At about age 40, many people develop presbyopia. Presbyopia is a normal loss of flexibility of the eyes's lens. Presbyopia usually makes it more difficult for people to focus on nearby objects. Reading small print and working with small objects up close is much more difficult. Vision changes due to presbyopia usually stabilize between the ages of 55 and 60.

Tear production changes, as well as making eyes too dry or too watery. Your ophthalmologist can provide eye drops that will relieve these problems. 
There are other normal vision changes, as well. Some people develop floaters which look like tiny spots, when they look at light-colored objects. Older people may also have more trouble seeing at night.

Some changes in vision may be warning signs of problems. If you see flashing lights, have problems with reading, black spots appear, or if your vision is distorted, you should tell your ophthalmologist immediately. These changes may be normal, but only an ophthalmologist can tell you this for sure.

Glaucoma can develop slowly over time, so you should continue to see your ophthalmologist as often as he or she tells you is necessary. Always follow your doctor's directions concerning your eyes. Also, be sure to take any medication that was given to you as prescribed by your ophthalmologist. If you experience side effects, tell your ophthalmologist.

Remember, any vision change, no matter how small or seemingly insignificant, should be reported to your ophthalmologist. That's the best way to preserve your sight and care for your eyes.

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A Clear Look at Cataracts

Dr. Eric E. Lindstrom with the Lindstrom Eye and Laser Center explains "centuries ago, people thought that the whiteness behind the pupil of the eye, a cataract, was a waterfall flowing from the brain. Today we know that cataracts are a result of clouding of the lens in the eye. The purpose of the lens is to focus light, and with aging, the water and electrolyte content of the lens changes, and the fibers within the lens opacify. Cataracts are most often seen in people older than 65, and if you live long enough, everyone would develop a cataract."

Who Is At Risk?

In addition to advancing age, risk factors for cataracts include: 

• Smoking
• Diabetes
• An injury to the eye
• Corticosteroid medications, which may be used to treat lupus or asthma
• Too much exposure to ultraviolet light
• Too much exposure to radiation, such as x-rays

Research suggests that people may reduce their risk for cataracts if they wear sunglasses and a hat when outside. Eating foods that are rich in vitamins A, C, and E has been determined to be important in reducing the risk of cataracts as well. Fruits, green leafy vegetables, and vitamin supplements are good sources of these vitamins. And of course, not smoking is important as well.

Symptoms and Treatment

A cataract progresses slowly and painlessly. Many people don't even realize they have a cataract at first, but after a while they may: 

• Experience blurred vision and increasing glare
• See poorly at night or in bright light
• See halos around lights
• Notice some colors-particularly blues-appear dull

As the cataract progresses, the lens in the eye swells which makes the eye more near-sighted. Changing the eyeglass prescription may help for a time, but eventually removing the cloudy lens may become necessary. When the best corrected vision is reduced to 20/50 or worse, most people notice that it is much more difficult to drive and reading is also impaired. Once your vision becomes seriously affected, your ophthalmologist will recommend corrective surgery. The operation is an outpatient procedure normally done under local anesthesia. Using a procedure called phacoemulsification, the cloudy lens material is removed through a tiny incision, and a permanent plastic intraocular lens is inserted. Postoperatively, the individual can return to the normal routine within a few days. Cataract surgery with an intraocular lens implant is highly successful, and it significantly improves the eyesight of more than 90% of those that have undergone this procedure.

Removing the cataract does not always significantly improve vision. For example, in people who have cataracts and other eye diseases such as macular degeneration or glaucoma, it may not be possible to restore the vision to 20/40 or better. These conditions can often be diagnosed prior to surgery, and if present, the individual would be cautioned that the final visual outcome would not be as good as would normally be expected. If you have cataracts, be sure to discuss all treatment options with your opthamologist so that together you make the decision that is best for you.

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Eye exams important for children

Preserving our eyes is a lifelong effort that begins at birth. Since a person's visual acuity is developed by age seven, it is important that proper care be taken to ensure visual problems are corrected as soon as possible.

According to Ophthalmologist Judith Bradley, M.D., a child's eyes should be examined at several stages of development. "It is never too early to begin caring for a child's eyes. There are things that can be done beginning at birth to ensure a child has normal vision."

A newborn's eyes are first evaluated by the pediatrician for any gross abnormality such as a cataract or corneal defect, Dr. Bradley explained. Parents should notice if a 2-month-old infant can fixate on objects and faces and whether or not a baby can make eye contact. The older infant should easily see and reach for small objects in his environment. If an infant is noted to have eyes that turn in or out, this should be evaluated by an ophthalmologist as the baby may need surgery or require glasses.

"It is not uncommon to prescribe glasses or surgery for babies. With a problem like strabismus or turning of the eyes, surgery can be performed with minimal risk because of the medical advancements in anesthesia," Dr. Bradley said. "The sooner you correct the optical error the better chance the child has of developing normal vision."

Many children have large refractive errors that at times go undetected. This can result in failure of the visual areas to the brain to develop fully. After age seven, even full correction with glasses may fail to improve a child's vision completely if the visual cortex has not developed. If visual acuity is corrected prior to age seven, amblyopia (lazy eye) can be prevented.

After age three, a child should be able to read a picture chart, and his visual acuity can then be assessed more accurately. A refraction is then performed to measure a child's need for glasses. Ophthalmoscopy is performed to make sure that the optic nerve and retina are normal.

"Testing children of this age is not a difficult procedure. In addition to looking at the eyes, we have the child pick up tiny objects to test his focusing ability," Bradley said.

Children's Vision Screening

Vision screening is one of the most important factors in pediatric health care.

The American Academy of Ophthalmology (AA0) and the American Academy of Pediatrics (AAP) recommend that children be screened in four stages.

1. In the newborn nursery: pediatricians or family physicians should examine all infants; ophthalmologists should examine all high-risk infants.
   
2. By age 6 months: pediatricians or family physicians should screen all infants.
   
3. At age 31/2 years: pediatricians, family physicians or ophthalmologists should examine all children.
   
4. At age 5 years and older: pediatricians or family physicians should screen children annually if this is not provided by school personnel or volunteer organizations.
   

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Information you should know about glaucoma

The normal eye:

• The eye is filled with aqueous humor, a fluid which circulates and drains through a channel (called the angle)
  
• The balance of production and drainage of this fluid is important to maintain the proper pressure inside the eye
  
• Maintaining a normal pressure in the eye is essential to protect the vital parts inside the eye (especially the optic nerve)

Open-angle glaucoma:

• Although the angle (channel) is open, the drainage is defective, causing the pressure inside the eye to increase, damaging the optic nerve fibers (cupping) and leading to vision loss
  
• Frequently there are no symptoms with this form of glaucoma, and vision loss occurs very slowly and is usually undetected by the patient
  
• Mild symptoms may occur, such as blurred vision, rainbow-like halos around lights, and chronic headaches

Closed-angle glaucoma:

• The drainage channel is blocked, causing pressure inside the eye to increase, resulting in damage to the optic nerve fibers (cupping) and leading to vision loss
  
• This type of glaucoma can be acute and abrupt
  
• Symptoms may include severe pain, a red eye, rainbow-like halos around lights, nausea, and vomiting

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COMPREHENSIVE DIABETIC EYE CARE
provided at Lindstrom Eye and Laser Center

All diabetics need to have a complete retinal exam once a year to screen for diabetic retinal disease, which is known as diabetic retinopathy. Early detection and treatment of diabetic retinal disease can reduce severe visual loss by 60%. In the early stages of diabetic retinopathy the patient may be unaware of visual changes.

Diabetic retinopathy is now the most common cause of blindness in patients under age 65 and is the most common cause of new blindness in the United States. The risk of diabetic eye disease increases with the number of years a patient has had diabetes. Fifteen percent of patients who have had diabetes for four years or less have retinopathy, compared to 90% of patients who have had diabetes for fifteen years or more. New studies this year have shown that better control of blood glucose can prevent development and progression of diabetic retinopathy. 

Drs. Eric Lindstrom, and Judith Bradley, recommend retinal exams yearly for diabetic patients. If diabetic retinal changes are present, the Lindstrom Eye and Laser Center has the facilities to evaluate the need for further therapy by performing a fluorescein angiogram in the office. This test shows which retinal vessels are affected and whether laser treatment would be beneficial.

The main treatment for diabetic retinopathy is laser photocoagulation. This is done in the clinic as an outpatient. Lindstrom Eye and Laser Center has a new Argon laser for the treatment of diabetic retinopathy.

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