Vision evaluation should be a key part of any primary-care exam. Whether it’s an easily treatable problem such as cataracts or warning signs of more serious conditions such as retinal detachment, age-related macular degeneration or glaucoma, a prompt evaluation is important, say two UCLA ophthalmologists.
A decline in vision “should dictate a referral to an eye-care professional,“ says Colin McCannel, M.D., a retina specialist and medical director of the Jules Stein Eye Center, Santa Monica. “If it’s a gradual decline, it is less urgent but still warrants an evaluation. If it’s a more rapid change, it is frequently something serious that needs immediate attention.”
Declining vision, particularly among patients entering their 60s, often is more evident at night and in dimly lit environments. This is most often due to the development of a cataract, notes D. Rex Hamilton, M.D., director of the UCLA Laser Refractive Center. “It’s inevitable that patients will develop cataracts as they get older, but it’s not something they should have to live with.”
Cataract surgery “is very safe and takes only 15 minutes,” Dr. Hamilton says. Vision generally returns to normal by the next day, and Dr. Hamilton adds that multifocal lenses implanted during the surgery give patients distance and near vision without glasses.
Sudden vision loss may also indicate vascular occlusive disease of the eye or a detached retina, Dr. McCannel says. All these conditions require immediate attention.
Macular degeneration , another serious condition, is characterized by a loss of central vision that often is associated with problems reading and, in more advanced stages, difficulty recognizing faces. Macular degeneration is most common among fair-skinned, light-eyed individuals of Northern European heritage. Patients with a family history of age-related macular degeneration should begin having regular eye exams at about age 50 to assess whether they have early signs and might benefit from vitamin supplementation, Dr. Hamilton says.
Family history and regular eye exams for at-risk patients (particularly African-Americans) are also vital to pick up signs of glaucoma, which tends not to show early visual symptoms; instruments used by eye-care professionals are required to determine presence of the condition. Symptoms of glaucoma can include eye pain, particularly if it is severe and associated with nausea and headache, or redness.
Drs. McCannel and Hamilton urge people to protect their eyes from bright sunlight as a way to reduce the progression of cataracts and the risk of macular degeneration. It also is important for patients with diabetes to have an annual eye exam and immediately ask their doctor to assess any vision complaints.
Dr. Hamilton notes, “A lot of people think it’s normal to have more difficulties with vision as you get older, and that there’s nothing that can be done about it. We need to change that perception.”