The eyes have it

by Charles Downey

Many men dislike seeking medical care for any reason. But when it comes to changes in your vision, do yourself a favor and get to an eye doctor.

One day in Rome, the great Norwegian playwright Henrik Ibsen saw a crowd gathered around a large red poster. Intrigued, he reached for his glasses, only to find he had left them back in his hotel room.

"Signore," said Ibsen, squinting and turning to the man beside him. "Could you please tell me what that sign says?" "Sorry, signore," said the Italian in a confidential whisper, "I don't know how to read either."

While most men today can read quite successfully, convincing them to get glasses or an eye check-up may be quite another matter.

"It's not always a matter of vanity," says David Kozart M.D., an associate professor of ophthalmology and vice chair of the department of ophthalmology at the Scheie Eye Institute in Philadelphia. "Most men don't like to admit they have any type of health problem. And some men just don't like to feel out of control."

But seeking out medical care puts a guy more in control. And medically speaking, men should care for themselves just like they would care for one of their kids. What responsible man would let his child do without eye care?

Even before the time comes for frequent eye exams, men should first get in the habit of protecting their eyes. "One of the biggest differences between the health of women's and men's eyes is that guys suffer far more accidents," says Eric Donnefeld, M.D., assistant clinical professor of Ophthalmology at Cornell University Medical College and a cornea and refractive surgeon at Ophthalmic Consultants of Long Island.

"Men should wear eye protectors around power equipment and while playing sports like racquetball or squash," he says. "I've seen many eye injuries caused by guys who were just hammering nails. But most men don't think about wearing eye protection for that."

The three primary types of eye protection -- safety glasses, safety goggles, and face shields -- are sometimes worn in combination. Experts say that handling chemicals, including lawn chemicals, requires goggles.

For any activity that involves chipping, grinding, riveting, sanding, or masonry, safety glasses or goggles should be worn. A face shield is often required if there are large flying objects or lots of debris. For ordinary woodworking, goggles usually do the job.

Men frequently think they are the only ones who have a particular health concern and thus never say anything about it. Especially to doctors. Topping the list is blurred vision.

One of the most consistent and predicable aging phenomena occurs right around age 45. All of a sudden, you must either hold printed matter at arm's length or take off your glasses entirely to clearly see what you're reading (presbyopia).

"It comes as a jolt but it happens to all of us," says Dr. Kozart. "To see clearly, you must either get bifocals or a pair of reading glasses. After age 45, you can't have it both ways."

The reason for the vision inconsistency is due to one of two things: either normal aging, which weakens the muscles that focus the eyes, or a change in the eyeball itself, which may become less round and create a less perfect focus.

One treatment method that people either love or hate: a technique known as "monovision." Glasses or contacts allow one eye to be used for distance while the other handles close-up matters. Experts say some adapt well, while others just can't get used to it.

Eye doctors also screen for disorders that, when caught early, can avert major problems later on. If you are African-American, if you have diabetes of if you have a family history of oscular diseases, you should have your eyes checked by an ophthalmologist annually. For the rest of your life.

"Medical science doesn't know why, but black people have about a 10 percent rate of glaucoma," says Dr. Kozart. "In Anglo populations, the rate is usually about 1 percent."

For most healthy men, glaucoma screening should start right around age 40, or sooner if they have a family history of the condition. Says William Lesko, M.D., assistant clinical professor in the department of Ophthalmology at Mount Sinai and an ophthalmologist at North Jersey Eye Associates in Clifton, New Jersey: "The baseball player Kirby Puckett lost the sight in his right eye from glaucoma earlier this year and was forced to retire from big league baseball. He is now spokesman for a campaign known as 'Don't Be Blindsided!,' a program to encourage everybody over 40 to have glaucoma screening."

Nearly 120,000 Americans yearly lose all or part of their vision while another 900,000 experience some form of gradual vision loss from the disorder, experts say.

"About 50 percent of all glaucoma cases go undiagnosed," says Dr. Lesko. "Regular screenings -- painless and quick -- are the only way to go."

Says Puckett: "I know what it is like to have a career that relies on solid instincts, split second reaction time and perfect vision. I also know what's like to wake up one morning and have it abruptly end. So I encourage regular eye exams to help detect this disease early."

Glaucoma increases pressure inside the eye and puts unhealthy pressure on the optic nerve. Moreover, there are several different types of the disorder. Left untreated, glaucoma can lead to blindness. Fortunately, medical science has several ways to control it.

"With a type of glaucoma known as 'acute angle closure,' a small opening can be put in the iris of the eye with a laser," says Dr. Kozart. "Other forms of glaucoma can be controlled with drops, pills and surgeries."

Men with diabetes are also at increased risk for glaucoma and yet another ailment known as diabetic retinopathy. Diabetes causes blood vessels within the eye to leak. "The longer a person has had diabetes, the greater the likelihood the diabetic retinopathy will occur," says Dr. Kozart.

Cataracts -- a whitish clouding in the lens of the eye -- usually come along about, or just after the age of retirement, experts say. "Unlike glaucoma or diabetes, cataracts don't hurt the health of the eye," says Dr. Kozart. "So a cataract operation is usually an elective procedure done to improve visual sharpness. You can have cataracts taken out today or 10 years from today."

The first signs of a cataract is a clouding or lessening of vision. The condition may first make itself known as a glare at night or trouble with oncoming headlights while driving. Or, a light bulb may be seen as a display of stars.

"Some patients say they experience blurred vision while others simply say they can't see well enough anymore to do they they want to do," Dr. Kozart says. Cataract surgery is the most commonly performed surgical procedure in the United States; surgeons remove the crystallized lens in the eye that causes the clouding and replace it with a man-made lens.

The American Academy of Ophthalmology urges everyone to get a medical eye examination and make eye safety a priority for you and your family. "It is extremely important to have your eyes checked on a regular basis," said H. Dunbar Hoskins Jr., MD, executive vice president of the Academy. "Many of the most common forms of eye disease, such as glaucoma, cataract and diabetic retinopathy, when caught in the early stages, can be successfully treated. If not caught in time, these diseases can lead to visual loss and blindness."

Which type of vision care practitioner should you see?

Ophthalmologists are physicians who specialize in eye disorders. They check eyes for vision problems, diseases, and abnormalities. They perform eye surgery, prescribe medication, and write prescriptions for glasses and contact lenses. You should see an ophthalmologist if you have a history of glaucoma, diabetes, high blood pressure, or cataracts.

Optometrists are not medical doctors, but hold a Doctor of Optometry degree. They give eye exams, practice visual therapy to counter certain eye problems, and are limited in the drugs they can prescribe. Most dispense eyeglasses and contact lenses.

Opticians have less training than ophthalmologists or opticians and cannot write prescriptions. They fit, supply, and adjust glasses, using a prescription from an ophthalmologist or an optometrist.