Rates of vision problems that can't be treated with glasses or contact lenses, known as nonrefractive vision problems, increased by 21% between two survey periods: 1999 to 2002 and 2005 to 2008. The findings suggest that as many as 700,000 more people developed these types of vision problems in a short amount of time.
Nonrefractive vision problems include glaucoma, macular degeneration, cataracts, and diabetes-related eye disease. They are caused by underlying diseases. Many of these diseases are age-related and would not be expected to increase among young people. Diabetes, however, is occurring in younger and younger people.
"The increasing diabetes prevalence in the U.S. is leading to more vision loss," says researcher David S. Friedman, MD, PhD, MPH. He is the director of the Dana Center for Preventive Ophthalmology at the Johns Hopkins Wilmer Eye Institute and Bloomberg School of Public Health in Baltimore. "We have to recognize that this is a large public health problem so we can start developing methods to deal with it."
The findings appear in the Dec. 12 issue of the Journal of American Medical Association.
Friedman and colleagues analyzed data from a large national database in 1999-2002 and 2005-2008. Participants aged 20 or older answered questions and underwent lab tests and physical exams.
Those most at risk were older, poorer, had less education, and had diabetes for 10 or more years. The only one of these risks that increased between the two surveys was a history of diabetes.
More Vision Problems to Come
"The number of people who have had diabetes for more than 10 years has more than doubled in the last six or seven years," Friedman says. The new findings are likely just the tip of the iceberg. If current diabetes rates continue, "we will see more and more people with diabetes and vision impairment."
Preventing diabetes in the first place is key to preserving vision, he says. This includes losing weight (if necessary), eating a healthier diet, and getting regular exercise. But, he says, "if you have diabetes, make sure get your eyes checked, as this type of vision loss is preventable."
Alan N. Carlson, MD, says that it is too early to say that the increase in vision problems is driven by diabetes. "Diabetes is on the rise and vision problems are on the rise, and patients with diabetes are more likely to have eye problems, but that is all we can say right now." He is the chief of the corneal and refractive surgery services at the Duke Eye Center in Durham, N.C.
"Certainly people need to be aware of the risks of getting nonrefractive vision impairment down the road," he says. "If there is a family history of certain diseases like macular degeneration, glaucoma, or diabetes, you should be seen more regularly by an eye doctor to make sure these diseases are caught earlier when they are much more treatable."
Roy Chuck, MD, PhD, is the chairman of ophthalmology and visual sciences at Montefiore Medical Center in New York. He says the new findings make sense and mirror what he has seen in his practice. "If you have diabetes or are at risk of other vision problems, you have to get checked out to see if your vision is changing."
The findings should also serve as a wake-up call for teens and young adults who are at risk for diabetes. "Things are not looking good for you if you are overweight, not eating right, and not getting exercise," he says. "These nonrefractive eye problems often strike older people, but diabetes is the great equalizer."
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