Medical Breakthroughs For Aging Eyes

As we age, our vision can be affected by a number of conditions, including cataracts, glaucoma, macular degeneration and diabetes-related eye damage as well as presbyopia (age-related farsightedness) and insufficient tear production (dry eyes). Catching and treating these problems early is the key to preventing long-term vision loss.

NEW EYE TREATMENTS

A number of new drugs and lens technologies are making it much easier to treat a variety of age-related eye ailments. The following treatments have become available just within the last several years...

Restasis eye drops for dry eyes. The drug cyclosporine A (Restasis), used to prevent rejection in heart and kidney transplants, also relieves tear-deficiency syndrome (dry eyes) when used as eye drops by decreasing inflammation in the tear glands. The drops are applied twice a day to increase tear production. Some people may experience slight stinging at first. Anyone with an active eye infection (such as conjunctivitis) shouldn't use the drops.
Improved glaucoma treatments. A new eyedrop medication, latanoprost (Xalatan), reduces fluid buildup better than older eyedrops. (Glaucoma eyedrop treatments work by enhancing the eye's natural filtering process) While very safe, latanoprost can cause occasional redness, tends to make eyelashes grow longer and may turn light-colored irises brown over time.

Other new treatments include selective laser trabeculoplasty (SLD, which uses a cool laser to enhance the eye's natural drainage canal and improve flow out of the eye without invasive surgery. SLT uses less energy than its predecessor, argon laser trabeculoplasry lowering the risk of damaging surrounding tissue. SLT is so effective and safe that it may even become a first-line treatment for glaucoma, in place of eyedrops.

Eyeglasses with progressive lenses. Progressive lenses are made by a computer to "morph" from one lens setting in the upper half of the eyeglasses (for far objects) into another in the lower half (for close objects). Progressive lenses have been around awhile, but the newest ones are a vast improvement over what was available just a few years ago.

Reason: Advanced computer designs allow a smoother transition from far to near.

Improved Lasik. Lasik surgery uses an "excimer" laser that can be focused very precisely to reshape the cornea to correct nearsightedness or farsightedness.

The newest version, the Allegretto Wave, uses tiny pulses of laser light adjusted by computer to match your eye's specific curvature. It can be used to treat more severe cases of nearsightedness, farsightedness and astigmatism, previously untreatable by laser, and also causes fewer side effects (such as seeing halos around car headlights at night), with less need for corrective follow-up treatments. (To find a doctor who uses the Allegretto Wave, visit www.alconrefractive.com.)

Replacement lenses for cataract patients. Cataract surgery in which the cataract-clouded natural lens is removed and replaced with an artificial lens, has long been effective at restoring distance vision. Now, several types of replacement lenses provide improved near and intermediate vision.

Each has its own strengths and weaknesses. Discuss with your doctor which is best for you...

The Crystalens from Eyeonics combines the distance vision of a traditional lens implant with an ability to flex slightly and turn into a lens for near vision when the eye muscles focus on closer objects. It's particularly good at providing clear intermediate vision.
The ReZoom lens from Advanced Medical Optics employs alternating rings of near- and far distance lenses.
The AcrySof ReSTOR lens from Alcon Laboratories has a series of tiny ridges that diffract light (instead of refracting it, like an ordinary lens), enhancing near and intermediate vision. This lens may be the best of the three for focusing on very close objects.

Note: Cataract surgery is extremely safe, with a success rate of more than 95% and a complication rate of less than 2%. Most complications, such as minor swelling of the cornea or retina, increased pressure in the eye or a droopy eyelid, generally resolve themselves with treatment and time. Rarely, cataract surgery can lead to severe visual loss as the result of surgery-related infection, bleeding in the eye or retinal detachment.

Intraocular contact lenses. For those too nearsighted for Lasik, there is the first intraocular contact lens—Myopic VISIAN ICL from Staar Surgical. The lens is implanted directly in front of your own lens through a tiny incision. The procedure is safe, and the lens can be surgically removed if necessary. A similar lens for farsightedness and astigmatism is in clinical trials.

Here are some essentials for keeping your eyes healthy...

See an ophthalmologist for a checkup at least every two years up to age 60, and annually after that. Be sure that the exam includes a careful check for cataracts, macular degeneration (a leaking of the blood vessels in the eyes) and glaucoma (a buildup of fluid inside the eye, which can damage the optic nerve).

Supplement your diet with fish oil (2 to 3 grams daily) or flaxseed oil (one to two tablespoons daily) supplements containing omega-3 and omega-6fatty acids. These supplements help reduce the inflammation in the tear glands that can lead to tear deficiency syndrome (dry eyes).
Eat dark, leafy greens, such as spinach, collard greens and kale. These are good sources of lutein—a carotenoid (naturally occurring pigment) found in the eye's macula that absorbs dangerous blue light and may help prevent macular degeneration.
Eat plenty of oranges, corn, nectarines and persimmons. These are good sources of zeaxanthin, another carotenoid.
Take supplements of antioxidants and zinc. The Age-Related Eye Disease Study (AREDS), sponsored by the National Eye Institute, found that taking high levels of antioxidants and zinc reduces risk of developing advanced age-related macular degeneration by about 25% in certain at-risk patients.

The study used the following daily doses—500 milligrams (mg) vitamin C,400 international units (IU) vitamin E, 15 mg beta-carotene, 80 mg zinc in the form of zinc oxide and 2 mg of copper in the form of cupric oxide (to prevent copper deficiency anemia, a condition linked to high levels of zinc consumption).

These antioxidant supplements should be taken in addition to a daily multivitamin. Products specifically formulated to meet AREDS levels include Ocuvite (which offers two versions—the "advanced" formula also contains lutein) and Viteyes (which also contains lutein and zeaxanthin).

Don't smoke. Nicotine constricts the blood vessels in the eyes, increasing the risk of cataracts and macular degeneration.

Note: Smokers should not take beta-carotene supplements.

If you have diabetes, work with your doctor to keep your blood sugar under control, and see an ophthalmologist at least annually, if not more often. Diabetes leads to damage of the eye capillaries, and ultimately to vision loss if untreated. By tightly controlling your blood sugar, you can largely prevent this damage. If capillary damage occurs, laser treatments can help mitigate the damage.
Wear UV-protective sunglasses outside. To prevent cataracts, wear sunglasses that offer UVA and UVB protection. If you spend significant time outdoors in ordinary eyeglasses, get a transparent UV-protective coating applied at any eyeglass store.
Wear shatter-resistant polycarbonate goggles whenever you use pos/er tools, a weed whacker or a hammer, or when playing sports like handball or squash. .Check with your doctor before using the impotence drugs sildenafil (Viagra) or vardenafil (Levitra). In some cases, these drugs can attack the optic nerves, causing damage to vision or to the nerves.

Stay in Control of Your Health Care

While most of us hope to age well, we all need specialized legal documents that ensure our wishes will be carried out with regard to our money and health care in the event we become mentally or physically incapacitated.

These documents include powers of attorney and several health-care directives, which appoint surrogates to carry out our financial and health-care wishes. The most comprehensive directives—living wills—set out our wishes for end-of-life planning and incapacity.

Other key directives: Health-care proxies, also called health-care poq/ers of attorney, which delegate responsibility for carrying out these decisions to others..."Do not resuscitate orders," which cover care in emergencies.

If you become incapacitated and don't have these documents, a court will appoint a conservator to take over your money and health-care decisions, potentially at considerable cost and heartache to you and your family.

Even worse: Strangers—doctors, medical institutions, etc.—will impose their decisions at critical times.

Careful—if these crucial documents are not drafted by an experienced elder law attorney, they can present a danger to your health and/or wealth. Here are the pitfalls to avoid...

Problem 1: A power of attorney is ineffective iust when you need it. A power of attorney appoints an agent to spend your money... buy, sell or make gifts of investments and other property to people you have designated... sign your name to other documents...cash checks...file your taxes...and engage in other financially related activities. Most people sign pov/ers of attorney for use in the event that they become incapacitated, but a traditional power of attorney is void if you become incapacitated.

Solution: Create a "durable" power of attorney, which is effective unless specifically revoked by you. The document must specifically state that it is durable and goes into effect upon your incapacity. To prevent your agent from controlling your finances right away, make it a "springing" power of attorney. This means it "springs" to life when certain conditions are met.

Example: Two physicians certify that you have become incapacitated, whether temporarily or permanently.

Your surrogate canactfclr you only if you are incapacitated. You can take back control when you regain competency.

Entrepreneurs: Create a separate business power of attorney. A well-thought-out business power of attorney can be flexible enough to allow you to maintain control over your business for as long as possible, even if your competency waxes and wanes.

Problem 2: The directions on your power of attorney are incomplete or incorrect.

Many powers of attorney are "one size fits all" forms that don't take into account individual needs or wishes. For example, giving your surrogate "the power to do everything I may have done under the law" may not give him/her the right to gift your property, making it difficult or impossible to plan for government assistance programs (see Problem 3).

Solution: Clearly establish your wishes. For example, a document might say, "It is understood that it is my wish to stay in my home in the event of incapacity. Therefore, I authorize my agent to make expenditures for home renovations, at-home medical equipment, mobility devices and services of a geriatric care manager and any other expenditure needed to create a state-of-the-art environment."

Problem 3. Your power of attorney fails to plan for long-term care.

Solution: If you don't have long-term-care insurance, give your agent the power to plan for government benefits that cover long-term health-care costs. Strategies include giving away assets or placing them in a trust so you can be eligible for government programs.

Caution: Most people name their closest heirs as surrogates, so there may be a conflict of interest in deciding who gets a gift if assets are transferred. Consider naming as surrogate a person who won't also be the recipient of the gift.

Problem 4: The wishes expressed in the health-care directives are too vague.

Without clear health-care directives, decisions regarding your medical care, custodial care (for feeding, toileting, bathing and mobility) and even your end-of life planning will be out of your hands. The quality of your final years may bear very little resemblance to what you wanted.

Solution: Make sure that your agent, usually a grown child or your spouse, understands and respects your desires. The American Bar Association (800-285-2221, www.abanet.org) and the National Academy of Elder Law Attorneys (703-942-5711, www.naela.org) offer information on holding a conversation with family members about your end-of-life preferences. Specifically express your desires with regard. to long-term care and pain treatment...

Long-term care. Make sure that the agent handling your money and arranging payment for your desired care is not at odds with your health-care agent. One easy fix is to make them the same person. If you have a clause in your durable power of attorney for "aging in place" (in your home), make sure that a similar clause exists in your health-care power of attorney.
Pain treatment. A typical clause gives your surrogate the power to arrange for various treatments.

Example: "The administration of pain-relieving drugs of any kind or other surgical or medical procedures to relieve my pain, including unconventional therapies that may be helpful, even though such drugs or procedures may lead to permanent physical damage, addiction or even hasten the moment of (but not intentionally cause) my death."

Problem 5: Your surrogate reinterprets or disregards your wishes. There are civil and criminal sanctions against surrogates who ignore your wishes deliberately or use your money for personal gain. But honest surrogates, even professional trustees, may decide to cut spending on health care because of concerns about objections from heirs.

Solution: One way to handle this is to specifically relieve your trustee or other surrogate of liability to your heirs if he spends too freely on your health care, so long as the decisions are in accordance with your expressed wishes. Such a clause might read like this…

"My trustee and my trustee's estate, heirs, successors and assigns are hereby released and forever discharged by me, my estate, my heirs, successors and assigns from all liability and from all claims or demands of all kinds arising out of the acts, except for willful misconduct or gross negligence, needed to carry out my wishes as expressed in clause X (specify the relevant clause in your trust) of this trust."