Every year 50,000 Americans go blind, most from treatable or preventable eye diseases such as diabetic retinopathy and macular degeneration. Yet just half of the 61 million Americans at high risk of losing their eyesight saw an eye doctor in the past 12 months, according to the Centers for Disease Control and Prevention.
That's partly because preventive eye exams are not covered by Medicare or most private insurance, says Peter J. McDonnell, M.D., director of the -Wilmer Eye Institute at the Johns Hopkins Medical Institutions in Baltimore. Not surprisingly, blindness is among Americans' most-feared medical conditions, along with Alzheimer's disease and cancer.
"What's sadder than working your whole life, getting ready to retire and developing something like macular degeneration, where you lose your central vision?" McDonnell says. "It's a big issue."
AARP spoke with McDonnell about what's fueling the rise in eye diseases, steps we can take to protect our eyesight and new developments in the treatment of blindness.
Q: By 2050, the number of Americans who are blind or visually impaired is expected to double to more than 8 million. What's behind that trend?
A: The two biggest drivers are the increase in the number of people with diabetes and the fact that we're living much longer. Thirty years ago, it was pretty rare for us to see someone who was 80 years old. Now, we routinely see patients over 100. Back then, people would have developed these age-related eye diseases, but they didn't live long enough.
Q: If you have diabetes, are you destined to get diabetic retinopathy?
A: The better you control your diabetes, the less likely you are to have a problem. And if you do develop the abnormal blood vessels in your retina that are a hallmark of the disease, we can treat them with lasers or medications. Unfortunately, only about 20 to 30 percent of people who have diabetes get regular eye exams, and up to 24,000 Americans go blind each year from diabetic retinopathy.
Q: What else can people do to protect their eyesight as they get older?
A: Eat a well-balanced diet, and don't smoke. We think that the loss of vision that accompanies some eye disease such as age-related macular degeneration may be related to oxidative damage to the eye. People who eat plenty of green, leafy vegetables and antioxidant-rich fruits and vegetables like blueberries and tomatoes might be better off. Plus, when you're out in the sun, you want to wear UV-absorbing sunglasses and a hat with a brim. Smoking doubles your risk of macular degeneration and cataracts, so if you smoke, quit.
Q: Dry eye syndrome seems to be on the rise. Even Jennifer Aniston has been diagnosed with it. What's going on?
A: Dry eye happens when your eye doesn't make enough tears, and it's one of the most common eye problems affecting Americans. A lot of people convince themselves it's normal to feel scratchiness or irritation in their eyes, or to think that it's just part of getting older. But it's not.
Q: What is the treatment?
A: We now have two FDA-approved drugs to treat dry eye: cyclosporine [Restasis] and lifitegrast [Xiidra]. Some people can benefit from corticosteroid eyedrops, but you only want to use those for a short period of time. We can also put a plug in your tear duct to make the tears that you do produce stay in your eye longer.
Q: Can you envision a time when no one in America would become blind?
A: I'm counting on it! We have scientists who are growing retinas from stem cells, and as best as I can tell, it's just a matter of time before we can implant those in people. We've also made progress on an artificial optic nerve, so if you can grow the retina and grow the artificial optic nerve that connects the retina back to the brain, hopefully you're there.
Q: About 2 million Americans — most of them over age 70 — have age-related macular degeneration [AMD], which affects central vision. What can people do to protect themselves?
A: About 14 years ago, we discovered that 75 percent of your risk for AMD is genetic. Obviously, you can't control who your parents are, but lifestyle choices such as getting regular exercise and not smoking might be protective. And now there are vitamin and mineral supplements that have been proven to slow down the progression of AMD.
Q: Are there any treatments for AMD?
A: People with advanced macular degeneration develop blood vessels that grow into the macula at the back of the eye, and that leak fluid and bleed, and cause scarring and distortion of the retina. We now have a group of drugs called anti-VEGF that you inject into the eye and that cause those abnormal blood vessels to dry up. In a number of patients, vision even comes back to normal. Unfortunately, it's only available for the 200,000 people a year who develop the "wet form" of neovascular AMD.
Q: How about those with a less advanced form of the disease?
A: We don't have a treatment yet, but companies are pouring hundreds of millions of dollars into finding a solution. I'd be surprised if we don't have a treatment 10 years from now, even five years from now.