Aging Pearls: Ophthalmology Answer Guide

Carol L. Howe, MD, MLS, College of Medicine, University of Arizona

  1. Because of the high incidence of diabetes in the Hispanic population in the Southwest, diabetic retinopathy is the leading cause of bilateral blindness among older adults in this population. True or False? False

A 2002 study published in Ophthalmology studied the causes of blindness and visual impairment in a random sample of 4774 Hispanic (mostly Mexican-American) residents in Santa Cruz and PimaCounties in Southern Arizona who were aged 40 years and older. The authors reported that open-angle glaucoma was the leading cause of blindness in this population compared with Age-related Macular Degeneration (AMD) and cataracts which have been found to be the leading cause of blindness in other groups. This was felt to be particularly important because knowledge and awareness about glaucoma was found to be generally low in this population. As far as visual impairment in general, cataracts were the leading cause of visual impairment (42%), followed by ARMD (15%) and then by diabetic retinopathy (13%). Specifically “Diabetic retinopathy, although present in the age group 65 or older, was less common as a cause of blindness and impairment compared with cataract, glaucoma, or ARMD. In part, this may be due higher mortality rates among persons with diabetes, as well as the age-related increases in the prevalence of these other diseases.”[1]

  1. It is generally difficult for older adults to learn new things and thus low-vision rehabilitation is usually not successful in the geriatric population. True or False? False

Low vision rehabilitation is a growing field, greatly aided by improvements in technology. Formal training—especially if started when patients still have some vision, can dramatically improve their quality of life and their ability to remain independent. Many older adults are both highly motivated to learn techniques that will allow them to remain independent and very successful at adapting to new ways of doing things.

  1. High doses of anti-oxidants may help ARMD and, because supplements are natural, can certainly cause no harm. All patients should be encouraged to take Vitamins A, C and E, Beta carotene, zinc and lutein in the highest doses they can afford. True or False? False

There is no evidence that Vitamin A is helpful for the prevention or treatment of ARMD. The evidence about Vitamin C is confusing and one study found that high doses of vitamin C might even increase the risk of ARMD. In general, the respected Natural Medicines Comprehensive Database (NMCD) recommends encouraging patients to increase their intake of fruits and vegetables, but not necessarily supplements. NMCD does, however, discuss the AREDS study which showed that a combination of zinc 80 mg, Vitamin E 400 IU, Vitamin C 500 mg and beta-carotene 15 mg does seem to reduce further progression (but not primary prevention) of intermediate ARMD. NMCD stresses that thecombination has been shown to be effective, but taking the components individually has not. (cont’d on back)

Additionally, beta carotene use in patients who smoke can “increase the risk of lung cancer, prostate cancer, and death from cardiovascular disease. Beta-carotene from DIETARY sources does not have this effect.”[2]

Lutein is a new supplement of interest and is included in many combination products. Again, lutein from dietary sources (some of which include spinach, broccoli, orange juice, grapes, kiwi, zucchini, and corn) seems to be helpful and dietary supplements may be helpful.2

[1]Rodriguez J, Sanchez R, Munoz B, West SK, Broman A, Snyder RW, Klein R,

Quigley H. Causes of blindness and visual impairment in a population-based sample of U.S. Hispanics. Ophthalmology. 2002;109(4):737-43.

[2] Natural Medicines in the Clinical Management of Eye disorders: Age Related Macular Degeneration, Cataracts and Glaucoma. Natural Medicines Comprehensive Database. Accessed 04/14/2011.