Dramatic rise in vision-threatening diseases that are readily treatable

About two years ago, Fredric Kornberg was in his Bermuda hotel on business when his eyesight started doing strange things. The smoke detector on the ceiling seemed to be moving, he said, and the pinstriping on his car became "distorted, wavy."

Kornberg, 81, a Bala Cynwyd resident, was diagnosed soon after returning home with an eye disorder called macular degeneration - the leading cause of vision loss in the United States for those 60 and older. Luckily for Kornberg, doctors began treatment early enough to save his vision, but many others are going untreated and becoming blind.

The last decade has brought a dramatic rise in the number of older Americans with vision-threatening diseases such as macular degeneration. A comprehensive report detailing the increase was released Wednesday by Prevent Blindness America, in partnership with the National Eye Institute and Johns Hopkins University.

The number of those with vision impairment and blindness has increased even though these diseases are treatable, the report states.

Julia A. Haller, ophthalmologist-in-chief at Wills Eye Institute in Philadelphia, said many patients weren't taking advantage of available care, due to, among other factors, a lack of education.

"There are people in this country, in this city, with arguably the densest concentration of health care in the world . . . going blind from preventable disease, and it's a shame."

"The reasons why people don't come in [for eye exams] are multiple," said Paul P. Lee, director of the University of Michigan's Kellogg Eye Center.

Many may not have insurance or the financial means, or they feel they wouldn't benefit from care, he said. Some may not trust the doctors, or simply may need help with transportation.

Diabetic retinopathy - damage to the retina's blood vessels - is the leading cause of blindness in American adults, and affects more than a quarter of all diabetics. While the U.S. population age 40 and older grew 19.5 percent between 2000 and 2010, the number of people with diabetic retinopathy rose more than 89 percent.

Thomas W. Gardner, a Kellogg ophthalmologist, says the Type 2 diabetes "explosion" explains the vast increase in retinopathy cases. The government, he said, needs to attack obesity with the same vigor as it opposes smoking.

Other eye disorders rose in prevalence, as well. The number of macular degeneration cases increased 25.3 percent in those age 50-plus.

Cataracts - where the eye's lens gets cloudy - rose 19.2 percent in those 40-plus. And glaucoma - where fluid pressure damages the optic nerve - went up 22 percent for the same group.

"I think it's alarming that the prevalence rates are rising, because these are devastating diseases," said Richard S. Kaiser, a retina surgeon at Wills. "It is heartbreaking to have to diagnose them with these conditions."

Those older than 50 and anybody diagnosed with diabetes should have an eye exam every year, Kaiser says.

At his worst, Kornberg could see only peripherally through his left eye. His central vision - the field of vision straight ahead, used when reading and interpreting fine detail - was declining quickly. "If I covered my right eye," he said, "I could see your silhouette, your hair, your body. But your face would be a blur."

Renee Elliott, a patient of Kaiser's with diabetic retinopathy, described the daily burden of her disease before treatment: "I have to work. I don't have a choice. So I would come to work, and my face would be right up to my computer screen. . . . I drove with one eye covered."

Even as cases are on the rise, recent advances in treatment have shown dramatic results. In particular, drugs for those with the most serious form of macular degeneration, called wet macular degeneration, have allowed even those diagnosed as legally blind to resume daily life.

"Fifteen years ago," Kaiser said, "if you were diagnosed with wet macular degeneration, you were going to lose your vision - it was just a matter of how quickly. [Now], if we catch people early, we are 95 percent effective in stopping progression of the disease, and can improve vision in 40 to 50 percent of patients."

Said Brian L. Vanderbeek, a retina specialist at Penn Medicine's Scheie Eye Institute: "People don't really think about their eyes till they're a problem."

He affirmed the importance of "educating the public about the necessity of a regular eye exam."

But Vanderbeek noted how funding for eye health by the Centers for Disease Control and Prevention dropped from $3.2 million last year to $511,000. "It's going to be harder for broad messages to be sent out."