Low Vision Information Library

Adult Vision Risk Assessment

This self-assessment will help you determine whether you are at risk of age-related eye disease. If you suspect that you are not seeing correctly or are having an eye problem, you should arrange for a professional eye exam, regardless of the results of this risk assessment. If you answer a "yes" to any of these questions, please arrange to see an eye doctor for a complete eye exam.

Your Results

1. Do you have blood relatives with glaucoma?
If you have a grandparent, parent, sibling or child with glaucoma, you are at risk for the disease. Get a dilated eye exam every two years to ensure good eye health.

2. Has a doctor treated you for or said you have glaucoma?
If you already know you have glaucoma, it is important to follow up with your eye doctor regularly and to continue prescribed medications so you can keep your eyesight.

3. Have you ever had an eye injury or eye surgery?
Eye injuries and surgeries can increase your risk for eye disease. See an eye doctor regularly and be sure to inform him or her about your eye health history.

4. Have you noticed a change in your vision over the last 12 months?
Changes in the way you see should be reported to an eye doctor. If you have not seen an eye doctor about these changes in the last year, make an appointment soon.

5. Do you have persistent pain in or around the eye?
Persistent pain not due to sinus problems, allergies, cold, flu, headaches or eye strain may be a sign of a serious eye problem. If your eye hurts continuously, see an eye doctor at an emergency room right away.

6. Are you black, Hispanic or Latino and age 40 or older?
Studies show that people of black, Hispanic or Latino heritage are more susceptible to glaucoma at an earlier age. If you are black, Hispanic or Latino and age 40 or older, you are in a risk category for glaucoma. Get a dilated eye exam every two years to ensure good eye health.

7. Are you age 65 or older?
Studies show that anyone age 65 and older is in a risk category for glaucoma. If you are in this category, get a dilated eye exam every two years to ensure good eye health.

8. Was your last dilated eye exam more than two years ago?
A dilated eye exam involves the use of eye drops by an eye doctor to enlarge your pupils. If you are in a risk category for glaucoma, (see questions 1, 6, 7) you should have a dilated eye exam every two years or as recommended by your eye doctor.

9. Do you have diabetes?
People with diabetes are at risk for diabetic retinopathy (an eye disease that harms blood vessels in the eye). If you have diabetes, you should have a dilated eye exam once a year or as often as your eye doctor advises.

10. If yes, was your last dilated eye exam more than one year ago?
If you are diabetic and have not had a dilated eye exam in the last year, make an appointment with an eye doctor to have one as soon as possible.

Prevent Blindness America

Our One Purpose: Saving Sight

Founded in 1908, Prevent Blindness America is the nation's leading volunteer eye health and safety organization dedicated to fighting blindness and saving sight. Focused on promoting a continuum of vision care, Prevent Blindness America touches the lives of millions of people each year through public and professional education, advocacy, certified vision screening training, community and patient service programs and research.

These services are made possible through the generous support of the American public. Together with a network of affiliates, divisions and chapters, it's committed to eliminating preventable blindness in America. For more information, or to make a contribution to the sight-saving fund, call 1-800-331-2020 or visit us on the web at www.preventblindness.org.

© 2005 Prevent Blindness America® All rights reserved.

Age-related Macular Degeneration

AMD, or age-related macular degeneration, is a leading cause of vision loss for Americans age 65 and older.

As you age, your risk for AMD increases. But you can take steps to help prevent loss of sight from AMD. If you are 65 or older, you should:

1. Visit your eye doctor regularly
2. Learn and watch for the signs of AMD
3. Take care of yourself

Visit Your Eye Doctor Regularly

The key to preventing vision loss is regular eye exams. If you are 65 or older, you should get a complete eye exam every one or two years, even if you have no problem seeing well.

During a complete eye exam, called a dilated eye exam, the eye doctor widens the pupil of the eye with eye drops to allow a closer look at the inside of the eye.

The exam is not painful, but it may not be part of an eye exam for a new pair of eyeglasses or contact lenses.

Ask Your Doctor

Be sure to ask your eye doctor for a dilated eye exam. This exam will allow your eye doctor to check for eye diseases such as AMD.

Learn and Watch for the Signs of AMD

Signs of AMD become more obvious the longer you have the disease. If you have AMD, you may notice that:

STRAIGHT LINES SUCH AS TELEPHONE POLES, THE SIDES OF BUILDINGS OR STREETLIGHT POLES, LOOK WAVY.

TYPE LOOKS BLURRY

A DARK OR EMPTY SPOT MAY BLOCK THE CENTER OF YOUR VISION

How Does AMD Hurt My Vision?

AMD affects part of the back of the eye called the macula, the central part of the retina. When AMD damages the macula, the center part of your vision may become blurred or wavy, or you may develop a blind spot.

AMD can cause vision loss quickly or slowly, and can make it very hard for you to do things that require sharp vision, such as reading, driving or sewing. The good news is that AMD almost never causes total blindness, since it usually does not hurt side vision.

There are two kinds of AMD.

"Wet" AMD causes the most serious vision loss. In this form of the disease, tiny unhealthy blood vessels grow under the retina. These blood vessels often break and leak, causing a loss of vision.
The most common form of AMD is "dry" AMD. This form of the disease usually progresses more slowly.

What Do I Do if I Have AMD?

If you have AMD, you must check the central vision in each of your eyes separately every day. If you notice any changes such as having trouble reading, or seeing straight lines that appear wavy, tell your eye doctor right away.

Are There Any Treatments for AMD?

THE TREATMENT OF AMD HAS CHANGED VERY RAPIDLY OVER THE PAST FEW YEARS, AND NEW TREATMENTS CONTINUE TO BE DEVELOPED AND TESTED.

Lucentis (ranibizumab) was approved by the FDA for treating AMD in June 2006. The drug is injected into the eye, often once a month over the course of many months. Lucentis has been shown to improve vision by at least three lines in about one third of patients over a one-year course of treatment.

Common side effects are conjunctival hemorrhage, eye pain, vitreous floaters, increased intraocular pressure and
eye inflammation.

Rare (less than 1 %) but serious side effects are severe eye infection, retinal detachment and traumatic cataract.

Avastin (bevacizumab) is a drug similar to Lucentis that was originally used to treat colon cancer. Ophthalmologists may prescribe Avastin "off label" for the treatment of AMD. The National Eye Institute has announced funding of research to compare Avastin
and Lucentis as treatments for AMD.

Macugen (pegabtanib) was approved in 2004 to treat "wet" AMD, and is used solely or in combination with other AMD treatments.

Photodynamic therapy (PDT) uses a laser beam with a light-sensitive dye to destroy unhealthy new blood vessels under the retina. This treatment is used in combination with other AMD treatments.

Photocoagulation, another laser treatment, uses a stronger laser to destroy new blood vessels. The treatment itself may leave permanent blind spots in a person's vision. But it helps to slow or stop the growth of new blood vessels.

Other treatments

Vitamin supplements. There is evidence that dietary supplements can help prevent the onset and progression of age-related macular degeneration. People with AMD should discuss nutrition strategies with their eye doctor and consider whether taking a vitamin supplement containing lutein might be right for them.

What Do I Do if I Lose Vision to AMD?

There are many things you can do to make your daily life easier even if you have lost much of your sight to AMD.

Special training, called vision rehabilitation, can give you skills for living with vision loss.

Low vision aids are tools that can help you if you have vision loss. Some of these tools are:
 • Magnifying lenses or special glasses
 • Closed-circuit TVs
 • Computers with large screens
 • Bright lamps, large-print books and magazines

All these things can help you keep the lifestyle you're used to having.

Take Care of Yourself

Good health is an important part of good vision. You can lower your risk of eye disease and vision loss if you:

 • Avoid smoking
 • Eat healthy foods
 • Control blood pressure and cholesterol
 • Stay active

Healthy habits can lead to healthy eyes. Talk to your doctor before starting an exercise program or adding vitamins to your diet.

The above information and recommendations have been compiled from sources considered to be accurate. The information is provided with the understanding that it is not intended as a substitute for professional eye care services or advice, nor does it serve as a complete resource for eye health, eye care or eye safety information. More current information may be available from:

National Eye Institute
2020 Vision Place
Bethesda, MD 20892-3655
(301) 496-5248
www.nei.nih.gov

Cataracts

Cataracts are a leading cause of blindness among older adults. Yet young people and even newborns can get cataracts.

More than 20 million Americans age 40 and older have cataracts. More than half of all Americans have cataracts by the time they are 80 years old.

The good news is that doctors can treat cataracts. Surgery restores sight in more than 95% of cases treated.

This information below will explain how cataracts can hurt your vision and how surgery can restore sight lost to cataracts.

What are cataracts?

A cataract is a clouding of the eye's lens. Normally, the lens is clear. It focuses light onto the retina at the back of the eye, which sends images to the brain.

A cataract blocks light needed for sight. Your vision may become blurry or dim because light can't pass properly through the lens to the retina.

A cataract is not contagious. Using the eyes will not make the cataract worse.

Normal eye
How light moves through the lens of a normal eye

Cataract eye
How light moves through a cloudy cataract lens

Are there any risk factors for cataracts?

The exact cause of cataracts is unknown. Most often, a cataract is part of getting older. These factors may also playa role:

 • Intense heat or long-term exposure to UV rays from the sun
 • Certain diseases, such as diabetes
 • Inflammation in the eye
 • Hereditary influences
 • Events before birth, such as German measles in the mother
 • Long-term steroid use
 • Eye injuries
 • Eye diseases
 • Smoking

"You need more light on your work, but less light near your eyes."
- an eye doctor describing the symptoms of cataract

How can I tell if I have a cataract?

Cataract generally does not cause pain, redness or tears. However, these changes in your vision may be signs of cataract:

 • Blurred vision, double vision, ghost images, the sense of a "film" over the eyes
 • Lights seem too dim for reading or close-up work, or you are "dazzled" by strong light
 • Changing eyeglass prescriptions often. The change may not seem to help your vision.

You may sometimes notice the cataract in your eye. It may look like a milky or yellowish spot in the pupil (the center of your eye is normally black).

Problems seeing become more noticeable as cataracts develop. A cataract may develop quickly over months or slowly over years. Many people never reach the point where surgery is necessary.

Eye doctors usually recommend surgery when vision problems interfere with day-to-day tasks.

Is surgery the only treatment?

Yes. Cataracts cannot be treated with medicines. Eye drops or other drugs will not dissolve a cataract or slow its progress.

Cataract surgery

Surgery is the only proven treatment for cataract. It is a delicate operation. Yet, it is one of the safest operations done today. More than 95% of surgeries are successful. Fewer than 5% of cases have complications such as inflammation, bleeding, infection and retinal detachment.

Most people need surgery when the cataract causes enough vision loss to interfere with work, play or other day-to-day tasks. You and your eye doctor should decide together when and if surgery is needed.

How does cataract surgery restore sight?

During surgery, the clouded lens is removed. There are a number of ways to remove cataracts. The eye surgeon will use the method that is best for the patient.

The surgeon reaches the lens with a tiny surgical scalpel. Then the doctor breaks up the lens with a probe that may use ultrasound, a laser or a water jet. The pieces of the lens are removed from the eye.

Cataract surgery is like taking the lens out of a camera. A new lens is needed so that the eye can focus light onto the retina, the way a camera focuses light onto film.

Almost all cataract patients receive an artificial lens, called an intraocular lens implant. This replaces the cataract-damaged lens that was removed.

Most patients go home the day of surgery. Depending on their overall health, others go home in a few days.

Implants are not a good idea for everyone. Sometimes there are complications and lens implants must be removed. These problems are rare. Contact lenses or cataract eyeglasses may be used in some cases instead of implants.

What will my sight be like after surgery?

Lens implants come closest to a normal human lens. You may not be able to see distant objects clearly for some time after surgery. You may also need eyeglasses for near or distant vision.

There is no loss of side vision with lens implants. The lenses move with the eye.

For those who do not have lens implants, cataract eyeglasses are effective. However, vision is not normal. Cataract eyeglasses magnify everything 30%. There is also a loss of side vision. Patients must turn their heads and look straight at objects. The glasses used to correct vision may also need to be changed as patients heal from the surgery.

The above information and recommendations have been compiled from sources considered to be accurate. The information is provided with the understanding that it is not intended as a substitute for professional eye care services or advice, nor does it serve as a complete resource for eye health, eye care or eye safety information. More current information may be avaible from:

National Eye Institute
2020 Vision Place
Bethesda, MD 20892-3655
(301) 496-5248
www.nei.nih.gov

Diabetes and your eyes

Diabetic retinopathy is an eye disease that is linked to diabetes. Anyone with diabetes is at risk for diabetic retinopathy. More than 5.3 million Americans age 18 and older have diabetic retinopathy.

The longer someone has diabetes, the greater the chance of retinopathy. Over time, the disease can cause severe vision loss or blindness.

If you have diabetes, you can take three important steps to prevent vision loss from diabetic retinopathy:

1. Watch and control your blood sugar levels
2. Take care of yourself
3. See an eye doctor at least once a year

Watch and control your blood sugar level

Poor blood sugar control is one of the strongest causes of diabetic retinopathy. If you have diabetes, you must watch and control your blood sugar levels carefully. You can do this with a healthy diet, insulin and other drugs.

Take care of yourself

Eating healthy and staying active are important for good health. High blood pressure, high blood fat levels and smoking also increase your risk of diabetic retinopathy. Quitting smoking and living healthy can reduce these risks.

Talk to your family doctor before starting an exercise program. If you have diabetes, see your doctor regularly to control the disease.

See an eye doctor at least once a year

Early treatment of retinopathy can improve the chance for saving your sight. For some people, diabetic retinopathy may be one of the first signs that they have diabetes. Adults and children who have diabetes should have a dilated eye exam at least once a year.

If you have diabetic retinopathy, you may need to visit an eye doctor more often than once a year. This helps the doctor check the disease and decide how to treat it. The eye doctor can decide if you need an eye exam more often.

At a complete eye exam, called a dilated eye exam, the eye doctor widens the pupil of the eye with eye drops to allow a closer look at the inside of the eye. This exam may not be part of an eye exam for a new pair of eyeglasses or contact lenses.

Be sure to ask your eye doctor for a dilated eye exam.

How can diabetic retinopathy hurt my eyes?

Diabetic retinopathy harms blood vessels in the retina (see diagram of eye) in the back of the eye. Small blood vessels in the retina become weak. They break down, leak, or bleed. Unhealthy new blood vessels may start to grow.

Weak blood vessels may leak fluid and cause swelling. This is called macular edema and can distort your vision.

When unhealthy new blood vessels grow, they can bleed into the clear, jelly-like fluid, called vitreous, that fills most of the eyeball. This causes dark spots, strands that look like cobwebs or clouding in your vision.

Scars from healing blood vessels sometimes pull the retina away from the back of the eye. The retina can then tear or become detached. This can result in serious vision loss or even blindness.

Are there any treatments for diabetic retinopathy?

Laser therapy

A doctor may use a laser to seal leaking or bleeding vessels. This treatment is called photocoagulation.

Vitrectomy

In this treatment, a doctor uses a small suction tool to take out the vitreous jelly of your eye. This operation removes blood and scar tissue in the vitreous as well. The doctor uses fluid to replace the vitreous.

Low vision aids

Some people lose so much sight to diabetic retinopathy that it becomes hard to do day-to-day tasks. Special training, called vision rehabilitation, can give you skills for living with vision loss.

Low vision aids are tools that can help you if you have vision loss. Some of these tools are:

 • Magnifying lenses or special glasses to help you read
 • Telescopic lenses that help you see distant objects more clearly
 • Closed-circuit TVs that magnify print or handwriting
 • Computers with large screens and programs to enlarge print and pictures
 • Adaptive devices such as bright reading lamps, large-print books and talking clocks

All these things can help you keep the lifestyle you're used to having.

The above information and recommendations have been compiled from sources considered to be accurate. The information is provided with the understanding that it is not intended as a substitute for professional eye care services or advice, nor does it serve as a complete resource for eye health, eye care or eye safety information. More current information may be avaible from:

National Eye Institute
2020 Vision Place
Bethesda, MD 20892-3655
(301) 496-5248
www.nei.nih.gov

Growing older with good vision

As you grow older, there's a lot you can do to stay healthy. Keeping active, eating right, and paying attention to how you feel are all part of healthy living as you age.

Good vision is also part of feeling your best. Your vision may change with age. You may need more light to see. It may get harder to tell some colors apart. You may have a harder time seeing things close up. It may get harder to adjust your eyes to glare or the dark. But you can do something to see better and keep your eyes healthy.

These three steps will help you take care of your sight:

1. Visit an eye doctor regularly
2. Make changes to help yourself see better
3. Take care of yourself

Visit an eye doctor regularly

If you are 55 or older, you should get a dilated eye exam at least once every two years.

If you have diabetes or other health problems, you may need to see an eye doctor more often.

The best time to see your eye doctor is before you notice any problems. Early on, you may not notice a change in your sight if you have an eye disease.

How can an eye doctor help me protect my sight?

At your eye exam, the eye doctor will:

 • Treat common eye problems
 • Keep your eyeglass prescription up-to-date
 • Check for eye diseases

How will the eye doctor treat my problems?

Glasses or contact lenses

You may have a harder time seeing objects up close as you get older. This common problem is called presbyopia. Your eye doctor can prescribe glasses or contact lenses to help you focus on close objects.

Eye drops and medicine

Your eye doctor may prescribe eye drops or other medicine to treat eye diseases. Your eye doctor may also recommend eye drops for more common problems such as watery or dry eyes.
Surgery

If you have a serious eye disease your doctor may recommend surgery.

Checking for eye disease

At a comprehensive eye exam, called a dilated eye exam, the eye doctor widens the pupil of the eye with eye drops to allow a closer look at the inside of the eye. The exam is not painful, but it may not be part of an eye exam for a new pair of eyeglasses or contact lenses.

Be sure to ask your eye doctor for a comprehensive dilated eye exam.

What is a dilated eye exam?
The dilated eye exam will allow your eye doctor to check for eye diseases that become more common with age.

The following eye diseases can cause serious loss of vision if not found and treated early.

Cataract

A cataract is a clouding of the lens of the eye. Most people 65 and older will get a cataract at some point. But younger people can also get cataracts. In almost all cases, surgery can improve vision. But not everyone who develops a cataract will need surgery.

Glaucoma

This disease is a leading cause of blindness. It may develop slowly and cause a loss of side vision (peripheral vision). Any vision lost to glaucoma is gone forever. But in most cases, finding the disease early and treating it with medicine will control it.

Diabetic Retinopathy

This disease is caused by diabetes. If not treated, it can lead to blindness. It damages blood vessels in the eye and can blur and distort vision. Although laser treatment can help in some cases, the best way to prevent this disease is by controlling diabetes. That means controlling blood sugar levels.

AMD

Age-related macular degeneration is a disease that damages the center part of vision. It is a leading cause of sight loss for older Americans. Treatment can help if the disease is found early.

When should I see an eye doctor right away?

See your eye doctor right away if you notice a change in your vision. Even small changes may be caused by serious problems such as glaucoma or other eye diseases.

Things to remember

Talk with your eye doctor.

Ask your doctor to explain anything you don't understand. Tell your eye doctor about eye problems you may have noticed. Find out when you should come back for your next eye exam.

Follow your doctor's advice.

Follow the schedule for taking your medicines. Skipping a dose or taking medicine late may cause more vision loss.

Make changes to help yourself see better

Small changes in the way you live can often help you see better as you age. They can make life safer and more fun!
 • Wear sunglasses if you are sensitive to bright light and anytime you are outdoors in bright sunshine.
 • Improve lighting around the house.
 • When working around the house or playing sports, wear safety eyewear. This will protect your eyes from injury.

If you have lost some sight to eye disease or eye injury, low vision aids can help you stay independent. Special training, called vision rehabilitation, can give you skills for living with low vision. Low vision aids include:
 • Magnifying glasses, screens and stands
 • Telescopic lenses
 • High-intensity reading lamps
 • Large-print newspapers, magazines and books
 • Closed-circuit TVs that magnify a printed page on screen
 • Computers

Take care of yourself

Good health is an important part of good vision. You can lower your risk of eye disease and vision loss if you:
 • Eat healthy foods
 • Stay active
 • Control blood pressure, cholesterol, diabetes or other health problems
 • Quit smoking
Healthy habits lead to healthy eyes. Remember, growing older with good vision is a key to an active and independent life.

Disclaimer:
The above information and recommendations have been compiled from sources considered to be accurate. The information is provided with the understanding that it is not intended as a substitute for professional eye care services or advice, nor does it serve as a complete resource for eye health, eye care or eye safety information. More current information may be avaible from:

National Eye Institute
2020 Vision Place
Bethesda, MD 20892-3655
(301) 496-5248
www.nei.nih.gov