Looking Into Our Eyes

By staff July 1, 2007

The eyes are the windows to our soul—and, sometimes, to the state of our general health. Vision abnormalities can be harbingers of other problems, including diabetes, brain tumors, multiple sclerosis, blood disorders, rheumatoid arthritis and lupus.

But trouble seeing can also indicate serious problems with, well, the eyes.

According to the American Foundation for the Blind, 6.5 million Americans over the age of 65 experience severe vision loss. Health officials predict that diseases of the eye, such as age-related macular degeneration (AMD), glaucoma and diabetic retinopathy will double as the nation's 78 million baby boomers reach retirement age and beyond.

One of the leading causes of impairment of vision in people over 50 is age-related macular degeneration, which is caused by the hardening of the arteries that nourish the retina. In 2004, the Archives of Ophthalmology estimated that 1.75 million U.S. residents show significant symptoms associated with AMD, with that number expected to grow to almost three million by 2020. Although AMD doesn’t often cause total blindness (peripheral vision is usually not affected), it can cause severe vision loss.

Sarasota resident Furman Arthur knows all about this devastating condition. Three years ago, he noticed that the vision in his right eye was more blurry than usual. In his early 80s, he chalked it up to old age. When it started seriously interfering with his reading and writing, Arthur, a former public relations director at New College and a journalist who still practices his craft, knew it was time to see his eye doctor. That doctor sent him to a retina specialist.

By the time Arthur saw the specialist, he had lost most of his central vision in his right eye. He still had peripheral vision, but anything in the center of his vision was blurred and mostly unrecognizable. The specialist told him what he feared: The macula in his right eye was showing signs of deterioration.

But let’s back up a minute. What the heck is the macula, anyway?

The macula is located in the center of the retina, says Dr. Harry Grabow, founder, medical director and chief surgeon of the Sarasota Cataract & Laser Institute, “and is the part of the eye used for focusing on detailed vision, especially reading and driving. One of the first symptoms of macular degeneration is difficulty reading very small print, especially newspaper print.” Patients complain, he says, of seeing a blank hole in the center of their vision.

“Macular degeneration happens when the arteries that nourish the retina begin to harden,” says Grabow. “The tissue of the retina becomes deprived of the oxygen and nutrients that keep it healthy. As a result, the central vision deteriorates.”

There are two types of macular degeneration. The wet type is the most aggressive form and occurs when new blood vessels grow under the macula in an attempt to carry much-needed oxygen to the area. “These vessels break easily, causing bleeding and damage to the surrounding tissue,” says Grabow. Statistics show that about 10 percent of patients who suffer from macular degeneration have the wet type. Arthur happens to be one of these people.

The dry type of AMD is more common and generally results in less severe loss of vision. It can progress to wet, so if you’re diagnosed with dry AMD, you’ll be advised to have your eyes examined at least twice a year.

What causes this unpleasant condition and how can we prevent it? While scientists still haven’t come up with one determining cause, the condition is aggravated by a variety of factors, including age, dietary habits and overexposure to sunlight. Smokers are found to have higher incidences of it. Recent research by Duke University and other research facilities shows that genetics play a role. If you have a family member with AMD, it’s a good idea to have your eyes checked at least once a year after 50. Obesity, lighter eye color, and high blood pressure are also seen as factors that point to a predisposition to AMD.

As for symptoms, says Grabow, the disease takes its time, and the process is usually slow and relatively painless. Most commonly, patients complain of experiencing fuzzy or distorted vision. They also report difficulty in reading. One way to tell if you’re experiencing AMD is to take an Amsler grid test. This is a chart of black lines arranged in a graph pattern that’s used to monitor vision loss.

We all want to be able to read and drive well into our 80s. If we can’t prevent the condition, what can we do to cure it?

There is still no outright treatment that cures either type of AMD. That said, there is a new FDA-approved drug being used to stop abnormal blood vessel growth for patients suffering from the wet type of macular degeneration, says Dr. Keye L. Wong of the Sarasota Retina Institute.

“Up until only a few years ago, treatment of AMD was not very satisfactory,” Wong says. “At the very best we could halt the progression. Then, last summer, a new drug called Lucentis was approved by the FDA. This drug has completely changed our perception of how we treat AMD. One out of three patients we’re treating with Lucentis can see significantly better. Some are actually driving again!”

Wong explains that the drug, which is injected directly into the eye, significantly reduces vascular growth. “I’m talking about a real ‘wow’ factor,” he says. “The difference for some of our patients has been the difference between being able to maintain independence and having to go into assisted living.”

There’s one downside to Lucentis: the cost. Wong explains that the drug costs $2,000 a pop—far out of the reach of most people, since it’s often administered on a monthly basis. Another drug, Avastin, is currently being tested for use in AMD but is not yet FDA-approved. (The Retina Institute has been chosen by the FDA as a testing facility for Avastin.) Wong says that thus far results are encouraging. Even better? If it’s approved, the cost will be around $50 a treatment. “Avastin could potentially save the health care system $4 billion a year,” he says.

Nutrition also plays a part in AMD. Research is indicating that certain nutrients such as zinc, lutein, zeaxanthin and vitamins A, C and E can lower the risk for AMD and slow down the progression of dry macular degeneration. Other studies show that consumption of omega-3 fatty acids may also protect against developing AMD.

Arthur, for one, is grateful for all of the new research being conducted to fight AMD. By the time his left eye started showing signs of AMD last year, his retina specialist, Dr. John H. Niffenegger of the Sarasota Retina Institute, started him on Lucentis, which has greatly helped slow the progression of the degeneration. “I check in with Dr. Niffenegger once every six weeks or so,” says Arthur. “If he sees that the vessels are leaking again, he’ll put me back on Lucentis to help stabilize the leaking.”

In the meantime, Arthur has immersed himself in finding resources to help him live with low vision. He uses ZoomText, a magnification and reading software program, so that he can work on his computer. He uses Talking Books to keep up with his reading. He’s a great believer in Lighthouse for the Blind, a national organization with local ties that promotes independence, equality and self-reliance of people who are blind or visually impaired. ”They taught me how to handle simple household chores, write checks, cook and so on,” says Arthur. Best of all, although he has difficulties seeing the ball, he still plays golf because “the swing is still there.”

If you’re of baby-boomer age, here’s a quick look at three other common eye conditions to be aware of:

Cataracts: We’re all well aware of the “c” word. Cataracts occur when the lens of the eye becomes cloudy, and we start to have difficulty with night driving, reading small print, and problems with light glare. As Grabow puts it, if we live long enough, most of us are not going to be able to avoid cataracts in one or both eyes. Indeed, cataracts affect nearly 20.5 million Americans age 40 and older. The good news? The cataract can be removed and replaced with an artificial lens. This relatively simple procedure usually corrects nearsightedness, farsightedness, astigmatism and presbyopia.

Dry eye syndrome: As we get older, our bodies produce less oil, which affects the tear film in our eyes. The result is dry areas on the cornea, causing irritation, redness and blurred vision. Other causes are linked to certain medications, thyroid conditions, autoimmune diseases and menopause. Grabow says that treatment ranges from using artificial tears to having the tear duct plugged or permanently closed.

Floaters and flashers: This common condition is also age-related. We’re born with a clear, gel-like substance called vitreous that fills the space between the crystalline lens and the retina. With age, the vitreous thins and can pull free from the retina. When this happens, we’ll experience floaters, or tiny bits of vitreous gel that cast shadows on the retina. Flashes occur when the vitreous tugs on the sensitive retina tissue. Although floaters and flashes are usually innocuous, in some cases they can actually harm the retina. For this reason, Grabow urges anyone experiencing either to see his or her eye doctor.

Body talk

BODY BY WON Tips from a local legend in fitness.

If you frequent the downtown YMCA, you’ll see T-shirts proclaiming “Body by Won.” The people wearing them are all ages and sizes bound by one common connection: Won Huh.

Who is Won Huh? He’s a former Mr. Korea with a pumped body that still looks like it’s made of steel. He’s father of Jason Huh, a young professional bodybuilder on the national competition scene, and brother to Ki Woon Huh, an acclaimed master potter. But ask Won and he’ll tell you this: He’s a fitness instructor with 30 years experience and one simple goal: to help others stay healthy and fit.

It’s not exaggerating to say Won is a legend in Sarasota’s fitness circles. People will wait as long as it takes to sign on with him, and they often work with him for years.  

Won says there’s really only one prerequisite: desire. “Everything else will follow,” he says.

He recommends working with a trainer to devise a program that’s followed at least three times weekly. “If your trainer is good,” says Won, “he or she will constantly re-evaluate it to reflect your ability level.” He also recommends making an appointment with a dietitian to plan a custom regime. Won prefers a high-protein, low-carb diet—and suggests “cutting out fast food.”

The third aspect to a healthy life: reducing stress. Won does that by finding time to kayak, bike, and read. Yoga is wonderful, he says, but you can find peace of mind simply by taking a walk or going into your yard and “touching the dirt. Connecting with nature brings ease to our souls.”

For an appointment or information, call (941) 724-5192.

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