The Worst That Could Happen? Going Blind, People Say
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“Feeling My Way Into Blindness,” an essay published in The New York Times in November by Edward Hoagland, an 84-year-old nature and travel writer and novelist, expressed common fears about the effects of vision loss on quality of life.
Hoagland, who became blind about four years ago, projected deep-seated sadness in describing the challenges he faces of pouring coffee, not missing the toilet, locating a phone number, finding the food on his plate, and knowing to whom he is speaking, not to mention shopping and traveling, when he often must depend on the kindness of strangers. And, of course, he sorely misses nature’s inspiring vistas and inhabitants that fueled his writing, though he can still hear birds chatter in the trees, leaves rustle in the wind and waves crash on the shore.
Hoagland is hardly alone in his distress. According to Action for Blind People, a British support organization, those who have lost some or all sight “struggle with a range of emotions — from shock, anger, sadness and frustration to depression and grief.”
When eyesight fails, some people become socially disengaged, leading to isolation and loneliness. Anxiety about a host of issues — falls, medication errors, loss of employment, social blunders — is common.
A recent study from researchers at the Wilmer Eye Institute at Johns Hopkins University School of Medicine found that most Americans regard loss of eyesight as the worst ailment that could happen to them, surpassing such conditions as loss of limb, memory, hearing or speech, or having H.I.
V./AIDS. Indeed, low vision ranks behind arthritis and heart disease as the third most common chronic cause of impaired functioning in people over 70, Dr. Eric A. Rosenberg of Weill Cornell Medical College and Laura C. Sperazza, a New York optometrist, wrote in American Family Physician.
Some 23.7 million American adults reported in 2015 that they are unable to see at all or have trouble seeing even with corrective lenses.
This number is projected to perhaps double by 2050 the aging of the population and increasing prevalence of diseases that can cause vision loss.
Yet, the Wilmer Eye Institute’s national study of 2,044 adults found that many Americans are unaware of the diseases and factors that can put their vision at risk and steps they might take to lower their risk.
Perhaps the single most valuable message to emerge from studies of vision loss is the importance of having a thorough eye checkup at least once every two years, if not annually. Many sight-robbing conditions can be effectively treated if detected early enough, in many cases limiting or eliminating the damage to eyesight.
Four eye diseases — age-related macular degeneration, diabetic retinopathy, glaucoma and cataracts — account for most cases of adult blindness and low vision among people in developed countries.
Un many other ailments associated with aging, they cause no pain and often no early symptoms and thus do not automatically prompt a person to seek medical care.
But a thorough checkup by an ophthalmologist can detect them in their earliest stages, followed by treatment that can slow or halt their progression or, in the case of cataracts, restore normal vision.
Macular degeneration, a leading cause of vision loss in Americans 60 and older, involves an irreversible loss of retinal cells that robs people of the central vision needed to read, watch a TV program or identify a face or object in front of them. There are two types, dry and wet. In the dry type, the light-sensitive cells in the macula, a structure near the center of the retina, gradually break down. In the wet type, abnormal blood vessels grow under the macula.
Steps you can take to lower your risk of macular degeneration or slow its progression include not smoking, eating lots of dark leafy green vegetables, wearing sunglasses to block ultraviolet light, and taking one or more supplements formulated to support macular health. There are also treatments specific for wet A.M.D., including laser surgery, photodynamic therapy and drugs that are injected into the eye to slow the growth of abnormal blood vessels.
Diabetic retinopathy, the cause of most blindness in American adults, also affects the light-sensitive retina, damaging the vision of more than half of people with diabetes age 18 or older.
The most effective preventive is maintaining a normal level of glucose in the blood through medication and a proper balance of diet and exercise.
Blood glucose should be routinely monitored, high blood pressure effectively treated and smoking avoided entirely.
Glaucoma, another leading cause of blindness, involves a rise in fluid pressure inside the eye that damages the optic nerve.
It affects more than four million Americans, about half of whom don’t know they have it, and is especially common among African-Americans and Hispanics.
It can be detected with a comprehensive eye exam, which should be done annually for African-Americans and those with a family history of the condition.
Although glaucoma is not curable, treatment to lower pressure in the eye with prescription eye drops and, in some cases, pills or surgery can control the condition.
Cataracts are the most common cause of vision loss among people over 40. They involve a gradual clouding of the lens, a normally transparent tissue directly behind the iris and pupil that helps to focus images on the retina. As cataracts progress, it becomes increasingly difficult to see clearly, impairing the ability to read, drive or recognize faces.
Preventing or slowing the development of cataracts involves protecting the eyes from sun damage, not smoking, consuming a diet rich in vegetables and fruits and, if you have diabetes, keeping blood sugar under control.
In years past, doctors often advised patients with cataracts to wait until they were far advanced before removing them surgically. This is no longer the case. Cataract surgery is now done when the condition begins to affect a person’s quality of life or interferes with the ability to perform normal activities.
The surgery is nearly always done under local anesthesia on an outpatient basis.
If both eyes have cataracts, as is usually the case, the second eye is typically treated some weeks after the first to avoid the rare risk of a postoperative infection in both eyes.
The operation involves removing the clouded lens and, in most cases, replacing it with a clear artificial lens that often gives patients better vision than they had even before developing cataracts.
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Hearing loss linked to accelerated brain tissue loss
Although the brain becomes smaller with age, the shrinkage seems to be fast-tracked in older adults with hearing loss, according to the results of a study by researchers from Johns Hopkins and the National Institute on Aging. The findings add to a growing list of health consequences associated with hearing loss, including increased risk of dementia, falls, hospitalizations, and diminished physical and mental health overall.
For the study, Frank Lin, M.D., Ph.D., and his colleagues used information from the ongoing Baltimore Longitudinal Study of Aging to compare brain changes over time between adults with normal hearing and adults with impaired hearing. The Baltimore Longitudinal Study of Aging was started in 1958 by the National Institute on Aging to track various health factors in thousands of men and women.
Previous research from other studies had linked hearing loss with marked differences in brain structure compared to those with normal hearing, both in humans and animals.
In particular, structures that process information from sound tended to be smaller in size in people and animals with impaired hearing.
Lin, an assistant professor at the Johns Hopkins University schools of medicine and public health, says it was unknown, however, whether these brain structural differences occurred before or after hearing loss.
As part of the Baltimore Longitudinal Study of Aging, 126 participants underwent yearly magnetic resonance imaging (MRI) to track brain changes for up to 10 years. Each also had complete physicals at the time of the first MRI in 1994, including hearing tests. At the starting point, 75 had normal hearing, and 51 had impaired hearing, with at least a 25-decibel loss.
After analyzing their MRIs over the following years, Lin and his colleagues, reporting in an upcoming issue of Neuroimage, say those participants whose hearing was already impaired at the start of the sub-study had accelerated rates of brain atrophy compared to those with normal hearing.
Overall, the scientists report, those with impaired hearing lost more than an additional cubic centimeter of brain tissue each year compared with those with normal hearing.
Those with impaired hearing also had significantly more shrinkage in particular regions, including the superior, middle and inferior temporal gyri, brain structures responsible for processing sound and speech.
That structures responsible for sound and speech are affected in those with hearing loss wasn't a surprise, says Lin — shrinkage in those areas might simply be a consequence of an “impoverished” auditory cortex, which could become atrophied from lack of stimulation.
However, he adds, these structures don't work in isolation, and their responsibilities don't end at sorting out sounds and language.
The middle and inferior temporal gyri, for example, also play roles in memory and sensory integration and have been shown to be involved in the early stages of mild cognitive impairment and Alzheimer's disease.
“Our results suggest that hearing loss could be another 'hit' on the brain in many ways,” Lin explains.
The study also gives some urgency to treating hearing loss rather than ignoring it. “If you want to address hearing loss well,” Lin says, “you want to do it sooner rather than later. If hearing loss is potentially contributing to these differences we're seeing on MRI, you want to treat it before these brain structural changes take place.”
Lin and his colleagues say they plan to eventually examine whether treating hearing loss early can reduce the risk of associated health problems.
The research was supported by the intramural research program of the National Institute on Aging, the National Institutes of Health's National Institute on Deafness and other Communication Disorders (K23DC011279), a Triological Society/American College of Surgeons Clinical Scientist Development Award and the Eleanor Schwartz Charitable Foundation.
Susan Resnick, Ph.D., of the National Institute on Aging was the study's senior investigator. Michael A. Kraut, M.D., Ph.D., of Johns Hopkins; and Luigi Ferrucci, M.D., Ph.D., and Yang An, M.S., both of the National Institute on Aging, also contributed to this research.
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Johns Hopkins Magazine
|Janet Hardy “An Extraordinary
Born: January 14, 1916
Education: BS, University of British Columbia (1937); MDCM from McGill University (1941). Decided on a career in medicine after her father, an internist, once told her, “No daughter of mine is ever going to be a physician.”
Career Highlights: Served on the pediatric house staff at Johns Hopkins Hospital (1942-1945), where she was charged with developing the hospital's first neonatology ward; consultant to state of Maryland Health Department (1946-1950), where she helped develop a statewide transport system for premature and at-risk newborn infants; worked for Baltimore City Health Department (1951-1957), first as director of maternal and child health, ultimately as assistant commissioner of health for preventive medicine; director of Johns Hopkins Collaborative Perinatal Study (1957-1976); director of the Office of Continuing Medical Education at JHMI (1974-1981); director of Johns Hopkins Adolescent Pregnancy Programs (1975-1985); director of Johns Hopkins Children and Youth Programs (1982-1985); fifth woman to achieve rank of full professor on the Hopkins medical faculty.
Family: Married to Johns Hopkins associate professor Paul H. Hardy for 66 years; has two children and three grandchildren.
The couple reared their family on a 35-acre farm in Glen Arm, Maryland, where she raised horses, kept a garden, and canned her own jams and vegetables. Says Anne Duggan: “She's an extraordinary role model for how you can really have it all.
She's an incredible researcher, wife, mother, grandmother, homemaker, gardener. And she has always made it look effortless.”
Several years later, Hardy became aware of new research by Laurie Schwab Zabin, a professor of population and family health sciences at the Bloomberg School of Public Health, that showed that pregnancy prevention efforts needed to reach teenagers earlier than previously thought.
The two worked with city children's advocate Rosalie Streett to develop the Hopkins Pregnancy Prevention Program. The innovative school-linked program was implemented at a Baltimore City high school and a junior high.
The program, which blended social support, education, and access to birth control for young men and women, succeeded in decreasing the pregnancy rate among participants by 30 percent while pregnancy rates at schools without the program grew 58 percent.
Zabin calls Hardy a dedicated, dogged researcher, someone who not only has curiosity but also has the ability to get the right people together for a project and find the funding to make it work.
“When she decided something was going to be done, she totally threw herself into it, picked very carefully who she was going to do it with, and did it,” Zabin says.
“She's always been a person who saw what the next step could be.”
Then there was the question of how the CPP participants, their children, and grandchildren were faring. After approximately 25 years since her last contact with CPP mothers and children, Hardy decided it was time for a follow-up.
In 1988, together with the late Sam Shapiro of the Bloomberg School's Department of Health Policy and Management, Hardy reconnected with a random sample of 2,694 CPP participants for the Pathways to Adulthood Study.
The goal: to see how their environment and health had influenced their development.
“Clearly the question was what had happened to the mothers and the children, and why did it happen,” Hardy says. Because of the fine relationship her CPP staff had with participants, Hardy had little trouble finding the children, who were now between the ages of 27 and 33.
There was the baby who, though tiny and brain damaged at birth, went on to lead an independent life and have a family. There was the girl with the high IQ who won a full scholarship to college. There were babies who grew up to be doctors, lawyers, and small business owners, and babies who grew up to continue the poverty cycle, live on welfare, and go to prison.
“It was amazing to see as the children developed and the families made their way in life,” Hardy says. “So many of them turned out to be successful.”
Hardy's follow-up study found that living with both parents, remaining free from poverty, and good behavior in and school were all predictors of successful adult lives among this inner-city population, which was largely African American.
She also found a strong link between a woman's age when she first gives birth and how her children do later on in life.
Those born to mothers in their late 20s were more ly to get high school diplomas, stay off public assistance, and avoid teenage pregnancies in their own lives than were the children of teenage mothers.
It was more than curiosity that brought Hardy back to the CPP data several years ago.
“We were beginning to hear of findings, particularly from a researcher named David Barker in England, that there was definitive evidence between perinatal factors and chronic diseases such as diabetes, heart disease, and hypertension, yet there were very few databases that included detailed prospective data from the mother's pregnancy through the children's development to adulthood,” Hardy says. The original CPP data, which included a collection of 60,000 frozen sera samples, could be a goldmine.
Now Hardy just needed Hopkins researchers who were interested in the next step — following the participants to middle age. Says Duggan: “[Janet] realized the incredible value [of continuing] to follow the cohort but [knew] it was never going to happen unless she took action to pass along to a next generation of researchers what she had done.”
William Eaton, chair of the Department of Mental Health at the Bloomberg School of Public Health, has been interested in life course studies for most of his career and immediately saw the value of continuing the CPP.
“We have studied thousands of generations of fruit flies . . . and hundreds of generations of rodents, but [there's not been] a single intensive study of even one generation of humans,” he says.
“Following up on the CPP is one of the first opportunities we have to do that.”