Neelakshi Bhagat, MD,
director of vitreoretinal and macular surgery, Institute of Ophthalmology and Visual Science, New Jersey
Medical School
Will Vitamins Restore "Boomersightis"?
by Jill Spotz
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f you are between the ages of 42 and 60 and feel the numbers on your watch dial are too small, ask your children to read the total on the dinner bill or have tried an extraordinary number of over the counter prescription eyeglasses at your local pharmacy, you may be suffering from “Boomersightis” or age-related eye decline. As we age, so do our eyes and along with the years come disorders such as presbyopia (difficulty reading at close range), age related macular degeneration (AMD), and diabetic retinopathy.
In 2004, the National Institutes of Health, National Eye Institute released an alarming statistic: 3.3 million Americans over the age of 40 are blind or suffer from low vision. These figures are expected to reach 5.5 million as baby boomers age. Even more disturbing are the projected statistics for other eye disorders. By the year 2020, the number of Americans with diabetic retinopathy could be seven million, those with AMD – three million, and there will be a shocking 30 million individuals with cataracts. As ominous as these statistics are, new treatments and procedures are offering a glimmer of light at the end of the tunnel. In fact, there are many therapies available now that the generation before didn’t have the opportunity to utilize.
Researchers are trying to answer the question of why AMD is on the rise. The disorder affects the area of the retina responsible for central vision. What scientists do know is that half of the individuals with the disease carry a gene defect called Complement H Factor. Due to these genetic conditions, if a family member has AMD, relatives are 50 percent more likely to develop the disease. Other factors that increase the risk include smoking, high blood pressure and intake of high fat foods.
According to assistant professor of ophthalmology at NJMS Neelakshi Bhagat, MD, antioxidants show great promise in reducing the risk of advanced AMD. “Daily supplements of antioxidants such as vitamins C, E, beta-carotene, zinc and copper decrease the risk of advanced AMD by 25 percent. Additionally, the risk of moderate loss of vision decreases by 19 percent in five years,” she explains. For those with the wet form of AMD, which is fueled by the growth of abnormal choroidal blood vessels, a new drug called Lucentis was recently approved by the FDA. Compared to Macugen, a similar drug that blocks vascular endothelial growth factor (VEGF), which is the molecule that promotes the growth of abnormal choroidal blood vessels under the retina, Lucentis has been shown to actually improve vision in clinical trials rather than just stabilize it. The medicine can be delivered directly into the eye by injection which then binds to all isoforms of VEGF and reduces its activity. “There are several reasons why this new anti-VEGF treatment is so exciting,” explains Bhagat, the director of vitreoretinal and macular surgery at the Institute of Ophthalmology and Visual Science at NJMS. “A once-a-month injection of Lucentis for one year has proven to either maintain vision or minimize vision loss in 90 percent of people with wet AMD, and 25 percent actually have reported improved sight.”
Baby boomers can look forward to additional promising treatments for AMD, one of which is being offered at the Institute. The Age-Related Eye Disease Study II (AREDS II) is a multi-center, randomized trial to assess the effects of high doses of macular xanthophylls (lutein and zeathanthine) and omega-3 fatty acids for the treatment of AMD and cataracts. The primary objective of AREDS II is to determine whether oral supplementation of these antioxidants will decrease the progression to advanced AMD. Results from part one of the study showed that doses of zinc and/or an antioxidant formulation of vitamin C, vitamin E, and beta-carotene reduced the likelihood of developing advanced AMD in approximately 25 percent of patients who were at moderate risk. Researchers believe the supplements are capable of hindering the cellular changes in the eye commonly associated with aging.
Diabetes is one of the primary afflictions of baby boomers. Over time, it affects the circulatory system of the retina, causing leaking vessels which lead to swelling and decreased vision. Gradually, circulation problems cause areas to become oxygen-deprived and the fragile vessels hemorrhage, producing spots or floaters. Because diabetic retinopathy is often symptom-less until it is quite advanced, it is frequently not diagnosed in earlier stages. By providing a detection mechanism for patients while they are treated in their primary care physician’s office, Bhagat is hoping to diagnose diabetic retinopathy earlier.
This concept of telemedicine, or exchanging medical information from one location to another via electronic communications, improves patients’ health by detecting symptoms faster and more efficiently. In the instance of diabetic retinopathy, Bhagat’s team is testing the use of a non-mydriatic (does not require dilation of the eye) camera to evaluate and diagnose the disorder in patients who either do not seek medical help or are based in remote locations where specialty care is not accessible. “Our camera can detect up to 90 percent of vision threatening retinal diseases without a clinical retinal examination,” she explains. “The photographs of the patient’s central retina are sent to an ophthalmologist who then analyzes the results.” Bhagat’s telemedicine team has brought this camera into the community at health fairs, to senior citizen centers and to public schools.
New Procedures Restore the Aging Eye
Peter S. Hersh, MD, clinical professor of ophthalmology at NJMS, offers a solution for baby boomers who have to continually reposition their reading material. The procedure known as Near Vision Conductive Keratoplasty (CK) improves presbyopia for people over 40. Presbyopia occurs when the lens of the eye becomes stiff with age and is less able to focus on images up close. Individuals with the condition become dependent on reading glasses. CK uses radiofrequency energy to reshape the cornea to improve reading vision, computer vision and eye fatigue at the end of the day. The technique is performed using a small probe that releases radiofrequency energy in a circular pattern to shrink the corneal tissue. “This shrinkage increases the curvature of the cornea and the result is like wearing a bifocal contact lens,” explains Hersh. Unlike LASIK, CK does not require a surgical flap or the removal of surface cells. The entire procedure takes only 10 minutes per eye.
Peter S. Hersh, MD, clinical professor of ophthalmology, New Jersey Medical School
CK was approved in 2002 for the treatment of hyperopia (farsightedness) and Hersh was involved in this initial approval process. The procedure was recently approved by the FDA as a form of treatment for presbyopia. Since CK does not involve any cutting or removal of tissue, there is less chance of complications. Hersh explains that the process itself is comfortable and patients may experience dry eyes or irritation for several days but these feelings will diminish. “Presbyopia is like a ‘moving target,’” he explains. “Some CK patients may need an additional procedure three to five years later as the natural lens of the eye continues to lose flexibility.”
As the lead investigator of the clinical trial that launched the Excimer laser for the treatment of nearsightedness in the ’90s, Hersh is a known expert on the technology. This method is also used for hyperopia, which frequently affects baby boomers since it starts to appear in the early 40s. During the LASIK treatment, a thin flap of the cornea is cut with a high speed laser and folded back. The Excimer laser is applied to reshape the cornea and the flap is then replaced. The new “steeper” cornea allows for clearer vision. The risks associated with this procedure include undercorrection, overcorrection, seeing a glare, haze, double vision especially at night or dry eye sensations. Some patients may need to undergo a second procedure to correct these complications. Hersh, who treats approximately 1,000 patients a year, says that all patients heal differently. Ninety percent have no difficulties and 10 percent may need a “fine-tuning” laser procedure three months after the first.
On the horizon is a promising new treatment using an intra corneal inlay — a small lens that is implanted inside the cornea, “like encasing a contact lens within the cornea,” explains Hersh. “The lenses change the cornea’s optical properties to make the eye focus properly to correct farsightedness and/or presbyopia.” The inlays are permeable to nutrients, thus well tolerated by the cornea and can be removed if needed. “We are hoping this procedure will be even more effective than CK,” says Hersh. Hersh’s team is expecting to start a study on this new technology in early 2007.
Tips for Boomers: Maintain Your Vision as You Age
- If you have a family history of AMD, start getting screened for the disease at age 45.
- If you have a family history of glaucoma, begin getting screened immediately.
- If you have diabetes, have your eyes examined regularly. Remember: individuals with diabetes have a 50 percent chance of developing diabetic retinopathy five years from diagnosis.
- Wear protective sunglasses.
- Decrease known risk factors within your control such as smoking, eating high fat foods and high blood pressure.
- Diets rich in antioxidants slow down the progression of macular degeneration. Eat green leafy vegetables and start nutritional supplements. (AREDS recommends Ocuvite®, Viteyes® and other brands.)