A woman nearing 60 goes to an ophthalmologist whose clinic she stumbles upon when the irritation in her eyes gets unbearable. She can’t keep her eyes open for more than a second, there is constant uncontrollable blinking and a burning sensation. Her two sons and husband are not very helpful, financially and otherwise. Doctor fees would be an extremely undesirable additional burden on the household. But working in the kitchen is becoming increasingly difficult and also dangerous. So she has to seek medical help.
The doctor tells her, ‘You are suffering from dry eye. You must’ve cried a lot in your life because you have no more tears left!’ surely a tragedy of Shakespearean proportions!
Mysterious and intriguing as that reason may sound, ‘dry eye’ can be caused simply by aging (post-menopause may be a particularly prone period), side-effects of certain medications, a problem with the tear ducts or conditions such as Sjogren’s syndrome and rheumatoid arthritis.
There is no cure for ‘dry eye’. A patient has to use so-called artificial tears as many times as he/she feels itching in the eyes. This can be a costly affair. Most drops for eyes have to be sterile and hence, they are high-priced. As a precaution, dry environments like air-conditioned rooms have to be avoided. Special glasses that completely cover the eyes so that no air can enter have to be worn. Tears/Moisture is vital for eyes. Blinking moistens and cleans the eyes. Knowing how many times one blinks in a single minute will tell you how vital this activity is. In the absence of this moisture, the eyes will deteriorate eventually leading to blindness.
When I came across this case, I couldn’t help but look into it. For most of us, anything related to the eyes is a mere hygiene factor. You only go to an ophthalmologist when you develop cataract with age. Now, with increasing use of lasers, anxiety related with this procedure is also decreasing. However, there are many potential complications that can make life more difficult than one can imagine.
The most common condition is Age-related macular degeneration (AMD), which is a disease associated with aging that gradually destroys sharp, central vision. Central vision is needed for seeing objects clearly and for common daily tasks such as reading and driving. The macula is the central part of the retina-the screen of the eye on which images are projected. Macula is responsible for finer details. It gives us central vision which accounts for about 35% of overall vision. Peripheral vision accounts for the remaining 65%. AMD occurs mostly in adults above 50 years, incidence increases with age.
It occurs in 2 forms, dry and wet. Dry AMD occurs due to the gradual and irreversible deterioration of photoreceptor cells in the middle part of the retina causing blurring of central vision.
In wet or exudative form, there is abnormal growth of blood vessels behind the retina. Bleeding and scarring of these vessels damage the retinal cells.
The dry form is more common then the wet form. However, all wet forms evolve from dry forms. So a dry form may progress in a dry state or turn to wet form. The wet form results in faster degeneration and is responsible for a majority of cases of vision loss.
Signs and Symptoms:
Vision loss may be so gradual that one may not pay too much heed to it, especially in a country like ours where the rigors of aging are taken in stride.
Vision loss from wet AMD is much faster and may be noticed in the form of lines appearing wavy. There might be central patches of blurred vision or missing patches altogether. This makes recognizing faces, reading and driving increasingly difficult.
The patient may have trouble differentiating colors too.
Overall, this condition is asymptomatic in that hardly any pain is experienced and therein lies the danger of detecting it late.
Besides age, predisposing factors include:
Diagnosis involves a comprehensive eye exam in which the retina is studied and strength of vision determined. Grids such as the Amsler grid are used to determine if lines appear wavy.
Fluorescein angiogram is used in case of wet AMD. A dye is used to visualize overgrowth of blood vessels. Such checks are continued throughout to note progress of the condition and effect of treatment. But the problem is the relatively asymptomatic and gradual presentation of the disease. How many of us go for regular and comprehensive eye exams just out general consciousness?
1. Laser Surgery: burns the leaky blood vessels but it is risky as the surrounding healthy tissue may also get burned.
2. Photo-dynamic therapy: Drugs such as verteporfin are injected into the arm. Bright light is then shined on the eye. This activates the drug which sticks to the abnormal vessels and destroys them.
3. Anti-growth factors: are drugs that fight against heightened levels of growth factors that promote the growth of blood vessels in the eye. These have to be injected directly into the eye and can be painful.
These treatments are suggested in advanced cases of AMD, i.e. mostly wet AMD. However, vision once lost can never be replenished. Also, blood vessels usually re-grow after surgery. So, repeated sessions are required. The best a treatment can achieve is a slow-down in vision loss. Unfortunately there is no bona fide cure for AMD. For dry AMD, a proposed cure is high doses of vitamins A, C, E, zinc and copper to slow down progression to later stages. Stem cell therapy may harbor some hope but its years away, if not decades away. These involve transplant of stem cells to the affected area. Grafts or bigger implants are seldom feasible or applicable.
AMD is the leading cause of blindness the world over. Blindness even if not in its full blown form can be a bigger handicap than other disabilities. Imagine not being able to recognize faces, read the newspaper or drive a car. It can very quickly lead to depression and a generally hostile or a diametrically opposite docile disposition.
Being out of a job and struggling to get donations/charity or worse, a license for a phone-booth for the disabled can be a nightmare, especially in a country where nothing moves without grease money.
What can I do?
Presence of AMD does not mean you can’t use your eyes to perform normal tasks such as reading. One can continue to do so; it does not lead to further damage.
As we have seen, AMD is a chronic condition and occurs with aging. The least one can do is go for a check-up at the first signs of blurred or abnormal vision, which is well worth the effort and cost. Do insist elders in the family, especially women who are neglected and often neglect their own health to go for a regular check-up. The redemption from years of painful abstinence from smoking and fatty foods is manifold. Lower risk of AMD is just part of the story. Diet rich in green leafy vegetables, vitamin and anti-oxidant in supplement form or from diet are strongly suggested.
Simple exercises like concentrating on a point on the wall, moving your eye-balls in all 4 directions, clock-wise and anti-clockwise etc help in the long-run.
I’m sure most of us were repeatedly scolded in school for reading books too up-close and badgered with the 30 cm or more rule. Now, laptops are available which flash warnings when you move too close to the screen. Would you like to pay 3-5 thousand more just tot get this facility?
Not all health insurance schemes cover for ophthalmic procedures. The absence of overnight hospitalization clause is bound to be thrown in your face. Even if some treatments are sanctioned, caps are put on what grade of treatment you can avail. A typical example would be how advanced a lens or implant you can choose. So, be clear about the clauses and what options you have before opting for a procedure.
Eye donation has still not caught on in India a decade after the ad campaign featuring Aishwariya Rai. The waiting time for getting a transplant maybe a decade or more. Even if you do manage to be eligible for one, you are only granted one eye for transplant. When you hit the bucket, you won’t need eyes where you’re going. The decision ought to be simple.