Skipping Eye Exams Is Common Despite Fear of Losing Vision - NYTimes.com

Skipping Eye Exams Is Common Despite Fear of Losing Vision - NYTimes.com

PERSONAL HEALTH
What We’re Not Looking After: Our Eyes
By JANE E. BRODY
Published: December 20, 2010
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Joe Lovett was scared, really scared. Being able to see was critical to his work as a documentary filmmaker and, he thought, to his ability to live independently. But longstanding glaucoma threatened to rob him of this most important sense — the sense that more than 80 percent of Americans worry most about losing, according to a recent survey.
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Partly to assuage his fears, partly to learn how to cope if he becomes blind, and partly to alert Americans to the importance of regular eye care, Mr. Lovett, 65, decided to do what he does best. He produced a documentary called “Going Blind,” with the telling subtitle “Coming Out of the Dark About Vision Loss.”

In addition to Mr. Lovett, the film features six people whose vision was destroyed or severely impaired by disease or injury:

¶Jessica Jones, an artist who lost her sight to diabetic retinopathy at age 32, but now teaches art to blind and disabled children.

¶Emmet Teran, a schoolboy whose vision is limited by albinism, a condition he inherited from his father, and who uses comedy to help him cope with bullies.

¶Peter D’Elia, an architect in his 80s who has continued working despite vision lost to age-related macular degeneration.

¶Ray Korman, blinded at age 40 by an incurable eye disease called retinitis pigmentosa, whose life was turned around by a guide dog and who now promotes this aid to others.

¶Patricia Williams, a fiercely independent woman legally blind because of glaucoma and a traumatic injury, who continues to work as a program support assistant for the Veterans Administration.

¶Steve Baskis, a soldier blinded at age 22 by a roadside bomb in Iraq, who now lives independently and offers encouragement to others injured at war.

Sadly, the nationwide survey (conducted Sept. 8 through 12 by Harris Interactive) showed that only a small minority of those most at risk get the yearly eye exams that could detect a vision problem and prevent, delay or even reverse its progression. Fully 86 percent of those who already have an eye disease do not get routine exams, the telephone survey of 1,004 adults revealed.

The survey was commissioned by Lighthouse International, the world-renowned nonprofit organization in New York that seeks to prevent vision loss and treats those affected. In an interview, Lighthouse’s president, Mark G. Ackermann, emphasized that our rapidly aging population predicts a rising prevalence of sight-robbing diseases like age-related macular degeneration and diabetic retinopathy that will leave “some 61 million Americans at high risk of serious vision loss.”

The Benefits of a Checkup

Low vision and blindness are costly problems in more ways than you might think. In addition to the occupational and social consequences of vision loss, there are serious medical costs, not the least of them from injuries due to falls. Poor vision accounts for 18 percent of broken hips, Mr. Ackermann said.

So, why, I asked, don’t more of us get regular eye exams? For one thing, they are not covered by Medicare and many health insurers. Even the new health care law has yet to include basic eye exams and rehabilitation services for vision loss, though advocates like Mr. Ackermann are pushing hard for this coverage in regulations now being prepared.

Lighthouse International is one of five regional low-vision centers participating in a Medicare demonstration project in which trained therapists teach patients how to use optical devices, how to make changes in their homes to facilitate independence and how to maintain mobility outside the home. Thus far, an interim analysis showed, the costs of providing these services are well below what had been anticipated.

I can think of no good reason for excluding this coverage in the nation’s health care overhaul, any more than there are good excuses for Medicare’s failure to pay for hearing aids. A lack of coverage for such services will inevitably carry its own heavy costs in the long run.

But even those who have insurance or can pay out of pocket are often reluctant to go for regular eye exams. Fear and depression are common impediments for those at risk of vision loss, said Dr. Bruce Rosenthal, low-vision specialist at Lighthouse. Patients worry that they could become totally blind and unable to work, read or drive a car, he said.

Yet many people fail to realize that early detection can result in vision-preserving therapy. Those at risk include people with diabetes, high blood pressure, high cholesterol or cardiovascular disease, as well as anyone who has been a smoker or has a family history of an eye disorder like macular degeneration, diabetic retinopathy or glaucoma.

Smoking raises the risk of macular degeneration two to six times, Dr. Rosenthal said.

Furthermore, he said, the eyes are truly a window to the body, and a proper eye exam can often alert physicians to a serious underlying disease like diabetes, multiple sclerosis or even a brain tumor.

Reasons Not to Wait

He recommends that all children have “a basic professional eye exam” before they start elementary school. “Being able to read the eye chart, which tests distance vision, is not enough, since most learning occurs close up,” he said. “One in three New York City schoolchildren has a vision deficit. Learning and behavior problems can result if a child does not receive adequate vision correction.”

Annual checkups are best done from age 20 on, and certainly by age 40, Dr. Rosenthal said. Waiting until you have symptoms is hardly ideal. For example, glaucoma in its early stages is a silent thief of sight. It could take 10 years to cause a noticeable problem, by which time the changes are irreversible.

For those who already have serious vision loss, the range of visual aids now available is extraordinary — and increasing almost daily. There are large-picture closed-circuit televisions, devices like the Kindle that can read books aloud, computers and readers that scan documents and read them out loud, Braille and large-print music, as well as the more familiar long canes and guide dogs.

On Oct. 13, President Obama signed legislation requiring that every new technological advance be made accessible to people who are blind, visually impaired or deaf.

Producing “Going Blind” helped to reassure Mr. Lovett that he will be able to cope, whatever the future holds. Meanwhile, the regular checkups and treatments he has received have slowed progression of his glaucoma, allowing him to continue his professional work and ride his bicycle along the many new bike paths in New York City.

This is the first of two columns on vision loss.

A version of this article appeared in print on December 21, 2010, on page D2 of the New York edition.
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