[humanser] Going Blind

[JD Townsend]

This is a all too common article on blindness, one I had hoped would be less common this century. 


New York Times 
Science Desk Section 
02/21/2017

PERSONAL HEALTH  
The Worst That Could Happen? Going Blind  
By JANE E.  BRODY  
'Feeling My Way Into Blindness,' an essay published in The New York Times in November by Edward Hoagland, 

an 84-year-old nature and travel writer and novelist, expressed 
common fears about the effects of vision loss on quality of life.

Mr.  Hoagland, who became blind about four years ago, projected 
deep-seated sadness in describing the challenges he faces of 
pouring coffee, not missing the toilet, locating a phone number, 
finding the food on his plate, and knowing to whom he is 
speaking, not to mention shopping and traveling, when he often 
must depend on the kindness of strangers.  And, of course, he 
sorely misses nature's inspiring vistas and inhabitants that 
fueled his writing, though he can still hear birds chatter in the 
trees, leaves rustle in the wind and waves crash on the shore.

Mr.  Hoagland is hardly alone in his distress.  According to 
Action for Blind People, a British support organization, those 
who have lost some or all sight 'struggle with a range of 
emotions -- from shock, anger, sadness and frustration to 
depression and grief.

When eyesight fails, some people become socially disengaged, 
leading to isolation and loneliness.  Anxiety about a host of 
issues -- falls, medication errors, loss of employment, social 
blunders -- is common.

A recent study from researchers at the Wilmer Eye Institute at 
Johns Hopkins University School of Medicine found that most 
Americans regard loss of eyesight as the worst ailment that could 
happen to them, surpassing such conditions as loss of limb, 
memory, hearing or speech, or having H.I.V.  /AIDS.  Indeed, low 
vision ranks behind arthritis and heart disease as the third most 
common chronic cause of impaired functioning in people over 70, 
Dr.  Eric A.  Rosenberg of Weill Cornell Medical College and 
Laura C.  Sperazza, a New York optometrist, wrote in American 
Family Physician.

Some 23.7 million American adults reported in 2015 that they are 
unable to see at all or have trouble seeing even with corrective 
lenses.  This number is projected to perhaps double by 2050 based 
on the aging of the population and increasing prevalence of 
diseases that can cause vision loss.  Yet, the Wilmer Eye 
Institute's national study of 2,044 adults found that many 
Americans are unaware of the diseases and factors that can put 
their vision at risk and steps they might take to lower their 
risk.

Perhaps the single most valuable message to emerge from studies 
of vision loss is the importance of having a thorough eye checkup 
at least once every two years, if not annually.  Many 
sight-robbing conditions can be effectively treated if detected 
early enough, in many cases limiting or eliminating the damage to 
eyesight.

Four eye diseases -- age-related macular degeneration, diabetic 
retinopathy, glaucoma and cataracts -- account for most cases of 
adult blindness and low vision among people in developed 
countries.  Unlike many other ailments associated with aging, 
they cause no pain and often no early symptoms and thus do not 
automatically prompt a person to seek medical care.  But a 
thorough checkup by an ophthalmologist can detect them in their 
earliest stages, followed by treatment that can slow or halt 
their progression or, in the case of cataracts, restore normal 
vision.

Macular degeneration, a leading cause of vision loss in Americans 
60 and older, involves an irreversible loss of retinal cells that 
robs people of the central vision needed to read, watch a TV 
program or identify a face or object in front of them.  There are 
two types, dry and wet.  In the dry type, the light-sensitive 
cells in the macula, a structure near the center of the retina, 
gradually break down.  In the wet type, abnormal blood vessels 
grow under the macula.

Steps you can take to lower your risk of macular degeneration or 
slow its progression include not smoking, eating lots of dark 
leafy green vegetables, wearing sunglasses to block ultraviolet 
light, and taking one or more supplements formulated to support 
macular health.  There are also treatments specific for wet 
A.M.D., including laser surgery, photodynamic therapy and drugs 
that are injected into the eye to slow the growth of abnormal 
blood vessels.

Diabetic retinopathy, the cause of most blindness in American 
adults, also affects the light-sensitive retina, damaging the 
vision of more than half of people with diabetes age 18 or older.  
The most effective preventive is maintaining a normal level of 
glucose in the blood through medication and a proper balance of 
diet and exercise.  Blood glucose should be routinely monitored, 
high blood pressure effectively treated and smoking avoided 
entirely.

Glaucoma, another leading cause of blindness, involves a rise in 
fluid pressure inside the eye that damages the optic nerve.  It 
affects more than four million Americans, about half of whom 
don't know they have it, and is especially common among 
African-Americans and Hispanics.  It can be detected with a 
comprehensive eye exam, which should be done annually for 
African-Americans and those with a family history of the 
condition.

Although glaucoma is not curable, treatment to lower pressure in 
the eye with prescription eye drops and, in some cases, pills or 
surgery can control the condition.

Cataracts are the most common cause of vision loss among people 
over 40.  They involve a gradual clouding of the lens, a normally 
transparent tissue directly behind the iris and pupil that helps 
to focus images on the retina.  As cataracts progress, it becomes 
increasingly difficult to see clearly, impairing the ability to 
read, drive or recognize faces.

Preventing or slowing the development of cataracts involves 
protecting the eyes from sun damage, not smoking, consuming a 
diet rich in vegetables and fruits and, if you have diabetes, 
keeping blood sugar under control.

In years past, doctors often advised patients with cataracts to 
wait until they were far advanced before removing them 
surgically.  This is no longer the case.  Cataract surgery is now 
done when the condition begins to affect a person's quality of 
life or interferes with the ability to perform normal activities.

The surgery is nearly always done under local anesthesia on an 
outpatient basis.  If both eyes have cataracts, as is usually the 
case, the second eye is typically treated some weeks after the 
first to avoid the rare risk of a postoperative infection in both 
eyes.  The operation involves removing the clouded lens and, in 
most cases, replacing it with a clear artificial lens that often 
gives patients better vision than they had even before developing 
cataracts.

This is the first of two columns on vision loss and blindness.  
Next week: Aiding the visually impaired.
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