By: Dr. Alan Glazier
Caring for aging parents is no easy task. The challenges behind the role reversal where child becomes caregiver can be overwhelming. There is a new physical and/or emotional challenge for the parent on a regular basis, and the responsibility of dealing with that challenge falls to the caregiver. Dealing with more than one health issue at a time, possibly for more than one parent while taking care of your own family and maintaining a job is a daunting task. One of 
the most serious of problems for the elderly is conditions that affect vision. As long as an elderly person can see, they have some independence; the ability to navigate their environment, the ability to use money or write checks, the ability to keep their mind active through reading or watching a broadcast. Once the vision goes, the senior is likely to lose much of their motivation for living. For this reason and others It is very common for vision loss to be accompanied by depression. This post is a guide for the caregiver for monitoring the status of their aging parents eye health, knowing what steps to take to prevent further deterioration and knowing the signs of an impending problem so the appropriate intervention can take place in a timely manner. It outlines some of the most common causes of vision loss in the elderly and what science knows about attempting to prevent the condition from leading to devastating vision loss.
Everyone will get a cataract if they live long enough. Cataract is a part of the natural aging process of the eye. A cataract is a clouding of the internal lens of the eye. As the clouding gets denser, the amount of light that enters the eye is gradually reduced creating vision loss. Signs of cataract include difficulty with vision at night, trouble with glare, difficulty distinguishing colors, squinting and complaints about difficulty seeing distance and near objects. The typical age of onset of cataract is between 65 and 74 and may occur earlier in someone who has been treated with oral steroid
medications for a systemic disease, someone who has smoked for a significant period of time or someone who has had trauma to their eye. The closer one lives to the equator, the earlier the onset of cataract, as UV radiation has been implicated as a cause of cataract. Preventive measures include (1) use of large, polarized sunglasses, preferably from an early age whenever one is outside, (2) diets high in anti-oxidants, (3) cessation of smoking as early in life as possible. Should your parent be diagnosed with clinically significant cataract and surgery is recommended, be sure to choose a board certified ophthalmologist who has performed a significant amount of cataract surgeries and is up on the latest technologies for implantation such as toric and multifocal IOL’s. They should be experienced performing the procedure known as “phacoemulsification”. This is the standard procedure that most cataract surgeons use and is tried and tested. The latest version is known as “micro-phaco” involving a smaller incision, thus less risk. If you or your parent are considering multifocal implants (implants that allow vision at far and near), be sure you ask about and understand the potential risks including visual acuity that is slightly reduced at distance and near compared to single vision lenses, the potential for glare and vision worse at night than at day.
The most common blinding eye condition in the over 65 age group and also the most devastating, macular degeneration therapies have come a long way. People with macular degeneration have difficulty recognizing objects that they “lock onto” to see. For example, they retain their peripheral vision and can navigate their environment, but they can’t recognize faces, read print or watch TV because everything they look directly at has a big blank spot. They 
are unable to see around this spot; it stays with them at all times and overlays whatever they look directly at. Risk factors for macular degeneration include family history, people with light eyes, people who have smoked in the past and people who have been exposed to high levels of UV light. The more of these risk factors that exist, the greater the risk of having macular degeneration. Macular degeneration should be tested for regularly by covering one eye then the other and testing with an Amsler grid, which will be discussed further on in the post. If one eye has macular degeneration and the other doesn’t, the parent may not notice their vision is affected as they are functioning mostly with their one better eye and it may go undetected until it is too late. The AREDS study, a government funded study, was designed to determine what nutrients, if any, are helpful in preventing or delaying the onset of macular degeneration. AREDS 2 is underway and a particular combination of antioxidants is believed to reduce the risk of developing macular degeneration up to 40% in some people. People with a family history of macular degeneration or early signs of the disease should eat fresh spinach and/or kale regulary. They should also eat fish high in omega-3. While supplements are available, the question exists as to whether the body is successful at absorbing enough of the necessary nutrients from the pills. It is better to attempt to get the Lutein and zeaxanthin (spinach and kale) and the omega-3 (fish) from their natural sources as we know they body absorbs these from food. The parent should be screened regularly using a home testing device known as an “Amsler Grid”. This piece of paper with a grid on it is excellent at detecting the more severe form of macular degeneration known as “wet AMD”. In 2007, Genentech brought to market Lucentis (Avastin also), a wonder drug that, when applied to the eye in a short window after an attack of wet macular degeneration helps to restore most of the patients vision in more than 40% of people. The wet form of macular degeneration leads to devastating vision loss so daily testing, monocularly, on the Amsler grid may turn up a sudden wet AMD event that, if treated in a 24-48 hour window may be mostly reversed. If the parent is in a nursing home, be sure to have the nurses test the parent on the Amsler grid once a day – it is a quick and easy test that can be obtained on line or at the eye doctors office.
DIABETIC EYE DISEASE
The symptoms of diabetic eye disease may be similar to those of macular degeneration, but the most important factor in avoiding diabetic eye disease is early diagnosis. Studies have shown that people who are on top of their disease and seek care quickly at the sign of any vision change were shown to retain vision longer. Diabetes is a systemic disease, so maintaining eye health in diabetics is best done by following the advice of the endocrinologist which is usually eat right, exercise, take medication as prescribed and attend regular follow up visits. Add a regular optometrist or ophthalmologist visit and you will be doing everything you can to maintain the vision of your elderly, diabetic parent.
Most glaucoma is genetic, and can only be detected through an eye examination by a qualified eye doctor. Things that can cause glaucoma other than genetics include eye trauma, certain steroid eyedrops, severe eye rubbing over long periods of time or a condition known as “angle closure”. As stated before, most glaucoma has no symptoms until it is too late, but the “angle closure” glaucoma has symptoms of intense pain, nausea and sudden loss of vision. Certain nutrients have been suggested to help people with glaucoma, but no study to date has been able to confirm any significant benefit of special diet in helping to minimize or delay the onset of glaucoma. One recent study implicated that neckties tied too tight may lead to high eye pressure, which is one of the problems in certain types of glaucoma. While this article is meant to be helpful to the caretakers of the elderly, the suggestions are in no way meant to substitute for regular, comprehensive eye care. Be sure to take your parent to the optometrist or ophthalmologist regularly and use this as a guide in between.
Keep your chin up!
Dr. Glazier
Dr. Alan Glzaier is a guest blogger for the IM Blog and a doctor at Shady Grove Eye and Vision Care.
Follow Dr. Glazier’s tweets @EyeInfo
For more information on eye and vision care issues visit youreyesite.com, or at eyeinfo.wordpress.com
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