Cataracts, Macular Degeneration and Glaucoma

At this week’s regular Wednesday luncheon with my five retired buddies, among other topics, we spent some time discussing one of my colleague’s recent cataract surgery, the very impressive return of his eyesight and the fact that his glasses are no longer needed. At the same luncheon, another of the gents needed to leave a little early to get a regular injection to control his macular degeneration.

Aside from the necessity for us to wear glasses with corrective lenses as we age, we are at increased risk for other eye conditions, most commonly cataracts, macular degeneration and glaucoma. As these eye conditions occur more commonly in seniors and, since life expectancy has increased substantially over the years, the occurrence of eye problems has also increased substantially. We need to be reminded of these conditions and ways to help prevent or control them, as well as becoming aware of modern diagnostic and treatment options.


It is estimated that more than 2.5 million Canadians are affected by cataracts and the numbers grow each year. A cataract is a clouding of the normally clear lens within the eye. The leading symptom is dim or blurred vision in one or both eyes. Persons affected usually complain of symptoms while driving at night. Cataracts usually develop in both eyes around the same time. Diagnosis is often made by a routine examination by an optometrist or ophthalmologist. In the early stages, there may be few or no symptoms, but the condition is progressive and should be followed by regular examinations.

It is well documented that ultraviolet light from the sun is damaging to your eyes and increases the likelihood of developing cataracts. Higher levels of exposure increase this risk of damage to your eyes and sunglasses with 100% protection against UVA and UVB rays should be worn. This is especially important for snowbirds who are subjected to more exposure, year-round. Smoking is associated with a threefold risk of developing cataracts, as well as increasing the risk for macular degeneration. Other preventive measures include a healthy diet, limiting your alcohol consumption and taking measures to prevent injury to your eyes.

The treatment is surgical removal of the lens and insertion of an artificial lens. The procedure may be performed on one eye at a time, but sometimes both eyes are done concurrently. In Canada, most procedures are carried out in ophthalmology surgical centres outside of the hospital, and the procedure is covered by provincial health insurance plans.

The basic artificial lens implant is also covered by the government but, if a more specialized lens is desired, the patient may incur additional costs which are not covered. The special lenses available include ones that reduce dependence on glasses, as well as lenses that may improve the quality of one’s vision. There might be other, uninsured services offered at these clinics or hospital that may not be necessary, and full explanations should be given by staff. Sometimes, private insurance will cover “extra” charges. The outpatient procedure is performed under local anaesthetic and is highly successful. About 500,000 such procedures were done in Canada in the last year.

Age-Related Macular Degeneration (AMD)

AMD affects more than 2.5 million Canadians and is the leading cause of vision loss over the age of 55. It is a progressive eye condition that usually worsens over time, but treatment can delay its severity in some cases. Initial symptoms are a blurring of one’s central vision field, making reading difficult. Glasses do not help. In its early stages, an ophthalmologist or optometrist may detect it before symptoms appear. The condition usually progresses to involve more extensive central vision loss, making driving and other activities more difficult.

There are two types of macular degeneration – dry AMD and wet AMD – the former accounts for more than 90% of cases and is the milder form. Dry AMD can develop into wet AMD at any time. In dry AMD, the macula, the light-sensitive tissue in the retina at the back of the eye, becomes damaged with age. In wet AMD, abnormal blood vessels grow in the macula, causing damage and loss of central vision.

The risk of developing macular degeneration is reduced by maintaining a healthy diet, not smoking, getting regular exercise and maintaining normal blood pressure and cholesterol levels. Treatment in the early stages includes special dietary supplements containing certain vitamins and minerals that are shown to slow the progression of the disease. In later stages of wet AMD, regular injection into the eye of certain drugs with or without laser treatment may help.


Almost 300,000 Canadians suffer from glaucoma, with the majority of cases presenting over the age of 70. This condition, although less common than cataracts and AMD, is a leading cause of blindness in seniors. Glaucoma involves an increase in the intraocular pressure of the fluid in the eye, causing damage to the optic nerve. The eye constantly produces fluid, and this fluid drains out through the drainage angle near the front of the eye. This maintains the pressure in the eye (the intraocular pressure) at a constant normal level. When this drainage angle is damaged or blocked, the pressure builds up in the eye causing damage to the optic nerve and visual impairment.

There are two main types of glaucoma – open-angle glaucoma and closed-angle glaucoma. In the former, the fluid does not drain properly from the eye and the pressure in the eye increases. In its very early stages, there may be no symptoms but during routine eye examinations when the pressure is measured, there may be abnormal levels detected. When symptoms do begin, there may be blind spots noticed in your side vision.

Closed-angle glaucoma occurs when the iris in the eye is very close to this angle and blocks the drainage function. Symptoms usually present as an attack involving the sudden onset of eye pain, as well as possible headache, blurred vision in one eye, redness of the eye and even nausea and vomiting. Emergency treatment is required, or blindness may occur. Some may develop it more slowly with no initial symptoms until there is damage to the optic nerve and impaired vision or an acute attack occurs.

Higher risk for glaucoma occurs with those who are seniors, have a family history of glaucoma, use long-term steroid drugs or have had eye injuries in the past. Treatment includes regular eye drop medication, oral drugs, laser surgery, surgical procedures and, more recently, glaucoma draining devices.

Very little is known that will prevent glaucoma, but early detection and treatment can reduce the risk of blindness.

Protecting our eyes with UV-blocking sunglasses, keeping fit, eating healthy foods, protecting our eyes from injury, avoiding smoking and limiting alcohol consumption are all measures that help to reduce the risk of eye disease. Regular examination by an optometrist or ophthalmologist is important in early detection, monitoring and treatment of these three conditions and others to give us the greatest chances of preserving our eyesight. Be sure that your checkups are up to date!

By Robert MacMillan MD