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Elderly Vision Loss Expected to Rise

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WASHINGTON, Sep 08, 2003 (United Press International via COMTEX) -- A new study suggests there has been a dramatic increase in the prevalence of eye diseases among the elderly in recent years that can result in vision loss or blindness. Furthermore, the problem is expected to worsen in the future, possibly placing a severe burden on eye specialists and other aspects of the U.S. healthcare system.

The results of the study, conducted by researchers at Duke University in Durham, N.C., indicate nearly half of all people over the age of 65 eventually will develop one of three eye diseases -- glaucoma, diabetic retinopathy and age-related macular degeneration -- which can cause disabilities ranging from partial vision loss or complete blindness.

The trend likely will be further exacerbated by the aging population of the United States, Frank Sloan, director of Duke's Center for Health Policy, Law and Management and principal author of the study, told United Press International.

Estimates are the U.S. population over age 65 will increase to about 70 million in the next 30 years and those over age 85 will jump from 4 million to about 9 million.

"The continued aging of the baby boomer population will result in an even greater burden of eye disease in the United States than previous ... estimates indicated," Sloan and his co-authors write in the Sept. 8 issue of the Archives of Ophthalmology.

"This increased burden has important implications for the nation's public health, for resource allocation, and for the financing of vision care in the future. As more elderly individuals live longer, we may see a rise in the prevalence of chronic eye diseases that will significantly challenge our ability to provide care," the authors conclude.

Dr. Michael F. Marmor, an ophthalmologist at Stanford University School of Medicine in Stanford, Calif., and a spokesman for the American Academy of Ophthalmologists, said the study's findings come as no surprise to eye specialists.

"The bottom line of the study is simply to emphasize what has been a little appreciated fact that eye disease is prevalent among the elderly," Marmor said.

Dr. Sue Taub, an ophthalmologist at Northwestern University Medical School in Evanston, Ill., and a spokeswoman for the Vision Council of America, said she is already noticing anecdotally the increase in elderly patients in her own practice. "We're getting busier as eye doctors (including) a lot more people of Medicare age," Taub said.

Whether the current level of eye specialists will be available to deal with the increase in elderly patients remains uncertain. Sloan said, "The demand will be rising for optometrists and ophthalmologists" but it will be difficult to predict if that will create a shortage.

Taub said there was the possibility of a shortage of eye specialists depending on the size of the increase of elderly patients but Marmor said there would be adequate numbers of physicians to handle the influx.

In the study, Sloan and his colleagues looked at the prevalence of three of the most common eye diseases in the elderly among a random sample of more than 10,000 seniors receiving Medicare from 1991 to 1999. During the study period, the percentage of people with glaucoma, diabetic retinopathy or age-related macular degeneration more than tripled, from 13 percent to 45 percent.

Applying this estimate to the total population of U.S. seniors means approximately 6.5 million suffered from one of these eye diseases.

The prevalence of people with diabetes nearly doubled during the study period and as a consequence those with disorders of the retina due to the disease more than doubled -- from 7 percent to 17 percent.

Glaucoma prevalence nearly tripled, going from 5 percent to 14 percent. Age-related macular degeneration showed the biggest increase -- a more than five-fold jump -- to 27 percent from 5 percent.

This has widespread implications beyond the healthcare system, Sloan said. "Not only will it have an impact on provider care, but visual impairment also has an impact on people's ability to function independently," he said. Thus, seniors with these conditions will require assistance from their family members, who themselves will be impacted both emotionally and financially.

Taub agreed with that assessment, noting she already "sees that on a day to day basis in my practice." One of the financial burdens family members encounter is the cost of medications for these eye conditions because Medicare currently does not cover prescription drugs so most elderly patients have to pay for it out of pocket, she said.

Marmor said another financial issue is Medicare and health insurance plans typically do not cover expenses for rehabilitation for eye problems to the same extent as other conditions.

There are ways of learning to deal with the vision loss induced by these conditions but insurance often will not provide coverage for the several months of training that patients require, which is in sharp contrast to the coverage offered for physical rehabilitation for other conditions, such as a broken arm, he said.

"This may be a serious issue that society is going to have to address," he said.

Another factor that likely will increase the number of elderly with eye problems is the current diabetes epidemic going on in the United States, Sloan said. This portends an increase eye complications resulting from that disease, such as diabetic retinopathy. "That's going to have a major impact," he said.

Taub agreed, noting anybody with diabetes is at risk of developing eye complications related to the condition. "If there's a rise in one, there's going to be rise in the other," she said.

The most important thing people can do to keep these diseases in check is to get annual eye exams beginning at age 40, Taub said. These diseases often cause no symptoms until they are in their advanced stages and by then they are much more difficult to treat and may have already caused irreversible damage to the eye.

"The earlier the diseases are detected ... the easier it is to get it under control and save sight," she said.

Copyright 2003 by United Press International.

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