Sight Month is organized every year around the world, including in Hungary. At the beginning of the sight month, the main topic was optical vision improvement (wearing glasses and contact lenses). Over the years, however, it has become an attention-grabbing month for the preservation and improvement of vision, primarily visual acuity. Today, we talked with Professor Gábor Holló, head of the Ophthalmology Center and glaucoma specialist, about current vision preservation in the year 2024 and the diseases that most threaten vision, as well as their early detection.
Correction of refraction errors
The improvement (correction) of refractive errors is the most important vision improvement activity worldwide. Interestingly, due to poor and highly populated regions, the most common cause of severe vision loss worldwide is inadequately corrected refractive error. In our country, there are every possibility to improve vision in this sense: glasses can be ordered from optometrists in optical shops, quality contact lens orders are also available, and some of the more significant refractive errors can be corrected with corneal shaping laser surgeries.
Cataract is the second most common condition causing visual impairment worldwide, the operation of which is widely available in Hungary. True, after a relatively long waiting period in the state system. Thus, we can make the conclusion typical of developed countries that the most common conditions leading to vision loss worldwide, i.e. improperly corrected refractive error and cataracts, can be fully managed by the domestic health care system. For this reason, we have to focus our attention on other diseases in our relationships.
Myopia, which can impair vision as a whole
Nearsightedness (myopia) does not simply mean that you have to wear spectacle lenses with minus diopters of refraction to see clearly. Myopia essentially results from abnormal elongation of the eyeball. It mostly starts in early adolescence, and due to the persistence of harmful environmental effects, it can increase until the beginning of adulthood. Myopia does not endanger vision primarily from the point of view of having to wear glasses or contact lenses, or that surgery on the cornea can reduce the degree of myopia in cases of high myopia. The serious danger is manifested in the biologically harmful effects on the eyeball.
In the abnormally elongated eyeball, the nerve membrane (retina) and the choroid suffer damage during the elongation, and the blood circulation of the nerve membrane may decrease. Myopia significantly predisposes to glaucoma (cataract), which is also common in our country and is accompanied by irreversible vision loss, and to hemorrhagic, wet macular degeneration caused by myopia. Therefore, from the point of view of myopia, one must first be aware of the possibilities of prevention. Myopia, as I mentioned, begins in the early teens. Its background is partly hereditary and partly environmental. We can change hereditary causes. However, the environmental factors that promote the development and increase of myopia are the same with our lifestyle.
Long-term, close viewing (a lot of reading) is one of the factors that provoke myopia. In recent decades, the prolonged use of computers, monitors and mobile phones has also caught up. This is mainly due to the wavelength of the illuminating light used in electronic devices. A number of conclusive studies have already shown that if young, adolescent persons spend a significant amount of time outdoors during the day (and do not spend it looking at mobile phones), then they are less likely to develop myopia, and the deterioration of myopia, i.e. the development of larger diopters is created much less. The reason for this is that the broad light spectrum of sunlight has a protective effect against the growth of the eyeball, while prolonged mobile phone use and computer monitor monitoring worsen it. Of course, modern electronic devices must be used, life cannot be lived any other way these days.
But special attention should be paid to long-term, outdoor activities (running, hiking, swimming, playing soccer), which significantly protect against myopia in the teenage years and, accordingly, against the later, serious vision-impairing consequences of myopia. These protective effects no longer apply later, when reaching adulthood. Thus, a person either takes advantage of this knowledge in the teenage years, or this opportunity is lost to him in terms of the development of myopia.
Macular degeneration and visual impairment
Macular degeneration is primarily a common disease of older age in the developed world, but as I mentioned, people with a higher degree of myopia are also exposed to an increased risk at a younger age with regard to this difficult-to-treat disease that threatens central vision. Although there are many forms of macular degeneration, most of which do not directly impair vision, over time they can lead to the most severe form, called wet or hemorrhagic macular degeneration. In the latter case, abnormal blood vessels grow into the neural membrane from the choroid that surrounds the neural membrane from the outside, in the area of the neural membrane that provides central vision.
Fluid (edema), blood and, after a few weeks, connective tissue come out of them. The connective tissue permanently blocks the vision in the given area, which can cause a loss of vision. Since the tendency to severe macular degeneration exists in the whole body, without proper treatment sooner or later the condition can develop in the other eye as well. In such a case, the patient will not be blind in a biological sense, but he will no longer see what he is looking at. He cannot recognize the face of the person talking to him, he cannot read, and he also has serious difficulties in transportation. Severe macular degeneration does not appear out of nowhere. Early signs are already visible in the “hallway” which causes mild symptoms and represents its early state. Therefore, a regular, targeted and sufficiently high-quality ophthalmological examination (with the use of OCT, OCT-angiography) is essential for those whose close blood relatives have had macular degeneration with a serious outcome, or who have a higher degree of myopia. If early conditions are detected, severe visual impairment can be prevented, partly by giving nutritional supplements and partly by using injections to prevent the formation of new blood vessels in the eye.
At the beginning of the development of severe visual impairment, when the image in the field of central vision is distorted due to edema and hemorrhages and becomes like our own image in the concave and convex mirrors in the enchanted castle of the amusement park, the condition can be reversed by starting the treatment, and the further deterioration can be prevented with proper care. However, once the scarring has already occurred, the scars that have already formed can never be removed. Older people, myopic people and their family members therefore have a great responsibility to consult an ophthalmologist urgently when they notice a decrease or distortion of the initial uncertain visual acuity.
If this is not available in public care due to long waiting times, it is definitely advisable to visit a private eye doctor’s office that is sufficiently equipped. After a few months, by the time they get their turn in public care, the scarring condition usually develops.
Glaucoma is a vision-impairing condition
The last major topic of our conversation today is glaucoma, which we have talked about many times before. Glaucoma is not a cataract at all, but vision damage resulting from the pathologically accelerated, irreversible destruction of the nerve fibers that make up the optic nerve and the nerve cells connected to them. This affects about 3 percent of people over 40 in our European population, but as we get older, its frequency increases significantly and exponentially. Thus, the frequency of this disease is already 10 percent in the group of people around 80 years old. There are many forms of glaucoma, which in clinical practice have different appearances and may require different treatment.
However, almost all of them are characterized by the fact that for a relatively long time (5-10 years) the place of visual acuity is not damaged. First of all, the visual field is irreversibly damaged, and the visual field damage mainly extends to the peripheral and central areas. As the disease worsens, visual field damage increasingly reaches central vision and its surroundings. In such cases, the patient may notice that what he is looking at, he can only partially see, certain areas are missing from vision. If you consult a doctor at this time, although you can receive the maximum medical, laser and surgical treatment, your condition is already very serious, since damage to central vision is the penultimate stage of this disease. Self-recognition is made difficult by the fact that the degree of glaucomatous visual impairment can be different in the two eyes, and the rate of deterioration can also differ between the eyes. For this reason, you can slowly get used to living life using both eyes together, relying on the sight of the less damaged eye. When the problem becomes obvious, the situation is very serious.
The fact that visual impairment is not revealed until it reaches the central area is the result of the brain filling in the missing visual information with crumbs of information, which is why the deficiency remains unnoticed. It is very important to understand that glaucomatous damage, which is also very common in our country and is a lifelong disease that often severely impairs the quality of life, should not be discovered in countries with modern health care when it already causes complaints. With a quality screening test, it can be detected over the age of 40 long before it leads to serious visual impairment. If effective treatment is started at this time, then most of the amount of nerve fibers and nerve cells can be maintained for the whole life, so visual impairment that impairs the quality of life will not develop.
Therefore, those who are health-conscious, and especially those who are short-sighted and whose blood relatives have had glaucoma, should definitely visit a specialist dealing with the issue after the age of 40, because it is not easy to detect the disease in its early stages. Diagnosing end-stage glaucoma is no big deal, except that in this case the situation cannot be reversed.
Overall, he says Prof. Dr. Gábor Hollóhead of the Ophthalmic Center, glaucoma specialist, on the occasion of sight month, attention should be drawn to the fact that sight is not the same as glasses or contact lenses. Biological causes and medically detectable and treatable diseases must also be actively sought during vision changes and deterioration. If someone only thinks in terms of glasses and has one pair of glasses made after another, because none of them are suitable, they can lose months until the correct diagnosis and the start of treatment. If, on the other hand, he receives ophthalmological care late, then unfortunately he has often already suffered such irreversible deviations, which could have been prevented with timely, early ophthalmological treatment.
The main message of today’s conversation is that in case of visual impairment, you should first visit an ophthalmologist. If there is no other reason for vision impairment than an optically correctable condition that can be corrected with glasses diopters, then the optometrist and the manufacture of glasses come into question. In the case of reverse order, late detection of avoidable changes can result in an irreversible state.
Source: Ophthalmology Center
Source: www.patikamagazin.hu
