Posts Tagged ‘cataracts’

Macular disease, cataracts and art

Thursday, October 24th, 2013

My wife and I are supporters of two art museums, one locally and the other in Denver. I also have a personal interest in eye problems, especially cataracts and macular disease, as my father had lost an eye as an intern (a paper cut led to an infection and, in those days, before antibiotics, there was concern about the other eye developing problems, a medical issue called sympathetic ophthalmia). In his late 80s he had a cataract in his remaining eye and, when he was examined by an ophthalmologist at the Cleveland Clinic, was found to have macular degeneration, a chronic eye disease  usually seen in people over 50.

Someday my visions may deteriorate to this point.

Someday my visions may deteriorate to this point.

I became aware, as I read about Dad's problem, that one day it might become mine as well; one of the risk factors for macular degeneration is a family history of the disease.

I've pasted in a list of symptoms from this condition (copied from a Mayo Clinic website).

  • The need for brighter light when reading or doing close work
  • Increasing difficulty adapting to low light levels, such as when entering a dimly lit restaurant
  • Increasing blurriness of printed words
  • A decrease in the intensity or brightness of colors
  • Difficulty recognizing faces
  • A gradual increase in the haziness of your central or overall vision
  • Crooked central vision
  • A blurred or blind spot in the center of your field of vision
  • Hallucinations of geometric shapes or people, in case of advanced macular degeneration

The National Eye Institute, a branch of the NIH, has a fact sheet on age-related macular degeneration (AMD) that's worth looking at if you or someone in your family develops this problem. I'll mention a few things from that website as AMD is a major cause of vision loss in older adults. To begin with the macula is the part of your eyes that gives you the sharpest, most detailed vision. It's the extremely sensitive part of the retina, the layer of tissue  at the back of your eye that responds to light, converting images, focused by the eye's lens on this equivalent of camera film, into electrical signals that travel via the optic nerve to the brain. If the macula is damaged, fine points of these images become less clear.

If this happens to a non-artist, someone who doesn't make their living through images they put into a form that others can enjoy, it still leads to less sharp vision. You may have problems reading, driving or recognizing an image such as a face. Since your peripheral vision isn't affected, you'll probably be able to walk around without major difficulty.

But image that you're an artist. You gradually realize your vision is becoming less clear. You used to be able to read an eye chart at the 20/20 level, meaning you can read the same row of small letters on the chart at 20 feet which those with normal vision can. Now your visual acuity, measured when you see your eye specialist, is slipping and you worry that it will affect your ability to paint as well as you once did.

Having 20/20 eyesight does not necessarily mean perfect vision. 20/20 vision only indicates the sharpness or clarity of vision at a distance. There are other important vision skills, including peripheral awareness or side vision, eye coordination, depth perception, focusing ability and color vision that contribute to your overall visual ability.

Some people can see well at a distance, but are unable to bring nearer objects into focus. This condition can be caused by hyperopia (farsightedness) or presbyopia (loss of focusing ability). Others can see items that are close, but cannot see those far away. This condition may be caused by myopia (nearsightedness).

I've written about these medical problems before, but was riveted by a pair of articles I found in two AMA publications yesterday. A Stanford eye surgeon, Dr. Michael F. Marmor, just published a supurb article on Edgar Degas' progressive loss of vision in his later years. Degas was born in Paris in 1834 and died there in 1917. His painting altered from 1860 , when he had essentially normal vision, to 1870 and beyond  when first one eye, then the other progressively lost visual acuity. By 1897 he was seeing at a 20/200 level; that means he could would have to be twenty feet away from an eye chart to read the letters that someone with normal vision could read from 200 feet away.

The style and details of his paintings, especially his pastels, have been shown to change as Degas' eye problems progressed, but Dr. Marmor's article calls our attention to one oil painting, Scene from the Steeplechase: The Fallen Jockey. Here's a link to the painting in the National Gallery of Art; it was originally painted in 1866 and reworked by the artist in 1880-81 and again in 1896 with considerable changes made which Dr. Marmor shows can be linked to Degas' declining visual acuity.

A number of other significant artists have demonstrated visual loss in their work. An April, 2007 article in ScienceDaily focuses on Dr. Marmor's work, mentioning he's authored two books on art and eye sight: Degas Through His Own Eyes and The Artists's Eye (I've ordered a copy of the latter book through Amazon).

The Blind with Camera School of Photography website mentions a number of other famous figures from the art world who struggled with visual issues. Among those were El Greco, Rembrandt, Van Gogh, Paul Cezanne, Claude Monet, Mary Cassatt, Camille Pissarro and Auguste Renoir. Georgia O'Keeffe, who lived to the age of 98, also suffered with significant eye disease in her later years; her almost complete loss of eyesight and ill health during the last fifteen years of her life significantly curtailed her artistic productivity. Her eye problems began in 1968, and by 1971 macular degeneration caused her to lose all her central vision.

How is this honeybee similar to Monet?

How is this honeybee similar to Monet?

Monet had cataracts which not only diminished his visual acuity, but also affected his perception of colors. He resisted having surgery, but eventually decided to have one cataract removed. After the operation, according to science writer Carl Zimmer's review of the San Francisco Exploratorium's free  publication, Color Uncovered, Monet, like honeybees, was able to see ultraviolet light (normally filtered out by the lens of your eye) and painted water lilies a pale blue. Bees are guided to pollen by light signals we are unable to perceive; Monet had lost a lens to surgery, but gained a spectrum of light perception the rest of us lack.

I have zero talent as a visual artist, but after bilateral cataract surgery my vision is correctable to 20/20...for now.




Part 2: Cataracts as a risk factor for hip fractures

Sunday, December 16th, 2012

This is not the kind of cataract I'm writing about

I recently found an article in JAMA, the Journal of the American Medical Association, that struck home. I've had both eyes surgically redone, i.e., had cataract surgery on first my left eye, then my right. The first hint was the inability to correct my vision to 20/20. Then I started noting oncoming lights had halos. I got mildly uncomfortable driving at night, but had no major difficulty until some time after my first laser operation. Then I started to note that street signs were hard to read.

Our ophthalmologist at the time reassured me that having a cataract was common and that the surgery would be very helpful.

It certainly was, although my right eye required a brief in-office touch-up after a few months.

Now it's my wife's turn. She's always had incredible vision; even after needing bifocal and then trifocal glasses her far vision corrected to better than 20/20. She had her left eye's cataract done about two years ago and was very happy with the result.

Then about three months ago she started having problems with driving at night. It's time for the right eye to have its turn. I took over the night driving chores and we had no difficulty on our 30-day, 4,000 mile drive to the far northwest and then across British Columbia and most of Alberta. She'll see our new ophthalmologist in a few days.

This is an ocular cataract.

There's lots of background information on the National Eye Institute's (part of the NIH) website (updated from when I first wrote this post) and a similar website for the UK sent me by a British reader:    I'll go through the basics: First a cataract is a change in the lens, the clear part in the front of your eye that you use to focus an image or light on the retina in the back much like you focus a camera. It can develop in one eye or both; roughly 50% of us will have to deal with at least one cataract if we live long enough, as the majority of cataracts occur as part of aging. You may have small cataracts when you are in your 40s and 50s without noticing significant visual loss.

The University of Maryland has a website with cataract risk factors; besides age as the primary risk factor, you may be more prone to developing a cataract if you are diabetic (either type 1 and 2), have excessive sun exposure, are African American, smoke (a pack a day doubles your risk), drink heavily, have a disease treated chronically with corticosteroids (AKA steroids), suffer a physical injury to an eye or even if you are nearsighted. Researchers think a diet rich in antioxidants (e.g., green,leafy vegetables) may help prevent cataracts.

If you have a cataract, your vision will not be as sharp and you may notice things seen change color to a brownish shade

Surgery is the most common treatment for significant cataracts and is regarded as a safe and effective procedure with 90%  of patients experiencing improved vision post operatively according to the National Eye Institute.

So what is this leading up to? The JAMA article dated August 1, 2012, is titled "Risk of Fractures Following Cataract Surgery in Medicare Beneficiaries. I was initially puzzled by this, but as I read the article, the actual title, in my opinion, should have been "Reduced Risk of Hip Fractures ..." Clear vision helps prevent falls and in a 5% random sample of Medicare beneficiaries (that meant 1,110,640), 410,809 had cataract surgery. When compared to those who did not, patients undergoing such an operation had a 16% decreased incidence of hip fracture in the following year.

I'm pleased with the results of my own cataract removal surgery. Are you about to have such a procedure?