Current Treatments and Updates of the Big 4 Eric A. Baas, O.D., F.A.A.O. Chief, Alfred and Sarah Rosenbloom Center on Vision and Aging Illinois Eye Institute

The Big 4 Glaucoma Age-related Macular Degeneration (AMD) Diabetic Eye Disease Cataracts

Glaucoma A complicated disease in which damage to the optic nerve leads to progressive, irreversible vision loss Functional vision loss Previously considered to be progressing peripheral loss creating ‘tunnel vision’ New research suggest multiple ‘blind spots’ throughout visual field Glare Reduced brightness and impair contrast sensitivity

Glaucoma Treatments Medication Most common early treatment Decrease fluid production, increase fluid drainage Laser (SLT) Implemented at any point of treatment Laser creates change to drainage tissue resulting in better outflow Safe, repeatable, may decrease number of medications Surgery Typically after medication and laser procedure(s) have failed New procedures Ex-Press Mini Shunt, Trabectome, Canaloplasty

Alternative Glaucoma Therapies Antioxidants Haven’t passed clinical trials, unknown if prevent vision loss Alcohol/Marijuana Small reduction in IOP for short period of time Significant side effects Exercise Evidence suggest it lowers IOP, but prevention effect unknown Meditation and Acupuncture No evidence Medication compliance is key. Follow advice of eye doctor, proper diet, adequate exercise

AMD Leading cause of vision loss in patients age 50 and older Dry (geographic atrophy) Gradual breakdown of light-sensitive cells (drusen) in macula Wet (neovascular AMD) Abnormal blood vessel growth under retina Risk Factors Smoking, Race, and Family History Functional vision loss Progressive blurred area near or at center of vision

AMD Treatments Early/Pre AMD Exercise, avoid smoking, maintain a healthy diet Intermediate and Late AMD AREDs/AREDs 2 Vitamin C, E, zinc, copper, and beta-carotene or lutein/zeaxanthin Reduce development of late/advanced AMD by 25% Advanced AMD *Anti VEGF Injections (Avastin and Lucentis) Blocks growth of new blood vessels PDT (Photodynamic Therapy) Laser Retinal chips and transplants still have a long way to go

Diabetes Fast Facts Affects 25.8 million people (8.3%) of the US population 26.9% of people age 65 and older Leading cause of new blindness in patients ages 20-74 During first two decades nearly all Type I and >60% of Type two have retinopathy

Diabetic Eye Disease Cataracts Develop at an earlier age with DM Glaucoma Twice as likely to develop with DM Diabetic Retinopathy (*Most common) Damage to blood vessels in retina or macula Leading cause of blindness in American adults Functional vision loss Depends on location and severity

Diabetic Retinopathy Treatments Laser Treatment Scatter vs. focal Damage necessary to prevent further vision loss Causes reduced color and night vision Injections Anti-VEGF (Avastin, Lucentis) Surgery Vitrectromy Current research focused on drugs that will prevent new blood vessel growth

Cataracts Protein changes of natural lens cause clouding Typically age related Functional vision loss Increased blur and glare Decreased contrast and color Wear sunglasses, don’t smoke, eat a balanced diet high in anti-oxidants

Cataract Treatments Cataract Surgery Phacoemulsification-small-incision Last <1 hour, patient typically awake Lens Options Traditional Mono-focal Premium IOLs Multi-focal Accommodating Toric (Astigmatism) Light Filtering and Light Adjustable

Take Home Points Undiagnosed ocular conditions can inhibit the effectiveness and success of vision rehabilitation Communication and a continuum of care between patients, rehabilitation specialists, and eye care providers is key Medication compliance “perfect attendance” Advocate for one another!

References Glaucoma.org Nei.neh.gov Ndep.nih.gov