Sight Saving Tests for Older Eyes

Many older people don't realize how untreated, age-related eye changes can harm vision and, eventually, their entire quality of life. In my practice, I sometimes see the unfortunate results of what happens when an older person waits too long for an eye exam.

A delay of even a few years can make the difference between normal vision and going blind. While some eye conditions can be pretty obvious, others may sneak up on you.

As an example, Delores Johnson (not her real name) came to my office for an eye examination after being pushed by her family to do so. She had not been seen by an eye doctor for 25 years. She insisted that she could see just fine, and that her eyes gave her no problems.

But warning bells went off right away when I noticed that her vision was only about 20/80. During the dilated eye examination of her retinas, I found terrible damage from diabetes, with blood leaks and permanent scarring.

I referred Delores to a retinal specialist and an internal medicine doctor. But it was too late. She went blind and then died within a year. While this is an extreme and very scary example, this true story clearly shows why regular eye exams are essential — especially as we age.

These critically important tests should be done on a regular basis:

• Eye pressures
• Visual field (side vision)
• Dilated retinal examination
• Slit lamp (microscope)
• Refraction

Each test gives your eye doctor essential information about how your vision functions.

Eye pressure testing (tonometry) is one of the ways we watch for glaucoma, a leading cause of blindness. Glaucoma usually has no symptoms until it becomes very advanced, at which point it's too late to save your vision. But if glaucoma is found early enough with proper testing, the eye disease can be treated very effectively.

Visual field testing (measuring side vision) is another way we watch for glaucoma. This test also can help us find such problems as brain tumors, aneurysms, strokes, and other brain diseases, which often are more common in older people.

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A dilated retinal examination is vitally important to your eye health. By looking through an enlarged pupil (or imaging the retina with a special laser instrument), we can spot many, many health problems and diseases. The pupil provides the only easily available window into the body, allowing us to find alarming changes early. Plus, this eye exam is painless and inexpensive.

Examples of what a dilated retinal eye exam might show us include:

• By looking for changes in the optic nerve, we may be able to tell if glaucoma is present.
   
• We can examine the area of the retina where fine focusing occurs (macula) to look for signs of macular degeneration.
   
• By evaluating the eye's natural lens, we can detect signs of cataracts.
   
• Damage to the eye's arteries and veins (blood vessels) can give us clues about the presence of diabetes, hardening of the arteries, high blood pressure, cholesterol damage, and other blood diseases.
   

A slit lamp examination helps us take a careful look at the front parts of the eye with a microscope to find such things as dry eyes, corneal dystrophies, pingueculae and pterygia (lumps and bumps on the sclera and cornea), eyelid disease, cancerous changes, and other abnormalities.

A refraction seems pretty basic. Most people recognize this eye test as important for determining your prescription for glasses. But did you know results of these eye exams also help us detect conditions including diabetes, cataracts, and thyroid problems? Eye doctors know these conditions can trigger certain, specific changes in your eyesight. For instance, diabetes can cause wild swings into nearsightedness, and thyroid problems can cause double vision.

At the beginning of this article I mentioned the tragic outcome involving one patient who skipped eye exams for too long. But now I'll tell you another story about Jim Nelson (not his real name), who has been my patient for many years.

Because Jim always undergoes yearly eye testing, I discovered that his eye pressures were going up and the appearance of his optic nerve was changing. Special testing confirmed that Jim has primary open angle glaucoma, an insidious eye condition that can cause blindness if left untreated.

Jim is now using the glaucoma eye drops prescribed for him once daily, and has 20/20 vision. However, this story could have been far different had it not been for regular eye exams and early detection of glaucoma.

Especially now, Jim certainly appreciates the value of regular eye testing in his older years — as should anyone interested in preserving eye health.