New treatments attacking eye diseases in elderly

Fourteen years ago, Irving Taber’s doctor informed him he had the beginning signs of macular degeneration.

Macular degeneration is a fairly common eye condition affecting people 50 and older. The condition, which has a genetic component, causes people to slowly lose their eyesight in the middle of the eye, while keeping their peripheral vision. There is no cure for the disease, but new treatments developed within the last decade dramatically slow the progress.

Taber’s condition progressed, and, after two car accidents, he decided to not only give up his driver’s license but his livelihood. The owner of a car lot, Taber was required to have a driver's license to maintain his business.

“It was depressing,” recalls Taber, now 85, who lives in Hollywood. “Now, my wife does all the driving. She opens the mail; she pays the bills. She’s my eyes. I’m lucky to have her.”

Macular degeneration is one of several eye conditions that afflict the elderly. The other two common ones are glaucoma and —the most common one — cataracts.

Cataracts affect nearly everyone once they reach a certain advanced age—currently, more than 22 million Americans age 40 and older, according to the organization Prevent Blindness America, which estimates 30 million Americans will be affected by 2020. They are the most common cause of blindness in the world, although highly treatable in the developed countries.

A cloudiness or film that forms over the lens of the eye, cataracts prevent light from passing through the eye, impairing vision. The good news is that the condition is easily diagnosed by an eye doctor and almost always curable. The film covering the eyeball is removed through a 10-minute surgery and a plastic lens is implanted inside the eye.

Once the surgery is done, it never has to be repeated, noted Dr. William Trattler, an ophthalmologist with the Medical Arts Surgery Center at Baptist Hospital in Miami. Patients can usually drive the day after surgery.

The first symptoms of the condition are typically when people have trouble reading road signs while driving or experience glare while driving at night, he said.

“It centers around distance issues,” said Trattler, who performs 700 cataract operations annually. “The surgery is 99 percent successful. Surgery for cataracts has been around for thousands of years.”

For Hollywood manicurist Anita Mansfield, the diagnosis of cataracts came when she was 55, with all the typical symptoms.

“My eyesight was getting blurry,” said Mansfield, now 68. “It was getting hard to see driving a car at night. It kept getting worse.”

Ultimately, Mansfield had surgery to remove the cataracts, at the Fort Lauderdale Eye Institute.

“They do it one eye at a time,” she said. “First they put drops in your eyes and then they give you twilight anesthesia. The whole things takes about an hour.”

Mansfield is now doing fine, but visits her eye doctor every six months for check-ups.

Those who develop cataracts are far luckier than those who face a diagnosis of macular degeneration or glaucoma.

Glaucoma is a condition in which fluid builds up inside the eye, causing pressure that damages the optic nerve and can lead to blindness. The condition affects roughly 5 percent of people in their 60s or older, and is more common in African Americans and Mexican Americans. There is a genetic link to the disease.

Glaucoma is easy to treat if caught early, but can be dangerous and lead to blindness if left untreated. Unfortunately, there are few symptoms at first, which is why the disease is called “the sneak thief of vision.” Eventually, peripheral vision is affected, and headaches, blurred vision or halos around lights can occur. In later stages, patients can experience eye pain, nausea and vomiting due to the eye pressure build-up.

“You start to permanently lose your vision,” Trattler said. “It is the leading cause of blindness in the United States.”

The primary treatment for the condition is special eye drops administered once or twice daily. Ironically, the drops have a positive side effect of causing the eyelashes to grow, which led to their marketing for that purpose by pharmaceutical companies.

The drops—developed nearly a century ago— are successful in 95 percent of glaucoma patients

For those whom the drops don’t work, there are some 10 different surgeries available. Laser surgery for glaucoma slightly increases the outflow of the fluid from the eye or eliminates fluid blockage by burning a tiny hole in the iris. For some patients, a glaucoma implant is the best option.

Thankfully, much progress has been made in the field of macular degeneration in the last decade or so.

“We really couldn’t do much to help these patients before,” noted Dr. Justin Townsend of Bascom Palmer Eye Institute at UHealth - University of Miami Health System. “We can do much more to help them these days.”

While there still is no cure for the condition, there is now a treatment that slows macular degeneration dramatically. It was a decade or so ago that doctors started treating the patients with special injections inside the eyeball. The injections are done on an outpatient basis, with numbing eye drops administered first, and are not painful, says Trattler.

“They work well,” he said. “This has changed the game completely.”

The injections are used for “wet macular degeneration,” in which leaky blood vessels allow fluid to seep into the eye. This form of macular degeneration is considered far more severe than dry macular degeneration, and can lead to vision loss and blindness quickly if action is not taken.

Another sign of hope on the frontier: a study pioneered at Bascom Palmer found that a cocktail of vitamins called AREDS, which contains Vitamin C, Vitamin E, zinc and copper, when taken in the early stages of the disease, can prevent malcular degeneration from advancing.

“It prevents the mild forms of macular degeneration from turning into the severe kinds,” Townsend said. “People can wake up with profound vision loss. Usually, the injections can roll the clock back quite a bit.”

The injections are administered monthly for “awhile,” he added—“until the disease quiets down.”

For those who are in the advanced stages of the disease and have little or no vision, there is also a glimmer of hope. A recently approved implant can bring back a small amount of vision to such patients, so they can at least see shapes, said Townsend, who has performed the surgery twice.

“As technology gets better and better, there’s hope for people with eye conditions,” he added.

This story was originally published April 21, 2016 at 10:20 AM with the headline "New treatments attacking eye diseases in elderly."