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Looking Good


Cindy Drew, a geriatrics educator at Bayhealth Medical Center in Dover, examines Matthew Hoskins of Dover. Photograph by Tom NutterSqueezing past several co-workers behind a pharmacy counter, 35-year-old Brian Begley of Wilmington tries to fill prescriptions as efficiently as possible, but he always seems to hit a speed bump when the light dims, whether from shadows, reduced wattage or time of day.

“Before I could have a lamp all the way across the room and be fine,” he says. “Now I need to be right under the light or else it’s a struggle.”

To make matters worse, Begley has seen a noticeable decrease in his eyesight, especially in his left eye, since his 30th birthday.

“You have to have your eyesight,” he says. “I can’t really get away with telling the customers, ‘I think these are the right pills.’”

Begley is not alone, according to Cindy Drew, geriatrics educator at Bayhealth Medical Center in Dover. “There are many changes with the eyes that are just related to aging,” she says, “and nobody is immune from these changes.”

Blurring vision, restricted vision, glaucoma, cataracts and other conditions occur either as a result of aging or a serious health condition. Most conditions can be corrected. And some can be delayed by simple care.

The human eye is a marvel of biological engineering, a complex machine that can view a whopping 200 frames per second. (A regular 35 mm movie camera pulls in a meager 24 frames per second.) And as impressive as the construction of the eye is, its function is much more important. Which is why it’s astounding that many people take their vision for granted, says Dr. Andrew Iwach, a clinical correspondent for the American Academy of Ophthalmology.

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“Eyes are amazing,” Iwach says. “A survey some years ago about health concerns said people are more worried with weight loss and back pain than they are with eye problems. Later in the survey, they were asked whether they would prefer to lose their sight, have regular back pain or to be overweight. No one chose to lose their sight. It is the most important of the senses.”

Biologically speaking, sight is the most important of the five senses to survival. As a result, the eye has evolved into one of the most complex structures in nature, says Iwach.

The way an eye works is fairly simple: The cornea refracts light to the pupil, which adjusts in size with the help of the iris, then sends light through the lens to the retina in the back of the eyeball. Cones and rods in the retina convert the input into a code that is transmitted electro-chemically along the optic nerves to the brain, which converts it into the image we see.

At age 30, the cornea begins to lose its form, like other parts of the body that have felt the effect of everyday use for too long, and it begins to flatten. The result is a less pronounced arch, leading to a decrease in the amount of light that passes to the pupil.

“With corneal flattening, you automatically need more light to see the same thing that a younger person would have no problem with,” says Drew. “It starts in your 30s, so by the time you hit 60, most changes have occurred or are well on their way.”

The process is a slow one and the effects can be reduced by adequately lighting your home and workspace.

But around age 40 another problem starts: presbyopia, which translates to “elder eye.” Up to this point, the eye’s lens was very elastic, expanding and contracting every time your eye needed to refocus. Forty years of stretching and shrinking have taken their toll, though, so the lenses lose elasticity, leaving them unable to focus on certain objects, especially those close to the eye, Iwach says.

“Basically, your arm gets too short to read effectively,” he says. That’s why many people over 40 begin to use magnifying glasses for reading or seek bifocals.

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Wear and tear on the eyes is unavoidable, Iwach says, but other health factors play roles. Gradual changes in quality and quantity of the blood supply, the amount of oxygen supplied by the blood, and exposure to ultraviolet light rays all play important roles in general eye health.

“I have noticed that I have helped a lot of patients stop smoking once I told them that cigarettes can severely impact eye quality in middle-aged people,” Iwach says. “Diabetes and high blood pressure can also play roles with eye problems because of their effect on blood. Also, UV radiation can lead to serious problems.”

Yet even someone who takes exceptional care of his eyes is still be susceptible to basic problems, due to the fact that eye use in unavoidable. The key to preserve good function and health is to limit risk, especially for severe eye problems such as glaucoma, macular degeneration and cataracts.

As with other health issues, eye problems can be treated more effectively when caught early, so visits to the eye doctor every two years are a must if you are 40 or over, Iwach says.

During the visits, the doctor can check for elevated eye pressure and loss of peripheral vision, a sign of glaucoma, and for a loss of vision in the center of the eye, a sign of macular degeneration. If either condition is detected, the doctor can prescribe steroidal eye drops or pills that can slow development or halt the problems, but damage can be permanent if symptoms go unchecked for too long, Drew says.

The least complex of the problems to work on is cataracts, a loss of transparency in the lens. Over time, the fibers in the lens get sinewy, like any other muscle that is used repeatedly. Those fibers develop a yellow tinge.

“The lens becomes less transparent, which changes the type of available light that comes into the eye. Lens fibers multiply at the edges of the lens, and old ones move into center so old fibers build up in center of the eye,” Drew says. “It changes how we see blue and violet, which appear greener. Reds and oranges get stronger in comparison.”

If untreated, cataracts can impede vision to the point of blindness, but recent medical breakthroughs have allowed for artificial lenses to replace the natural lens of the eye, leading to improved recovery for people who suffer from cataracts.

Eye Insight

The key to preserving good eye function and health is to limit risk.

 Wear and tear on the eyes is unavoidable, but there are several basic steps you can take to avoid trouble:

  •  Visit the eye doctor every two years if you are 40 or older. Regular visits can also catch serious health problems.
  •  Light your home and workspace adequately
  •  Wear safety glasses when doing work
  •  Wear sunglasses that block at least 99 percent of UV rays
  •  Quit smoking
  •  Stay hydrated

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