1. 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

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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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!

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