It is time we said 'I care' to eye care

April 24 2003 began just like any other day for Pauline Edwards. Then she opened her eyes and found that overnight her world had changed, dramatically and for ever.

"Everything that should have been horizontal was wavy," recalls the registered nurse from Salford. "I've had some frightening experiences in my life, but nothing like this."

Edwards thought she had suffered a detached retina. In fact, although she was only 48, she had contracted a virulent form of age-related macular degeneration (AMD), a disease that - if left unchecked - destroys central vision.

"I thought my life was over," says Edwards, now 54. "I sew, embroider, make cards, read ... it was just the worst thing that could possibly happen to me."

AMD, responsible for nearly a quarter of a million people registered as blind or partially sighted, is the single biggest cause of sight loss in the UK. Yet Edwards, like many people, had never heard of it.

A smoker all her adult life, she also had no idea that smoking had substantially increased her risk of contracting the disease. Edwards had one other major factor working against her. Because she had never needed glasses she had never been for an eye examination, which meant there was no chance that the early signs of AMD or any other potentially catastrophic eye condition could be picked up.

Her story has a relatively happy ending. In 2003 there was very little that could be done for her. Since then, however, drugs have been developed that can halt and even slightly reverse the deterioration in sight caused by wet AMD, and since June 2006, she has had a series of injections in her eyes which have partially restored her vision.

"A few years ago, all we could do for the vast majority of patients with AMD was pat them on the shoulder, direct them to the low vision aids clinic and wish them the best of luck," says Simon Kelly, a Bolton ophthalmologist who has played a leading role in linking AMD with smoking. "The past few years have been a revolutionary period in retinal disease, as a result of which we can do so much more for patients with both prevention and treatment."

The key to successful treatment of wet AMD and many eye diseases, however, is to start it early, and every year thousands of people learn a brutal truth about looking after their sight: if you leave it until you have symptoms, you have left it too late.

"It is very dangerous to leave an eye test until you notice something is wrong," says Sonal Rughani, an optometrist at Wycombe General Hospital. "Because tests are associated so strongly with a need for glasses, many people feel that if they don't need them they don't need a test, but it is an important health check that can pick up on serious conditions people won't know they have got."

Avoidable sight loss

The Royal National Institute of Blind People (RNIB) estimates that there are about two million people in the UK with sight problems and that every day another 100 join them. Most shockingly of all, evidence suggests that half of all this sight loss is utterly avoidable.

"All research tells us that sight is the sense people fear losing most," says Geoff Roberson an adviser at the Association of Optometrists, "but we do seem to have this ambivalent attitude towards it."

And eyecare isn't just about eyes: in addition to AMD, glaucoma, cataracts, diabetic retinopathy and other less common eye diseases, a sight examination can reveal the first sign of a range of other serious conditions, including high blood pressure, rising cholesterol levels, hardening of the arteries, diabetes and even strokes and brain tumours.

One eye condition that can be picked up and has few warning signs is glaucoma, which can cause irreparable damage before the sufferer notices. There are, says Steve Winyard, head of campaigns at RNIB, about half a million people with glaucoma in the UK, only half of whom have been diagnosed: "That means there are a quarter of a million people gradually losing their sight."

Thanks to regular eye checks, Anna Bishop, a teaching assistant from Plymouth, is not one of them. She was only 44 when a high street optometrist spotted the early signs of glaucoma.

"I've always worn glasses and had gone for a routine eye examination," she says. "Nothing had made me suspect something might be wrong. I had no symptoms."

Anna was prescribed beta-blocker eye-drops to control the pressure in her eye and her condition was stabilised. Now 51, she has lived with glaucoma for six years: "Because they picked it up so early there are no symptoms at all."

Everyone should have an eye test every 24 months, but each year an estimated 12 million people fail to keep this vital, 30-minute appointment. By the time you reach 60, when one in 12 develop sight problems, RNIB recommends annual tests, yet almost half (some six million people) fail to take advantage of the free examinations available to them.

By the time we hit 75, one in six has sight problems, yet a survey carried out in September found that as many as half of those over 75 struggling with sight loss needed nothing more than new glasses or a routine cataract operation to restore full sight.

Quite apart from lost pleasures and necessities such as reading and driving, the consequences of poor sight can be devastating, especially for older people who risk falls, injuries and premature admission to expensive residential care. According to a 2007 report by the Domiciliary Eyecare Committee, poor sight causes 90,000 falls a year among elderly people, costing the NHS £270m.

With the number of people of pension age expected to almost double to 18 million by 2055, but with "health expectancy" failing to keep pace with increases in life expectancy, the situation is primed to get worse.

"The real challenge we face as a nation is that without decisive action the number of people with serious sight loss is set to double over the next 25 years," says RNIB's Winyard.

Lifestyle

Having a regular check-up isn't the only step we can take to save our sight, and prevention needs to start early. Excessive exposure to the UV rays in sunlight, for instance, has been linked to cataracts and AMD, and it's never too early to start wearing sunglasses that block out 100% of UV-A and UV-B rays.

"Children's eyes are much more susceptible to sun damage than those of adults," says Rod Lane, president of the European Sunglasses Association. "As a result, by the time a person is 18, they will have absorbed more than half a lifetime's worth of UV rays."

Many general messages about fitness and diet also have a direct bearing on eye-health. Smoking, for instance, increases the risk of AMD fourfold, according to some studies, and 54,000 sufferers in the UK over the age of 69 owe their sight loss to the habit. Smokers are also likely to develop the disease 10 years earlier than non-smokers.

Nutrition also plays a part in prevention. With a clear link between rising obesity and sight loss, diet and exercise are important. Early obesity is associated with diabetes and 60% of people with type 2 diabetes will develop diabetic retinopathy.

Studies show that various micronutrients, such as the antioxidants Lutein and Zeaxanthin, found in green leafy vegetables and yellow-coloured fruits and vegetables, and the Omega-3 polyunsaturated fatty acids, found in some nuts and fish, may also help to reduce the incidence of various eye diseases.

Socioeconomic and genetic factors also play a part in deciding who keeps or loses their sight. Because of complex cultural and genetic factors, some black and minority ethnic communities are more at risk of vision loss than others.

People of African origin, for instance, are more likely to suffer cataracts, have a threefold risk of developing diabetes, with its attendant risk of diabetic retinopathy, and four times more likely to contract glaucoma.

People of Asian origin are also more at risk of developing glaucoma and cataracts and six times more likely to develop type 2 diabetes, which affects as many as 25% of the Asian community in the UK.

This susceptibility is compounded, says RNIB, because black and minority ethnic groups are among the hardest to reach with healthcare messages and less likely than their white counterparts to have their eyes examined.

"People in different communities have different cultural priorities and won't necessarily put their health first," says optometrist Rughani, who also works at a diabetic monitoring clinic. "The message may not be reaching them that worsening eyesight is not an inevitable consequence of increasing age."

Economic disadvantage also appears to condemn many people to a life of avoidable sight loss. Free NHS eye tests and help with the cost of glasses are available to people receiving certain benefits, and free examinations are on offer for children, the over-60s, and anyone in Scotland. Yet cost still appears to dissuade many people from having their eyesight checked.

Optometrists recommend comprehensive eye tests - lasting around 30 minutes or longer - for everyone every two years (or more often if needed).