Vision Services
Disorders of Vision
The National Eye Institute (NEI) was established by Congress in 1968 to protect and prolong the vision of the American people. Thirty eight million Americans suffer significant vision impairment, a figure that is expected to increase 40% by 2020, particularly in Americans over age 40.
Impaired vision and blindness is a world-wide health burden. The World Health Organization estimates that there are greater than 160 million people worldwide who are visually disabled. Of these, approximately 40 million persons are blind and, by definition, cannot walk about unaided. Blindness represents a public health, social and economic problem, especially for developing countries, where 90% of the world’s blind population live. The largest proportion of blindness is related to aging. Approximately 50% of the world’s blind suffer from cataracts. The majority of the remaining visually impaired individuals are blind from conditions that include glaucoma, age-related macular degeneration, corneal opacities, diabetic retinopathy, trachoma, onchocerciasis (also known as river blindness) and conditions that cause childhood blindness. Glaucoma is the second leading cause of blindness globally, followed by age-related macular degeneration (NEI website).
Age-Related Macular Degeneration (AMD)
Macular degeneration gets its name because the macula, in the retina, begins to deteriorate. This deterioration can cause blurry vision or create a blind spot making driving, reading, or face recognition difficult. MD is the third leading cause of blindness worldwide. Symptoms include:
- An increased need for increased light for reading, words become blurry
- Wavy lines in Amsler grid (a lined chart used to test the integrity of the macular).
- Face recognition becomes more difficult.
- Blind spot in central vision.
Age of onset
Older people (50+) are greater risk for Macular Degeneration, however, it can occur during middle age. Age-Related Macular Degeneration is not aggravated or accelerated by vision use such as reading and has been primarily linked to genetic causes.
Treatment
Photodynamic therapy, using verteporfin (a medication used for therapy to eliminate the abnormal blood vessels in the eye) has had some success in slowing the loss of vision in wet AMD.
Prevention
The NIH indicates that smoking, obesity, family history of MD, gender and race are all risk factors for developing macular degeneration. Women are at more risk than men, and Euro-Americans have a greater incidence than African-Americans. A variety of eye examinations are available to test for both wet and dry AMD. Research has found that anti-oxidants and zinc can be helpful in preventing AMD. Regular eye exams are also important to detect any degeneration early. Many clinical trials are underway to discover the cause of, and treatments for, dry AMD. Research and clinical trials are also being conducted for wet AMD, no cure is yet available.
Other Eye Problems In Older Adults
There are several other eye problems that are more common among people as they age, although they can affect anyone at any age. They include:
• Presbyopia
This is the loss of the ability to clearly see close objects or small print. It is a normal process that happens slowly over a lifetime, but you may not notice any change until after age 40. Presbyopia is often corrected with reading glasses.
• Floaters
These are tiny spots or specks that float across the field of vision. Most people notice them in well-lit rooms or outdoors on a bright day. Floaters often are normal, but can sometimes indicate a more serious eye problem, such as retinal detachment, especially if they are accompanied by light flashes. If you notice a sudden change in the type or number of spots or flashes you see, visit your eye doctor as soon as possible.
• Dry eyes
This happens when tear glands cannot make enough tears or produce poor quality tears. Dry eyes can be uncomfortable, causing itching, burning, or rarely some loss of vision. Your eye doctor may suggest using a humidifier in your home or special eye drops that simulate real tears. Surgery may be needed in more serious cases of dry eyes.
• Tearing
Having too many tears can come from being sensitive to light, wind, or temperature changes. Protecting your eyes by shielding them or wearing sunglasses can sometimes solve the problem. Tearing may also mean that you have a more serious problem, such as an eye infection or a blocked tear duct. Both of these conditions can be treated or corrected by an eye doctor.
• Cataracts
Cataracts are cloudy areas that cover part of or the entire lens. Since a healthy eye lens is clear like a camera lens, light has no problem passing through the lens to the back of the eye to the retina where images are processed. When a cataract is present, the light cannot get through the lens as easily and, as a result, vision can be impaired. Cataracts often form slowly, causing no pain, redness or tearing in the eye. Some stay small and do not alter eyesight. If they become large or thick, cataracts can usually be removed by surgery.
• Glaucoma
This condition develops when there is too much fluid pressure inside the eye. It occurs when the normal flow of the watery fluid between the cornea and the lens of the eye is blocked. If not treated early, this can lead to permanent vision loss and blindness. Glaucoma is less commonly caused by other factors such as injury to the eye, severe eye infection, blockage of blood vessels, inflammatory disorders of the eye. Because most people with glaucoma have no early symptoms or pain, it is very important to get your eyes checked by an eye doctor regularly. Treatment may include prescription eye drops, oral medications, or surgery.
• Retinal disorders
The retina is a thin lining on the back of the eye made up of cells that collect visual images and pass them on to the brain. Retinal disorders interrupt this transfer of images. They include age-related macular degeneration, diabetic retinopathy, and retinal detachment. Early diagnosis and treatment of these conditions is important to maintain vision.
• Conjunctivitis
This is a condition in which the tissue that lines the eyelids and covers the cornea becomes inflamed. It is sometimes called "pink eye" or "red eye." It can cause redness, itching, burning, tearing or a feeling of something in the eye. Conjunctivitis occurs in people of all ages and can be caused by infection, exposure to chemicals and irritants, or allergies.
• Corneal diseases
The cornea is the clear, dome-shaped "window" at the front of the eye. It helps to focus light that enters the eye. Disease, infection, injury, and exposure to toxic agents can damage the cornea causing eye redness, watery eyes, pain, reduced vision, or a halo effect. Treatments include making adjustments to the eyeglass prescription, using medicated eye drops, or having surgery.
• Eyelid problems
The eyelids protect the eye, distribute tears, and limit the amount of light entering the eye. Pain, itching, tearing, and sensitivity to light are common symptoms of eyelid problems. Other problems may include drooping eyelids, blinking spasms, or inflamed outer edges of the eyelids near the eyelashes. Eyelid problems often can be treated with medication or surgery.
• Temporal arteritis
This condition causes the arteries in the temple area of the forehead to swell. It can begin with a severe headache, pain when chewing, and tenderness in the temple area. It may be followed in a few weeks by sudden vision loss. Other symptoms can include shaking, weight loss, and low-grade fever. Scientists don't know the cause of temporal arteritis but they think it may be caused by an impaired immune system. Early treatment with medication can help prevent vision loss in one or both eyes.Guide Dogs for the Blind
Guide Dogs for the Blind provides enhanced mobility to qualified individuals through partnership with dogs whose unique skills are developed and nurtured by dedicated volunteers and a professional staff.
Established in 1942, Guide Dogs for the Blind continues its dedication to quality student training services and extensive follow-up support for graduates. The programs are made possible through the teamwork of staff, volunteers and generous donors.
Services are provided to students from the United States and Canada at no cost to them.
A Guide Dog team consists of a dog and a person. The dog has been specially trained to assist a person who is blind with mobility. The dog is trained to lead, obey commands, avoid distractions, and disobey a command if it would put the team in danger.
One of the unique features of our program is our lifetime promise of support. Not only do we create the best partnerships, they also offer support throughout the life of a Guide Dog team, free-of-charge. As you know, our furry friends don't live as long as we do. Someone who is blind may be paired with many Guide Dogs throughout their lives.
Guide Dog For the Blind Campuses only operate in California and Oregon. In order to be trained for mobility and a guide dog, one has to travel to California or Oregon and attend their trainings. The general toll-free telephone number for both campuses: 1-800-295-4050.
Resources for sight-impaired individuals
Resources for individuals who are sight-impaired are typically offered by state or local governments. The National Federation for the Blind has divisions in each State.
For information regarding these resources, please refer to the Resources list on this page.