changes or taking oral diabetes David F. Chang, MD, University of California, San Francisco medications, such as metformin (Glucophage) or a sulfonyl urea drug, such as glimepiride (Ama- ryl). These drugs are often tried before starting a long-term insulin regimen. You Can Have Cataracts ■ Manage depression. Depres- sion is about twice as common And Not Even Know It among people with diabetes as it A renowned expert describes the latest developments is among those in the general pop- in treatment. ulation. This might be due to the metabolic effects of diabetes on the brain and the stress of living with a chronic disease. ataracts can de- location, severity and type Caution: Some of the commonly velop so slowly in of cataract. Cataracts may used selective serotonin reuptake some people be age-related, due to inhibitor (SSRI) antidepressants, that they do an eye injury or con- such as paroxetine (Paxil), cause C What is a not even realize they genital (present at weight gain as a side effect—which have an eye problem. CATARACT? birth or appearing in can be dangerous if you have dia- In the early stages, just cataract is a clouding childhood). Questions betes. Ask your doctor if he/she can a small portion of the Aof the eye’s lens that to ask yourself… prescribe an antidepressant that is eye’s lens may become leads to progressive loss of Do colors appear less likely to cause weight gain. cloudy. Only when vision. Ordinarily, the lens, faded or washed out? ■ Take care of your feet. Years the cloudiness of the which is located behind Do I have trouble of elevated glucose can damage eye’s lens increases the pupil, is clear—light seeing distant ob- the tiny blood vessels that supply over time—some- passes through it, allowing jects, such as highway nerves, particularly in the legs and times over a period of us to see. Cataracts most signs, while wearing feet. Impaired circulation and sen- years—does the per- often are a normal result eyeglasses? sation greatly increase the risk for son’s vision worsen. of aging but also can result Do I need more blisters, sores and infections—con- Even though cata- from eye injury, certain ditions that eventually may lead to racts are quite com- eye diseases and drugs, light than I used to the need for amputation. mon—about half of and some medical dis- for close work, such as reading small print Important: Because people with people over age 65 orders, including diabetes. diabetes may not feel foot injuries, have some signs of In the US, cataracts are and sewing? Do my they need to inspect their feet dai- the condition—few the most common cause eyes tire more easily ly. See your doctor if foot or leg people are aware that of reversible vision loss. when I’m engaged in injuries don’t seem to be healing many common vision these activities? within a few days—or even ear- problems actually can be the result Does glare make it much hard- lier if you have a history of poor of cataracts. er for me to drive at night or see circulation. To learn more about diagnosis well in bright sunlight? ■ Eat well and exercise. Exercise and the latest treatment options, Do I ever experience “ghost and diet improve insulin’s ability Bottom Line/Health spoke with images,” such as seeing multiple to remove glucose from the blood. internationally recognized cataract moons at night? The Diabetes Prevention Program surgeon and researcher David F. If you answered “yes” to sev- study found that people who ex- Chang, MD… eral of these questions, consult an ercised daily (walking for 30 min- ophthalmologist (a physician who utes), lost weight, if needed (7% SYMPTOMS THAT CAN BE MISSED specializes in medical and surgical to 10% of their body weight, on If your vision starts to appear eye care) or an optometrist (a non- average) and ate a healthful diet cloudy or blurry, you might suspect Bottom Line/Health interviewed David F. Chang, reduced their risk of getting diabe- a cataract—these are among the MD, clinical professor of ophthalmology at the University of California, San Francisco. Dr. Chang tes by 58%. These approaches also most widely recognized symptoms. codiscovered intraoperative fl oppy iris syndrome can reduce the risk for long-term But there are many other symptoms (IFIS), an iris problem that can com- plicate cataract surgery. He serves as complications and enable some that are not nearly as well-known chair of the Cataract Clinical Commit- diabetes patients to reduce drug and that can prevent people from tee of the American Society of Cataract and Refractive Surgery and is coauthor doses—or even, in some cases, getting proper eye care. Symptoms of Cataracts: A Patient’s Guide to Treat- discontinue medication. can vary greatly, depending on the ment (Addicus).
JuNE 2008 BOTTOM LINE health ■ 11 physician who can test for common are the most common cause of de- of about one-eighth inch in the eye problems, such as nearsighted- creased vision. Other risk factors… cornea. The cataract is removed ness and cataracts, but who does ■ Family history. In some fami- with ultrasound wave technology, not perform surgery). lies, cataracts tend to occur at an vibrating at 40,000 times per sec- A doctor can identify a cataract by earlier age. If a family member, ond, to break up the cloudy lens dilating a patient’s pupil and exam- such as a parent or sibling, de- into smaller fragments. ining the eye with a table-mounted veloped cataracts before age 60, After these pieces of the lens are ■ Zapf Ding 8pt microscope called a slit lamp. you also may be at increased risk gently suctioned out, an artificial Important: Even if you do not of developing cataracts at around lens, called an intraocular lens, is experience any of the symptoms the same age. permanently implanted in place of the natural lens. Once removed, described above, get your eyes ■ Medical conditions. Diabetes checked regularly after age 40 to increases the risk for cataracts cataracts will never recur, and the artificial lens will last for the pa- help identify any treatable eye three- to fourfold. This is because tient’s lifetime. problems, such as glaucoma, a elevated blood sugar levels can Small-incision surgery can be vision-robbing eye disease marked cause changes in the lens that, in performed with topical anesthesia by pressure within the eyeball. turn, can lead to cataracts. Self- (eyedrops) and usually requires no defense: Work with your doctor to ARE YOU AT INCREASED RISK? sutures. (A tiny flap is created that manage your blood sugar levels. Age is a primary risk factor for closes on its own.) The success cataracts. After age 50, cataracts ■ Nearsightedness. For reasons rate of cataract surgery in other that are not yet understood, se- wise healthy eyes approaches 98%. verely nearsighted people often de- Severe complications, such as in- velop cataracts at an earlier age. fection or bleeding in the eye, are ■ Steroid use. Long-term (one rare. FOR A HEALTHIER YOU year or more) oral steroid use can in- Latest development: New artifi- crease risk for cataracts. Long-term cial lens implants that can reduce a use of inhaled steroids, taken at high patient’s dependence on eyeglasses FREE Bonus doses, also may increase risk. are now available. These multi Information for You ■ Eye diseases. Some eye dis- focal lenses may provide focus for eases, such as chronic eye inflam- both near and far distances, allow- mation (uveitis), increase risk for ing many patients to read without Easy Secret to cataracts. Prior eye surgery—for eyeglasses. Healthy Weight Loss retinal problems, for example— Because multifocal lenses are also raises risk. considered a convenience—rather ost people think that ■ Eye injuries. Cataracts may de- than a medical necessity—patients Mthey are overweight velop, sometimes years later, as a must pay an additional out-of- because of the food they result of eye injuries, such as those pocket cost ($2,000 to $3,000 per eat. But the truth is that that can occur when being struck lens) under Medicare and private food is only a small piece of by a blunt object (like a ball). Self- insurance plans. the puzzle. Learn the secret defense: Wear polycarbonate safety Important new finding: Recent to weight loss that has goggles (available at sporting-goods research has shown that use of absolutely nothing to do stores) when playing sports such as drugs called alpha-blockers, such with food…or exercise. squash and racketball. as tamsulosin (Flomax) taken for ■ Sun exposure. The sun’s ultra- an enlarged prostate, can interfere violet rays also can increase cata- with the necessary dilation of the ract risk. Wear a broad-brimmed pupil during surgery. Known as Bonus: Important hat and UV-blocking sunglasses. intraoperative floppy iris syndrome, information for you this condition can make cataract from our free E-letter DO YOU NEED SURGERY? surgery more difficult for your Bottom Line’s If cataracts interfere with your surgeon. Daily Health News ability to read, drive, work or enjoy If you are planning to have cata- a hobby, you may need surgery. ract surgery, tell your doctor if you Most ophthalmologists in the US are taking an alpha-blocker, such as View the article at: perform “small-incision” surgery, a tamsulosin. Patients with cataracts www.BottomLine 20- to 30-minute outpatient proce- or symptoms of poor vision should Secrets.com/HotTopics dure in which the surgeon uses an have an eye exam before starting to ultrathin blade to make an incision take an alpha-blocker.
12 ■ BOTTOM LINE health June 2008