Glaucoma, leading cause of irreversible blindness, can be detected and treated; get an eye exam every 2-4 years after 40

Regular eye exams are the key to detecting glaucoma.
(Photo from peakSTOCK, iStock/Getty Images Plus via UK)

By Dr. Elham Ghahari
University of Kentucky

Glaucoma is a disease of the optic nerve that can cause vision loss. It is the second leading cause of blindness in the U.S. and the leading cause of irreversible blindness worldwide, and 111.8 million people worldwide will have glaucoma by the year 2040.

Glaucomatous damage is the loss of optic nerve cells, which leads to changes in the head of the optic nerve at the eye, with damage to the field of vision. Glaucoma cannot be cured, but it can be controlled and stabilized with proper treatment.

The most common form of glaucoma is primary, open-angle glaucoma. It is associated with several risk factors such as family history, African ancestry, other eye diseases such as diabetes or inflammation, past eye injury, and elevated eyeball pressure.

High eye pressure is the most important risk factor because it is the only effective target of therapy for glaucoma. Although some forms of glaucoma develop even when the eye pressure is normal, the risk of abnormally high eye pressure increases with age.

Early detection and intervention can help prevent vision loss from glaucoma. However, most patients don’t know they have the disease because it is generally asymptomatic in the early stages, which means symptoms don’t present themselves.

A routine eye exam can identify the risk for glaucoma and early signs of the disease. During an eye exam, glaucomatous optic-nerve damage can be assessed by clinical examination of the optic nerve head and eye pressure can be checked.

The risk of having abnormally high eye pressure as the most important risk factor for glaucoma increases with age. Glaucoma screenings are suggested beginning at age 40 and should continue after that in intervals suggested by your eye doctor, usually every two to four years.

There are usually no early symptoms of glaucoma, so screening exams are very important. Gradual dimming or weakening of vision is sometimes reported. Some patients with acute glaucoma develop severe eye pain and rapid visual changes.

Glaucoma treatment consists of reducing eye pressure using medications, lasers or surgery. Most glaucoma patients can be stabilized with prescription eye drops or in-office laser treatment.

Once the pressure is stabilized, it is important to continue regular follow-ups to make sure the pressure remains low enough. Less frequently, glaucoma surgery may be required.

Elham Ghahari, M.D., is an assistant professor of ophthalmology at UK HealthCare Advanced Eye Care.

State health department offers safety tips for Aug. 21 solar eclipse; cautions to not look directly at it without eye protection

In an eclipse, the moon shadows part of Earth.

The Kentucky Department of Public Health is warning the public to not look directly at the solar eclipse without proper eye protection.

“Looking at an eclipse without proper eye protection can cause permanent and irreversible eye damage, including blindness” Health Commissioner Hiram C. Polk Jr. said in a news release. “We encourage everyone to enjoy this special celestial event, but urge the public not to look directly at the uneclipsed or partially eclipsed sun without special-purpose solar filters such as eclipse glasses or handheld solar viewers.”

This long awaited celestial event Polk is talking about will happen Monday, Aug 21. While Hopkinsville, Paducah and the Land between the Lakes are in the 70-mile path of totality, all of Kentucky will be able to see a "deep partial eclipse." Totality will last less than three minutes, but the sun will be partially obscured for more than two hours. Online interactive maps and guides give the times; one is https://www.vox.com/science-and-health/2017/7/25/16019892/solar-eclipse-2017-interactive-map.

State officials offers tips on how to safely view a solar eclipse and avoid permanent eye damage:

• Only use eclipse glasses or handheld solar viewers that meet the International Organization for Standardization international standards.
• Homemade filters or ordinary sunglasses, even very dark ones, are not safe for looking at the sun.
• Telescopes with solar filters on the large end can be used, but older telescopes that have small solar filters that attach to the eyepiece are not safe.
• It is safe to use pinhole projectors and other projection techniques that offer indirect viewing of the eclipse. These can be made with paper or cardstock.
• Do not look at the eclipse through an unfiltered camera, telescope, binoculars or other optical device.
• Do not look at the sun through a camera, telescope, binoculars or any other optical device while using your eclipses glasses or handheld solar viewer. The concentrated solar rays will damage the filter and enter your eye(s), causing serious injury.
• Seek expert advice before using a solar filter with a camera, telescope, binoculars or any other optical device.

The state health department also offers safety tips for those who will be spending the day outdoors while waiting on the eclipse, including: stay hydrated and drink plenty of water; avoid drinking alcohol, which causes you to lose fluid; wear light colored, loose fitting clothes and a hat; apply and reapply sunscreen throughout the day with at at least a SPF 15 rating; use an Environmental Protection Agency-registered insect repellent, and keep your hands washed to avoid spreading germs.

State health officials will deploy portable medical tents at an upcoming eclipse event in Hopkinsville and all food vendors in the region will be inspected, says the release.

Click here for a link to the state released video about eclipse eye safety. Click here for one directed toward children.

New cases of diabetes decrease, but experts continue to call it an epidemic in Kentucky and the U.S.

The number of new diabetes cases in adults has significantly decreased in Kentucky and the U.S., reversing a trend, according to a federal Centers for Disease Control and Prevention report, but experts say there is still a diabetes epidemic.

In 1991-2009, adult diabetes cases in the U.S. increased sharply from 573,000 per year to more than 1.7 million. But in 2009-14, they "decreased significantly to approximately 1.4 million," says the report.

"This has been really encouraging, but we do need to recognize that those rates are still 60 percent higher than what they were in the '80s," Dr. Edward Gregg, chief of the epidemiology and statistics branch at the CDC, told The Huffington Post. "Even though we’re seeing a reduction, we had such a large increase that we're still at such a high level." Since 1980, the number of cases has more than tripled, says the CDC.

Gregg said he believes the recent decrease in new cases could be a result of people getting more exercise and eating healthier, along with increased awareness of the diabetes epidemic.

Kentucky’s statistics are mostly paralleling the national figures, Ja'nel Johnson reports for WFPL after interviewing Theresa Renn, manager of the Kentucky Diabetes Prevention and Control Program.

“They are also coming down as well,” Renn said. “It looks like we may have had a little bit higher peak and are also coming down nicely as well.”

Kentucky's most recent figure was 7.6 new diabetes cases per 1,000 adults Its peak, in 2007, was 11.2 new cases per 1,000 adults, Johnson reports.

In 2013, 10.6 percent of Kentucky adults (359,000) had diabetes. In 2000, the numbers were 6.5 percent and 240,000 adults, according to the 2015 Kentucky Diabetes Report. The current national rate is 9.7 percent. And 289,000 Kentucky adults have been diagnosed with prediabetes, making them at high risk of progression to diabetes.

Diabetes can cause heart disease, blindness, kidney failure and leg amputations. In The Great Diabetes Epidemic: A manifesto for Control and Prevention, Dr. Gilbert H. Friedell and J. Isaac Joyner, offer some details, excerpted in an op-ed for the Lexington Herald-Leader.

"This year an estimated 72,000 Kentuckians will develop significant visual impairment, including blindness. There will be some 1,000 amputations, about three a day in the state, and an estimated 800 people will develop kidney failure, many of whom will start dialysis," they write.

"The cost of dealing with the complications is enormous. Dialysis alone costs about $80,000 per person per year. Diabetes patients on Medicare cost three times as much per year as those without diabetes, $15,000 versus $5,000. The annual price tag for those with diabetes on Medicaid in Kentucky is about $1 billion. The total annual cost of diabetes in Kentucky for 2015 is estimated to be $5.6 billion."

Friedell and Joyner also say it is time for Kentucky to recognize diabetes is an epidemic, and adopt a public-health approach that includes widespread preventive screening, as the CDC has recommended since 1994.

Teri Wood, chronic-disease epidemiologist for the Kentucky Department of Public Health, told Johnson that the poor and less educated are more likely to get diabetes.

“Whether it’s because people have less access to healthy food, less knowledge about how to eat healthfully, perhaps less access to places to be physically active … and access to health care can be very important,” Wood said.

Authors of The Great Diabetes Epidemic will talk on KET about its causes, myths, complications, treatment and prevention

Kentucky Health News

The message that the authors of The Great Diabetes Epidemic: A Manifesto for Control and Prevention want readers to take from their book is that "diabetes is a serious, but preventable disease, if proper early interventions are implemented through a community-based, public health approach," KET says in a press release.

Authors Dr. Gilbert Friedell and J. Isaac Joyner will discuss this message with host Renee Shaw, and look at the root causes of the high number of diabetes cases in the U.S. and what needs to be done about it, on "Connections with Renee Shaw" on KET2 Friday, March 27 at 5 p.m. ET and on KET Sunday, March 29 at 1:30 p.m. ET.

Other topics discussed include common misconceptions and barriers to treatment, belief systems around diabetes that aren't based on fact, and the significant health ramifications of the disease, including complications such as blindness, amputations and renal failure.

"In Kentucky alone, for example, there are 72,000 diabetes-related cases of blindness and visual impairment diagnosed each year – roughly 200 per day," KET notes.

Clinics in 9 Appalachian counties will offer high-tech eye screenings to head off common ailment that blinds diabetics

Kentucky has one of the nation's highest rates of diabetes, but half the diabetics in rural Kentucky don't have annual eye exams – even though nearly 30 percent of diabetics over 40 have diabetic retinopathy, the leading cause of blindness among diabetic adults.

To stem that threat, units of the University of Kentucky are using a three-year federal grant to bring diabetic eye screening to diabetics in nine Kentucky Appalachian counties. Diabetic retinopathy can be treated, or avoided altogether, if the disease is detected early enough.

While studies have found that 90 percent of diabetics consult their doctor about their disease, about half the diabetics in rural Kentucky do not have annual eye exams. The grant will make technologically advanced exams available at clinics in Bath, Carter, Elliott, Estill, Jackson, Madison, Menifee, Rockcastle and Rowan counties, sending digital images of the eyes to UK's Department of Ophthalmology.

The specialists will screen the images for cataracts, glaucoma, macular degeneration, and other retinal abnormalities that can lead to vision loss and blindness. They will also enter the results into the patient's electronic medical record, for reference by other health-care providers. Currently, only a fraction of the results of community-based eye exams are imported into such records.

The partnership between the UK ophthalmologists, the university's Kentucky TeleCare, and primary care centers where the screenings will be done, is called the Appalachian Eye Network. It will reach nine counties with a combined population of 206,000. All the counties have diabetes rates higher than the national average. The project is expected to screen 4,860 people over the three-year term of the grant.

"Our goal is to reach patients with diabetes and those with high risk factors for diabetes who do not get annual eye exams and help uncover potentially devastating eye disease so it can be treated before the patient loses their vision," said Rob Sprang, director of Kentucky TeleCare. "I believe we have the opportunity to save people’s vision and change lives."

January is Glaucoma Awareness Month; disease is second leading cause of blindness

One million Americans will be diagnosed with glaucoma in the next 10 years, prompting Kentucky optometrists to raise awareness of the disease this month.

"People who do not visit their eye doctor on a regular basis are putting their vision and quality of life at risk," said Dr. Ben Gaddie, president of the Kentucky Optometric Association. "Glaucoma is often referred to as 'the sneak thief of sight' because it can strike without pain or other symptoms. Vision lost to glaucoma cannot be restored, so early detection and treatment are paramount."

Glaucoma is the second leading cause of blindness in the country. Data from the American Optometric Association show 50 percent of Americans incorrectly believe glaucoma is preventable and fewer than 20 percent of Americans are aware glaucoma causes deterioration of peripheral vision.

The Glaucoma Research Foundation has found African Americans ages 45 to 65 are 14 to 17 times more likely to go blind from the disease than Caucasians. People with a family history of glaucoma, those over the age of 60 or people who have experienced severe eye trauma are also more prone to the disease. (Read more)