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Wednesday, Mar 25, 2015

Major conditions and diseases of the aging eye

Hernando Today correspondent


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Most of us would agree that aging gracefully is the preferred method.

Yet as signs of aging begin to interfere with everyday schedules and independent lifestyles, it gets increasingly difficult to accept the changes without some kind of resistance.

Gradual changes in vision are normal. But some conditions and diseases that may dramatically affect the health of the eye, particularly as we age, are important to understand in case further medical attention becomes necessary. Some conditions, if left untreated, can lead to blindness.

Most will begin experiencing significant changes in their vision as they near middle age. The inability to read small print, increased resistance to glare or requiring more lighting for reading are common changes noticed as the body ages.

Simple fixes might include better lighting or the use of inexpensive reading glasses or the transition from typical glasses to bifocals.

But what happens when the eye conditions become more severe?

According to the Mayo Clinic, some eye conditions that affect vision are more serious than simply needing to wear corrective glasses.

Cataracts, for instance, are a "clouding of the normally clear lens of the eye" and develop slowly. Eventually, however, cataracts can interfere with vision and, if left untreated, could lead to blindness.

Dr. Joe Militello, an ophthalmologist of the Eye Center in Spring Hill, says nearly 90 percent of his patients experience common eye issues like cataracts, glaucoma, macular degeneration, floaters, retinal tears or detachments, diabetic neuropathy and dry eye. Most are conditions that are typical symptoms of aging. Others are serious enough to require intervention.

Cataracts, for instance, are common yet misunderstood. Cataracts are an age-related change in the lens of the eye.

"Everyone gets cataracts," Militello said. "But not everyone requires cataract surgery."

Cataracts are not a disease process, he explained.

"Oftentimes when a patient gets a cataract they believe it is a disease or that it is unique," he said. "But it is not. It is like wrinkling of your skin or graying of your hair. It's the lens of the eye that becomes cloudy with age."

When the cataract becomes cloudy enough that it affects vision, cataract surgery is then discussed.

"I've done thousands of cataract surgeries here," Militello said. Modern cataract surgery involves removing the old cataract lens and replacing it with a new one.

"It is basically like a lens exchange," he added. "That is what cataract surgery is."

The goal of cataract surgery is to replace the damaged lens while also decreasing a patient's need for corrective glasses. Depending on the implant selected, many previous issues like near or farsightedness or astigmatism can be eliminated.

Surgery takes an average of about 10 to 15 minutes to complete, Militello explained, and is an outpatient procedure. After about three hours, the patient goes home and is asked to return the next day to see the ophthalmologist. Post-op instructions usually involve the use of some sort of drops and limited physical activity for about a week.

"It is the most commonly performed adult surgery in the United States," Militello said. "There are more than nine million cataract surgeries performed every year."

Glaucoma, unlike cataracts, is a group of diseases that are typically associated with abnormally high blood pressure inside the eye, according to the Mayo Clinic. The pressure can damage the millions of nerve fibers that carry vision information from the eye through the optic nerve to the brain.

As the optic nerve deteriorates, blind spots develop in the vision fields. Left untreated, glaucoma can lead to irreversible blindness.

Glaucoma is usually discovered in a routine eye exam, explained Militello, which is recommended annually for patients over the age of 50. It shows no symptoms in the early stages but will slowly damage the optic nerve. The patient will begin to lose their side vision and eventually central vision.

"The most important factors to consider about glaucoma is that the most common form is caught on a routine eye exam and has no symptoms," Militello said. "It's kind of like hypertension and diabetes. Those conditions are commonly caught during the yearly exam with the primary care physician."

Glaucoma is treatable with eye drops, laser or surgery.

Age-related macular degeneration occurs when the tissues of the macula, the part of the retina responsible for the center vision field, deteriorate, according to the Mayo Clinic. This causes blind spots that form in the center of vision.

Macular degeneration is the leading cause of blindness in the United States, said Militello.

AMD has two types; wet or dry. Wet macular degeneration typically occurs when blood vessels grow and begin to leak fluid beneath the macula. Dry cases are not accompanied by bleeding or leakage of fluid but may lead, if untreated, to wet AMD.

The wet form involves leakage of fluid or blood, said Militello, and is the more aggressive of the two. "It results in faster vision loss but can be treated with injections into the eye to treat the bleeding and leakage of fluid."

Dry eye AMD is treated with drops and AREDS2 vitamins, which have been proven to slow the progression. Militello also said that patients who suffer from dry eye AMD are encouraged to quit smoking. "People are always shocked that smoking can affect their eyes," he said.

The Eye Center has been serving Hernando County for 10 years. Militello has been a practicing ophthalmologist for 11 years, obtaining his undergraduate degree at the University of Florida. He continued his education at USF, where he graduated at the top 10 percent of his class.

Militello specializes in diseases of the aging eye. And when he's not serving his patients, he enjoys spending time with his wife and two children.

For more information about conditions relating to the aging eye, contact Dr. Militello at the Eye Center; 120 Medical Blvd., Spring Hill.

Contact the office at (352) 683-4500.

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