After 33 years in the rough and tumble of Cambridge politics, including several stints as mayor, Walter Sullivan, 73, has developed a new — albeit unwanted — preoccupation during retirement: eye troubles.
In fact, there are four major vision problems that often plague older people — cataracts, glaucoma, macular degeneration and diabetic retinopathy — and Sullivan has them all.
His first brush with blindness “scared the hell out of me,” he said last week by phone from Florida. “I was walking along the Charles River at 6 a.m. one day when I went blind in both eyes briefly. . . I didn’t know what the heck was happening. I thought my sight was gone.”
It wasn’t. In fact, by the time Sullivan walked home — very slowly — hisvision had returned as mysteriously as it had disappeared, a phenomenon his doctors still can’t explain, despite his multiple eye problems.
With four different diseases, of course, Sullivan’s case is unusually dramatic. But the fact is that, for all of us, the odds of having eye problems — from the merely annoying to the sight-threatening — increase sharply with age.
People 65 and older constitute only 12 percent of the population but account for more than 50 percent of all cases of blindness, according to the American Academy of Ophthalmology. By age 65, in fact, one in every three people has some form of vision-limiting eye disease.
And with the aging of Baby Boomers, now fumbling with bifocals and trying to read with arms that are suddenly too short, the number of older people with eye problems will soar to more than 66 million, according to Dr. Carl Kupfer, director of the National Eye Institute.
To be sure, some of the problems of aging eyes are nearly universal — and little worse than bad bifocal jokes.
At midlife, almost everybody finds it harder to read or do close work, to see at night, to adjust to sudden changes in illumination and to judge the speed of moving objects, says James Fozard, associate scientific director of the Baltimore Longitudinal Study of Aging, one of the longest-running and most detailed studies of the biology of aging.
One reason is that as we age, the pupil, the black part of the eye, no longer expands as readily in dim light. That means, among other things, that the older you get, the more crucial it is to have good light for reading and close work.
Aging also affects light-sensing cells called rods and cones in the retina, the tissue in the back of the eye. Cones are sensitive to color and bright illumination like daylight; rods are sensitive to movement and dim light.
With age, it takes longer for the rods to activate, which means, Fozard notes wryly, that it takes you longer at 60 to find a seat in a darkened movie theater than it did at 15.
It’s also normal to find glare more troublesome as you get older and to need starker contrast — very dark letters on a very white page — to read well.
But the most obvious normal change is presbyopia, the decreased ability to focus close-up because of changes in elasticity of the lens and in the eye’s focusing muscles. This ability peaks at age 12 — and, sad to say, goes downhill from there.
At some point between 38 and 50, we find “our arms are not long enough to read the phone book. This is absolutely inevitable,” says Dr. Edward Murphy, director of the general eye service at the Massachusetts Eye and Ear Infirmary.
Even people who’ve been nearsighted all their lives aren’t immune from presbyopia. For them, it means taking off glasses or contacts to see up close.
One solution is to wear bifocals with clear glass on the bottom and prescription lenses on top. Another is to adjust contact lenses so one eye sees well at a distance, the other, close-up.
But these annoyances “pale beside the serious, sight-threatening eye diseases of later life such as cataracts, glaucoma, macular degeneration and diabetic retinoapthy,” says Tony Cavallerano, director of the New England Eye Institute.
“All these diseases develop slowly and insidiously, which means early detection through regular eye exams is crucial,” adds Dr. Carmen Puliafito, director of the New England Eye Center and chairman of ophthalmology of Tufts University School of Medicine.
A cataract is a clouding of the lens caused by the buildup of yellow and brown pigments. Eventually, this clouding can become so severe that light cannot pass through.
So far, drugs have proved ineffective against cataracts, but surgery often works extremely well, says Puliafito. In the surgery, performed 1 million times a year in America, doctors make a tiny incision at the edge of the cornea, then use high-frequency ultrasound to break the lens into millions of pieces that can be sucked out through a tube.
Once the old lens is gone, a lens of acrylic or silicone is slipped in. ”The patient goes back to normal activities the next day and vision gets better in a few weeks,” he says.
Glaucoma, too, is an insidious problem.
In a normal eye, there is a slow, constant flow of fluid from the middle of the eye to the bloodstream though a network of drainage cells. In glaucoma, which affects about 2 million Americans, this drainage system becomes blocked, leading to a buildup of pressure inside the eyeball. Untreated, the pressure can damage the optic nerve and eventually cause blindness.
Often, there is no pain or other symptoms, which unfortunately means glaucoma can go undetected until some damage is done.
Once glaucoma is detected, further damage can be prevented with eyedrops containing beta-blockers (the same kind of drugs used to control bloodpressure) to improve outflow of fluid, or with drops such as Trusopt, which contain drugs that decrease the production of fluid.
If drugs don’t work, laser surgery often does. In a procedure that takes about 10 minutes, a laser beam is used to create tiny holes to improve drainage. If this fails, a last resort is non-laser surgery to create a larger drainage channel.
The leading cause of legal blindness in older people is age-related macular degeneration, which strikes about 500,000 people a year. It develops when something, probably dangerous oxygen molecules called free radicals or the buildup of fatty deposits, damages the macula, a tiny spot in the center of the retina.
Typically, it does not affect peripheral vision, but macular degeneration, which often affects both eyes, makes it harder to read, drive and recognize faces. Some controversial research suggests it may be prevented with anti- oxidant vitamins and minerals such as vitamin E and beta-carotene, selenium and zinc.
Once you get it, there is little doctors can do, although magnifying devices and computer-enhanced TV projections may help focus images on healthy cells around the macula.
On the other hand, if the degeneration is complicated by new blood vessels growing underneath the retina and by leakage of fluid from these vessels into the macula, there is a solution: once again, laser surgery, which can shut down the new vessels.
Leaky blood vessels are also the culprit in diabetic retinopathy, a major problem for millions of older Americans with diabetes. In diabetic retinopathy, blood vessels grow into the retina itself, where substances leaking from the vessels can cause swelling. Blood may also leak into the rest of the eye, blocking transmission of light.
In many cases, says Puliafito, laser surgery helps by stimulating the eye to absorb the fluid and by getting rid of abnormal blood vessels.
Walter Sullivan, the veteran of three surgeries at the New England Eye Center, can now see well enough to drive, walk, read and lead a normal life. He counts himself a lucky man.
“I’ve had great results,” he says. But it would have been better to have caught his problems even earlier.
His advice is simple: “Keep getting your eyes checked.”
SIDEBARTO LEARN MORE
– New England Eye Center at New England Medical Center, 1-800-231-3316 or 617-636-4600.
– Massachusetts Eye and Ear Infimary, 617-573-4199.
– New England Eye Institute, 617-262-2020. The institute also runs a mobile van for outreach toolder people, at 617-236-6317.
– National Eye Care Project, 1-800-222-EYES (1-800-222-3937). If you’re 65 or older, this service will help you find an ophthalmologist who will do an exam free if you have no insurance, or who will waive the co-pay or deductible if you have insurance, including Medicare and Medicaid.
– American Foundation for the Blind, 1-800-232-5463, for referrals to a low-vision specialist.
– Massachusetts Commission for the Blind, 617-727-5550 or 1-800-392-6450, if you are legally blind (10 percent vision or less). If you use a telecommunications device for the deaf, call 1-800-392-6556.
– Vision Foundation Inc., 617-926-4232 or 1-800-852-3029 (Massachusetts residents only).
– Prevent Blindness America, 617-489-0007 or 1-800-331-2020.
– Massachusetts Association for the Blind, 617-738-5110.
– Carroll Center for the Blind, 617-969-6200 or 1-800-852-3131.
For more information or referrals, call:
SIDEBARTO LEARN MORE
– New England Eye Center at New England Medical Center, 1-800-231-3316 or 617-636-4600.
– Massachusetts Eye and Ear Infimary, 617-573-4199.
– New England Eye Institute, 617-262-2020. The institute also runs a mobile van for outreach toolder people, at 617-236-6317.
– National Eye Care Project, 1-800-222-EYES (1-800-222-3937). If you’re 65 or older, this service will help you find an ophthalmologist who will do an exam free if you have no insurance, or who will waive the co-pay or deductible if you have insurance, including Medicare and Medicaid.
– American Foundation for the Blind, 1-800-232-5463, for referrals to a low-vision specialist.
– Massachusetts Commission for the Blind, 617-727-5550 or 1-800-392-6450, if you are legally blind (10 percent vision or less). If you use a telecommunications device for the deaf, call 1-800-392-6556.
– Vision Foundation Inc., 617-926-4232 or 1-800-852-3029 (Massachusetts residents only).
– Prevent Blindness America, 617-489-0007 or 1-800-331-2020.
– Massachusetts Association for the Blind, 617-738-5110.
– Carroll Center for the Blind, 617-969-6200 or 1-800-852-3131.
For more information or referrals, call: