing colors • increased sensitivity to glare; light scatters and appears like a "halo" A cataract is a clouding of the lens that reduces visual acuity, producing an overall haze, loss of contrast and increased sensitivity to glare. Cataracts diminish the sharpness of detail, resulting in hazy vision, particularly in glaring light. And as the lens becomes more yellow with age, colors may not appear true; it may be difficult to distinguish between navy blue and black, for example. In the advanced stage of cataracts, print appears faded and words become harder to read. Vision Loss Is Not a Normal Part of Aging Page 13 Although the cause of cataracts is unknown, some factors may increase your risk, including: aging, long-term exposure to sunlight, smoking, high cholesterol, diabetes and eye injury. Treatment Options A cataract can be removed in a short surgical procedure to replace the affected lens with a plastic one. The most appropriate time for cataract surgery depends partly on its impact on daily activities, bothersome symptoms and maturity of the lens. Although some people have no symptoms, they should have surgery if the lens is hardening and becoming more difficult to remove. There is good news: Cataract surgery has a high success rate in normal eyes. After surgery, patients may need to change their eyeglass prescriptions. Diabetic Retinopathy Diabetic Retinopathy in Brief What it causes: hemorrhages in the retina, including the macula Warning signs may include: • blurred vision • near vision distortion (difficulty reading) Page 14 Diabetic retinopathy is one of the complications of advanced or long-term diabetes. It is caused by leaking blood vessels that damage the entire retina, including the macula. While the effects of diabetic retinopathy vary, near vision can be distorted, and parts of the visual field may be blurred or obstructed. The most important way that people with diabetes can protect their vision is by monitoring blood glucose levels strictly and visiting an eye doctor who specializes in the treatment of diabetic retinopathy regularly (in addition to being followed medically by a diabetes specialist and a dietician). Not everyone with diabetes develops retinopathy, which is why dietary control (low blood glucose) and exercise are so important. Treatment Options In the early stages of retinal bleeding, laser treatment of localized areas of leakage can sustain vision levels. And early treatment may prevent the more severe complications of late-stage retinopathy, such as hemorrhage and scar formation, resulting in a detached retina. Page 15 How Vision Rehabilitation Can Help You Cope and Restore Independence Dealing with vision loss can seem overwhelming, especially because many people are unaware of vision rehabilitation services — counseling and training that help people overcome the challenges of vision impairment — which are available in their area. In fact, Lighthouse research shows that 94% of middle-aged and older adults who reported some form of vision problem did not take advantage of any type of vision rehabilitation services. Learning about these services early, and understanding how they can actually improve everyday functioning, can greatly help people deal with changes in vision loss over time. Certified vision rehabilitation professionals teach new ways to accomplish everyday tasks, such as: traveling safely, taking care of your home, preparing meals, cooking safely, managing your medications, writing letters and more. Research has shown that these services can lead to better adjustment in everyday life, in terms of how people with vision loss feel and what they can do. Most people report that vision rehabilitation helps them realize their personal goals. Vision Loss Is Not a Normal Part of Aging Page 16 Vision rehabilitation services include: • Making the Most of Existing Vision — Low Vision Care Most people with age-related vision loss do not become totally blind — they still have some usable vision. Therefore, they can benefit from services provided by a low vision specialist, in addition to the care received from regular eyecare professionals. Specialized ophthalmologists or optometrists, who have particular expertise in low vision care, can assess patients' usable vision and prescribe optical devices (such as high-powered magnifiers) and electronic devices (such as computers and closed-circuit TVs for reading) to help people perform day-to-day activities. The choice of devices depends on the activity, and instruction is essential to ensure that they are used effectively and successfully. • Getting Around Safely — Orientation and Mobility Training Certified orientation and mobility specialists teach people with vision loss to move around safely both indoors and outdoors — through the use of existing vision, auditory cues and/or other techniques (using a white cane, dog guide or a sighted guide) — so they can shop safely, Page 17 visit friends, keep medical appointments and travel on their own. Detecting curbs, crossing streets, riding public transportation, and getting into and out of cars safely are all possible when the correct techniques are used. • Relearning the Tasks of Daily Living — Vision Rehabilitation Therapy Certified vision rehabilitation therapists help people with vision loss learn techniques to remain independent at home, at work and in the community. For example, they can teach safe, new ways of doing many essential tasks — from operating a stove or microwave, to organizing and labeling medications. They also may suggest adaptations to everyday items such as large print or talking products, and using contrasting colors and tactile markings to better distinguish objects — all of which make it easier for people with vision loss to live independently. • Coping with Vision Loss — Counseling An important part of the rehabilitation process, counseling is conducted by trained social workers or psychologists — in both individual and group sessions — to help people and their families cope with the depression and frustration that may accompany serious vision loss. Vision Loss Is Not a Normal Part of Aging Page 18 • Learning from Others — Support Groups It helps to know you're not alone. Many people with vision loss, as well as their family members, benefit from meeting with, and talking to, others in similar situations. Support groups meet in person, by conference call or in chat rooms on the Internet. Involving Family and Friends Family and friends can provide much-needed support. Research has shown that by understanding more about what people with vision loss can do, family members learn how to help more effectively, worry less and are able to have more time for themselves. In addition, family members' active involvement in vision rehabilitation is associated with increased participation in social activities over time by those with vision loss. So everyone benefits! Getting Help Lighthouse research showed that only 40% of middle-aged and older adults reporting problems with their vision were aware of vision rehabilitation services in their area. But the more you know, the better you can adjust positively if vision loss happens to you. Page 19 To locate vision rehabilitation services, support groups, and low vision clinics and specialists in your area, search our Help Near You database on www.visionconnection.org or call (800) 829-0500. Additional Resources • Family and Friends Can Make a Difference! How to Help When Someone Close to You Is Visually Impaired — A brochure that demonstrates the important roles family and friends can play in helping someone with a vision problem — available online at www.lighthouse.org. • When Your Partner Becomes Visually Impaired: Helpful Insights and Tips for Coping — A booklet that provides firsthand, practical tips for partners and families of people with impaired vision — available in print and online at www.lighthouse.org. • Sharing Solutions — A biannual newsletter for people with vision loss and their support networks that covers a range of topics, including the latest treatments, new technologies, research and interactive exchanges on coping and adjusting to vision loss — available in large print, on audiocassette and online at www.lighthouse.org. • www.visionconnection.org — A one-stop, accessible resource on vision impairment and vision rehabilitation. Vision Loss Is Not a Normal Part of Aging Page 20 Vision Loss Is Not a Normal Part of Aging is also available online at www.lighthouse.org. The material in this booklet was drawn in part from research conducted by the Arlene R. Gordon Research Institute at Lighthouse International and summarized by Joann P. Reinhardt, PhD. The development and first printing of this publication was supported by grants from the AARP Andrus Foundation and the National Eye Institute. This publication was reprinted thanks to a special grant from Novartis Ophthalmics. Novartis Pharmaceuticals Corporation East Hanover, NJ 07936 6/05-P1261 Lighthouse International is a leading resource worldwide on vision impairment and vision rehabilitation. Through its pioneering work in vision rehabilitation services, education, research, prevention and advocacy, Lighthouse International enables people of all ages who are blind or partially sighted to lead independent and productive lives. Founded in 1905 and headquartered in New York, Lighthouse International is a not-for-profit organization, and depends on the support and generosity of individuals, foundations and corporations. Lighthouse Center for Education Lighthouse International The Sol and Lillian Goldman Building 111 East 59th Street New York, NY 10022-1202 Tel (212) 821-9200 (800) 829-0500 Fax (212) 821-9705 TTY (212) 821-9713 E-mail info@lighthouse.org www.lighthouse.org www.visionconnection.org Novartis Pharmaceuticals Corporation East Hanover, NJ 07936 This publication was reprinted thanks to a special grant from Novartis Ophthalmics. This booklet is provided to you by: By Eleanor E. Faye, MD, FACS; and Carol J. Sussman-Skalka, CSW, MBA Copyright © 2002 and 2005 Lighthouse International