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Help the elderly care for their eyes

Pank Jit Sin
20 Dec 2018

The elderly should make it a point to get their eyes checked out by ophthalmologists at least once or twice a year, says an expert.

The necessity for eye checks increase over time as the risk of age-related macular degeneration (AMD) increases over time. As the name suggests, one of the biggest risk factors associated with AMD is age—everything degenerates to a certain degree as we age, and the eye is no exception. However, macular degeneration, like many eye diseases, can progress slowly, giving little to no symptoms until it suddenly takes a turn for the worse. According to Dr. Amarjeet Kaur, consultant ophthalmologist, many associated the blurring of vision to the effects of aging. While this may be true, it is always important to rule out more sinister causes such as glaucoma, neuropathy and macular degeneration. Amarjeet was speaking at an eye health awareness session recently. 

Ageing, the main risk factor for the development of AMD, is unavoidable. Similarly, genetic factors are also unavoidable (Caucasians are more likely to develop AMD, possibly through the lack of pigmentation) or gender (females are more likely to develop AMD).  However, other factors such as hypertension, smoking, obesity and ultraviolet exposure can be circumvented or reduced to varying degrees.

Symptoms of AMD are often missed but warning bells should be sounded should a person complain of difficulty in recognizing faces, has crooked central vision, blurred or blind spot at the center of vision and general haziness in overall vision. Additional symptoms include the need for brighter light when performing work close up, increased blurriness of printed words and visual distortions eg, straight lines look bent.

Proper diagnosis will require a comprehensive eye examination by a specialist. Many types of eye checks can be performed by an ophthalmologist to assess the severity of AMD or eye diseases, if any. These include the usual visual acuity check, slit lamp examination and fundus examination. AMD can also be diagnosed via optical coherence tomography (OCT) and fluorescein angiography.

Amarjeet said taking a proper diet, which involves proper nutrition and in proper ratios, will help to maintain the general health of a person. In addition to a proper diet, some supplements may also help to maintain eye health and delay the decline associated with AMD. The Age-Related Eye Disease Study (AREDS) and AREDS-2 revealed that lutein, zeaxanthin, copper, zinc and antioxidants such as vitamins A, C and E are linked to reduced risk of developing advanced AMD. Lutein and zeaxanthin are pigments found in the retina and levels of these pigments drop as one ages. [JAMA 2013;309(19):2005–2015] Fish oil has also been associated with an improvement with dry eyes, but current scientific evidence does not support its use. [N Engl J Med 2018;378(18):1681–1690]

Wet AMD, a less common subset of AMD, is more severe and involves bleeding of the eye tissue surrounding the macula. Wet AMD happens when photoreceptors and pigment epithelium send distress signals to choriocapillaris to make new vessels behind the macula. The new blood vessels are fragile and easily leak blood and fluid into the macula, leading to its scarring and subsequent vision loss. This treatment for wet AMD should be initiated immediately and monitored closely or the patient risks permanent blindness. Wet AMD is sometimes treated with intraocular anti-vascular endothelial growth factor (VEGF) injection, which prevents abnormal blood vessels from forming around the macula. Laser surgery is also carried out to seal the leaking blood vessels caused by wet AMD.  

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