This article is more than 5 years old. Information may no longer be current.
Ophthalmologists focus on preserving, restoring and enhancing vision in aging patients
Click Here to Manage Email Alerts
 Richard L. Lindstrom |
Aging is one risk factor for disease and degeneration that no one can avoid. As all of us over the age of 60 know, the only good thing about aging is that it is superior to the alternative. It is telling that in the U.S., those over the age of 65 years consume 10 times the eye care as those under the age of 65 years.
The challenge for all seniors is to age gracefully, remaining as healthy, wealthy and wise as possible, allowing a high-quality, joyous life. It is part of our duty as physicians to assist our patients in meeting the challenges of aging as best possible. This challenge includes helping them preserve their vision, restoring visual function when treatable diseases are present and, in many cases, enhancing their visual function by, for example, reducing their dependence on glasses when desired.
Preservation of vision includes diagnosing age-related eye disease in a timely fashion and treating patients appropriately. The most common age-related diseases such as age-related macular degeneration, diabetic retinopathy, retinal vein occlusion, cataract, glaucoma and ocular surface disease are all best managed when diagnosed early and treated as indicated. We are all well-trained and experienced in the this type of restorative medical care.
On the other hand, counseling patients in preventive medical care through proper diet and lifestyle habits was not taught in my medical training, which began some 40 years ago. When I began my medical training in 1969, the significant impact that nutrition and behavioral choices can have on health and quality of life were both less well-understood and, to be direct, neglected in our formal educational process. Today we know that lifestyle choices can have a significant impact on our patients’, and our own, health and quality of life. Clear risk factors include smoking, a poor diet high in saturated fats, inadequate fruit and vegetable ingestion, lack of exercise and improper eye protection when performing dangerous activities, such as pounding a nail. It is important for us all to be aware of these factors and share this knowledge with our patients.
I am an advocate of nutritional supplements and encourage for many patients antioxidant and multiple vitamin supplements as well as omega-3 fatty acids. I take these myself as well as a daily dose of aspirin. Avoidance of smoking is critical. If one enjoys the occasional alcoholic drink, red wine seems the best choice with its high content of the antioxidant resveratrol — ideally never more than two glasses in a given day. Fish is to be encouraged frequently in place of meat. My internist’s recommendation is fruit for breakfast, salad for lunch, and fish or white meat for dinner with lots of green vegetables. In addition, exercise is critical. For most in their senior years, walking is the best therapy, along with light weight training. In addition, the impact of companionship on health and quality of life is well-established. Isolation often leads to depression, and it is important for all physicians to look for and offer referral to the untreated depressed patient.
In regards to vision restoration, the most common cause of visual disability in advanced countries, AMD, can in many cases be mitigated by referral to a specialist in low-vision aids. I ask every new patient I see with significant visual disability whether they have seen a low-vision specialist, and sadly, I would estimate that only about 10% have been previously evaluated. In addition, well more than 50% of senior patients with a visual disability also suffer from an untreated hearing disability. We now screen for this in our practice as well and offer treatment. This is an area where we as a profession can do better.
Of course, most rewarding is the restoration of vision, and the miracle of modern cataract surgery remains one of the most satisfying operations in all of medicine to perform. For many patients, we can not only restore good vision, but in many cases enhance visual performance and quality of life through the utilization of refractive cataract surgery customized to the individual patient’s lifestyle goals.
While the rewards of visual restoration remain at the core of our practice as ophthalmologists, it is important that we do not neglect our duty to preserve vision as well. I also believe it is now appropriate for every cataract surgeon to learn and practice the skills required for refractive cataract surgery, which provides the most common opportunity today for visual function enhancement in the senior patient. As always, the demand for lifelong learning and surgical skill advancement remains a challenge, but the positive impact on our senior patients’ quality of life is well worth the effort.