Staying Alive / Eye disease often has no symptoms
The following story includes some corrections that came in after print publication.
At a holiday party in January—coincidentally Glaucoma Awareness Month—a friend told me her mother had been diagnosed with a rare eye cancer and, that while her mother had experienced some blurred vision, most people who get this disease have no symptoms at all. That freaked me out.
As someone who had 20/20 vision until age-related far-sightedness set in, I’d never gone for eye exams. At the urging of my sister, I finally went for my first comprehensive exam with an ophthalmologist about a year ago, and was told if drugstore cheaters were working fine that I should just keep using them. I took that to mean yearly exams weren’t necessary. And, since I knew that any eye disturbance—blurred vision, sudden floaters, shadows, blind spots, double vision, “curtains” over the eye, sudden flashes of light, web-like obstructions—is cause for immediate attention, I felt in the clear.
But no symptoms? That freaked me out—and sent me to Google, where I learned that:
• In the early stages, age-related macular degeneration goes largely unnoticed, and can only be detected through a dilated eye exam. (National Eye Institute)
• At first, symptoms of cataracts may be undetectable or very slight. (Bausch and Lomb)
• Though it’s a rare disease, CMV (cytomegalovirus) retinitis often presents no symptoms. (Bausch and Lomb)
• Glaucoma often develops with no symptoms, making it impossible for patients to detect until significant (and irreversible) damage has been done.(Bausch and Lomb)
• You might not have symptoms in the early stages of diabetic retinopathy. (Mayo Clinic)
• People with intraocular melanoma often have no symptoms. Many times, an ophthalmologist finds the melanoma during a regular eye examination. The most common symptom is painless loss of vision. (cancer.net)
These diseases can put patients at risk of severe vision loss and yet often present no symptoms until the disease has advanced. The most threatening are age-related macular degeneration, diabetic retinopathy, and glaucoma; cataracts are the least threatening.
“Cataracts are definitely one of the leading causes of blindness worldwide, but it is definitely fixable,” says Dr. Sandra Sieminski, clinical assistant professor, University at Buffalo Department of Ophthalmology. “There are some instances where it’s medically necessary to remove cataracts, but, for the most part, it’s an elective surgery that can be done at any time of the cataracts’ maturity.”
That’s the good news. The bad? The Centers for Disease Control and Prevention estimates that sixty-one million adults in the United States—about one in five—are at high risk for serious vision loss, but only half visited an eye doctor in the past twelve months. That means someone is going to have compromised vision as a result.
Perhaps even more significant is this CDC statistic: more than seventy percent of respondents from the National Eye Health Education Program (NEHEP) 2005 Public Knowledge, Attitudes, and Practices survey consider that loss of eyesight would have the greatest impact on their day-to-day life; however, less than eleven percent knew that there are no early warning signs of glaucoma and diabetic retinopathy. And, as the population continues to live longer, the number of people with vision problems will increase.
“CMV retinitis is a little bit of an outlier, because you’d have to be immune-compromised to have it, so you’re a sick person already, but the others are more common,” acknowledges Sieminski, who points to a confusion in terminology as a part of the problem with preventative eye health. “In Buffalo, I feel that getting [checked and] fitted for glasses is interpreted as getting an eye exam; [since I’ve been] here, I’ve had to change the way I [refer to procedures], because, to me, having an ‘eye exam’ is having your pupils dilated and your eyes thoroughly checked. It’s confusing, because people think they’re getting their eyes looked at when they get glasses.”
“Until you dilate the pupil, you are not getting a great view of the back two-thirds of the eye—the retina, the optic nerve, all those things—which is where all of these diseases, except for cataracts, are happening,” Sieminski points out. “Especially ocular melanoma and things like that, they can be off in the periphery of the retina. When you’re looking through an undilated pupil, it’s like looking at a whole room through a toilet paper roll.” And that little air puff test that optometrists do? It tests eye pressure, as ocular hypertension can be an early sign of glaucoma, but Sieminski cautions that while it can serve as a screening tool, it’s not a substitute for looking inside the eye.
Because most of these diseases are not fast moving, a yearly exam should suffice to catch them; this is particularly important for diabetic patients at risk of diabetic retinopathy. “It’s the only place in the body where you can see the manifestations of the disease firsthand,” explains Sieminski. “In some cases, the diagnosis might be reversed; people learn they have diabetes because of something found on their dilated eye exam.”
A comprehensive eye exam is not painful or lengthy, but is critical to early intervention, because eye disease progression is individual. For example, “You can have mild diabetic retinopathy and it will be OK if your [sugar levels] are controlled, or you can go blind within a year of being diagnosed if you’re uncontrolled,” Sieminski says. “Same with glaucoma. It takes years and years to cause blindness, and it’s very slowly progressing, but there are aggressive hereditary forms that progress much faster without treatment. Macular degeneration has two forms—dry and wet—and dry is treated with vitamins and wet is treated with lasers and injections. Wet can progress quite quickly, and dry can turn to wet suddenly, but there are people with dry who are stable their whole lives.”
Sieminski also notes that people often grow accustomed to their worsening vision, or base their vision health on their ability to read an eye chart. “With glaucoma, vision can be worsening, and I’ll hear, ‘I can read the chart fine,’ and meanwhile,” she says, “it’s slowly taking away their peripheral vision and they’re accommodating.”
Both optometrists and opthalmologists can perform complete eye examinations in order to screen for eye disease, but it is important that your pupils are dilated to get a complete picture. Eye exams intended to check glasses perscriptions do not always include this type of examination.
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Donna Hoke is a frequent contributor to Spree.