The Case of the Defective Hunting Rifle Scope
Mark loved to hunt every fall. He would get up early, brave the elements, and he and his buddies would go hunting as soon as deer season began.But this season he noticed that his scope no longer worked. It must have become damaged over the winter and he would need a new one. His buddies had a successful hunt, but he came home empty- handed. But at least they all had a good time with their camaraderie and good natured fun. He couldn't wait until he got a new sighting scope and then installed it on his rifle and eagerly went hunting the next weekend. Much to his surprise he still was unable to see well out of his scope. Finally it dawned on him. Maybe it was his eye that was the problem and not the scope.
He made an appointment with me to have his eyes examined. He had been a childhood friend of mine, but it had been more than 30 years since I had seen him socially and I had never seen him professionally. In fact he had never had his eyes examined, other than for his driver's license, and he had never had trouble getting his license. (Incidentally, the drivers' license test is not an "eye examination"; it is merely a screening test checking the most basic of visual abilities.)
When he was in his early 40's he could no longer see very well at near, but "magnifying glasses" from Walmart worked just fine. His wife urged him to get his eyes examined, but he reasoned, "why should I get my eyes examined when I have no trouble with my eyes and I just need my magnifiers to see small print?"
Mark's reasoning is typical, but wrong. It would be like waiting until you had a heart attack before you saw a doctor "because your heart was beating just fine." The fact that we have two eyes is a blessing as well as a curse. In Mark's case his vision was deteriorating in his right eye, the eye that he used while sighting through the hunting scope. But in normal conditions he was relying upon the vision of his left eye and not aware of the poor vision of his right eye. This happens more often than you would think.
I often see people who are seeing poorly out of one eye but who are totally unaware of it until their eye examination. But even more frightening, I often see individuals that have normal visual acuity, that is they still have 20/20 vision, but a comprehensive eye exam reveals that they have an eye condition that needs treatment immediately - or at least preventative measures - to enable them to retain their vision. Just as your doctor might say, "your coronary arteries are 80% blocked and you need coronary bypass surgery" or "you need to take medication that will help you avoid a heart attack" eye doctors also recommend measures to help you preserve your vision. (I'm not talking about a new, stronger pair of eyeglasses.)
Mark's problem turned out to be macular degeneration in both eyes, but much more advanced in the right than in the left. Macular degeneration is the leading cause of blindness in older adults (60 an older) and seems to be increasing exponentially. The macula is the most central part of the retina (the part of the retina that images focus most sharply upon) and is essential for normal, 20/20 vision. A person with macular degeneration will eventually notice that when he looks directly at an object it is blurry, but peripheral vision still remains normal. This is terribly disabling because it will eventually prevent one from driving or reading or recognizing faces.
The macula is vulnerable to damage because bright light is focused upon it, and for the same reason that sunlight can damage skin it can damage the macula. The macula is highly metabolically active which means it generates many free radicals in the process of seeing which makes it more susceptible to damage than most other tissues of the body.
We can't stay indoors at all times to protect our eyes and we certainly can't stop using our eyes so what can we do to prevent damage? There are several ways of helping prevent damage to our eyes from macular degeneration.
The first way is akin to using sunscreen to protect your skin. A hat should be worn when outdoors to shade your eyes and a quality pair of sunglasses with UV protection. Sunglasses should be worn year round, not just in the summer, and even on hazy days. The UV radiation from the sun generates free radicals that damage the DNA of the cells in the retina and the macula. (Incidentally, UV radiation also increases the incidence of cataracts.)
The second way of protecting your eyes from macular degeneration is by eating kale and sardines several times a week. If you ate kale (or green, leafy vegetables like kale and spinach) and sardines (or cold water fatty fish like sardines and salmon and herring) you would have plenty of nutrients like lutein and zeaxanthin and the omega 3 oils EPA and DHA in your normal diet. But, you probably don't, do you? Fortunately, there are supplements that will give you these essential nutrients that help protect your eyes from macular degeneration. Many people take supplements that include lutein and omega 3, but at far lower doses than is necessary.
The omega 3 oils are concentrated more in your eye and brain than in any other organs of your body because they are so critical to their proper functioning. Lutein and zeaxanthin are called macular pigments because they absorb harmful UV rays, preventing them from damaging the fragile cells of the macula. They are about 1000 times more concentrated in the macula than any other part of the body and also act as antioxidants, neutralizing the harmful by-products of metabolism.
We took photographs of Mark's retinas which showed multiple drusen. The first signs of degeneration are called drusen and are fatty deposits that accumulate between the retinal pigment epithelium and the retina. The number and size of the drusen help us determine the severity of the macular degeneration. We also did a test called OCT (Optical Coherence Tomography) that gives us a view of the retinal and macula in cross section. The OCT is an amazing instrument that allows us to image the retina and the thin macula (only 1/100th of an inch thick) to a detail of a 5,000th of an inch and visualize the many layers of the retina to determine the extent of damage. This is important information because it enables us to differentiate between wet macular degeneration, which can be treated, and dry macular degeneration which cannot. It is also useful to see changes in the retina caused by diabetes, the other major cause of blindness up to the age of 60, and other diseases of the retina.
I sent Mark to a retinal specialist (who treats diseased of the retina and the vitreous) who decided that treatment would not be beneficial. A treatment that has proven successful for wet macular degeneration - although it cannot restore totally normal vision - is called Lucentis (or Avastin). It is injected into the eye and helps control the bleeding that is the hallmark of wet macular degeneration. This treatment usually has to be done multiple times in order to control neo-vascularization - the growth of new, fragile blood vessels in the retina that tend to bleed.
Most people take their vision for granted, the most precious of all senses. Surveys show that, next to life itself, the loss of vision is the most to be feared. Yet, sadly, many people like Mark pay little attention to their vision until it is too late. At the very least, lutein, zeaxanthin and omega 3 fish oils can be thought of as a good insurance policy. And if you smoke, we now know that it is a major contributor to macular degeneration.