Following World Sight Day on October 8, we take a look at eye diseases that commonly affect women.

TO achieve the goals of VISION 2020: a global initiative for the elimination of avoidable blindness by the World Health Organisation (WHO) and the International Agency for the Prevention of Blindness (IAPB), World Sight Day has been observed every second Thursday of October since the year 2000.

Over the years, many issues related to sight, including the high prevalence of low vision and refractive errors, and blindness in children and the elderly in developing nations, have been were addressed. This year, the theme "Gender and Eye Health - equal access to care" seeks to shine the spotlight on these realities:

"Nearly two-thirds of blind people worldwide are girls and women.

"In many places, men have twice the access to eye care as women.

Although Malaysia does not have such glaring disparities, what Malaysian women have to realise is that there are indeed some eye diseases that are more prevalent among women, says consultant ophthalmic, cornea, and refractive surgeon Dr Shamala Ganesan.

The reasons these eye diseases affect more women than men vary, she says, but can usually be traced to physiological differences, such as the fact that women generally have smaller eyeballs and experience hormonal fluctuations during menopause.

This predisposes them to eye problems ranging from dry eyes to more serious ones such as glaucoma.

Another convenient assumption is that the average woman lives longer. Therefore, her chances of getting age-related degeneration in the eyes are higher.

However, with regular eye-checks and timely treatments, Dr Shamala believes that even when there is currently no cure for some of these diseases, there are ways for us to slow down and outlive the deteriorating function of our eyes.

Eyes diseases that affect more women than men

Dry eye syndrome

The reason dry eyes are more common in women, especially those over 50 years old, is the hormonal changes experienced during menopause, resulting in lower tear production, says Dr Shamala. But younger women can also experience it due to allergies or the prolonged use of contact lenses.

Dry eyes occur when the eye does not produce enough tears quickly or when the tears are not of correct consistency and evaporate too quickly.

"When people start to have dry eyes, they will usually have redness in the exposed part of the eye (not covered by their eyelids)," says Dr Shamala. "But when it progresses, some will say that their eyes are so sore, they just do not want to open them."

Usually, the redness and soreness will go away after resting the eyes, but for people who have chronic dry eyes, rest and blinking does not make it go away.

"That's when you may need some treatment," she says. Artificial tears are usually enough to control mild to moderate dry eye symptoms. More severe symptoms will need immunomodulators to enhance tear production and control the chronic inflammation at the eye surface.

As further progression of chronic dry eyes may result in protein filaments forming in the outer layer of the eye or extensive erosions causing soreness and blurring of vision, it is best to treat chronic dry eyes early, she adds.
 
Glaucoma

The two main types of glaucoma (a condition where there is an increased pressure in the eye) are primary open-angle glaucoma and angle closure glaucoma (ACG). However, women are four times more likely to get ACG compared to men.

"You don't find this in young girls - those who have ACG are usually those around 55 to 60 years old," says Dr Shamala.

"It is more common in women who are small and petite, because when we are smaller, our eyeballs are also shorter. And when our eyeballs are shorter, it predisposes us to ACG," says Dr Shamala.

This is because people with shorter eyeballs have a narrower space in between eye structures where the drainage channels drains fluids out of the front of the eye.

And as the eye ages, these structures (especially the lens of the eye) may thicken and further constrict this space, reducing the drainage of fluids and causing pressure to build up in the eye.

Initially, people with angle closure will notice intermittent attacks - which is commonly tension with mild to moderate pain in the eye, usually at night or in a dimly lit room.

This is because when the pupil dilates, it will further narrow the space between the eye structures, resulting in reduced drainage of fluid and pressure build-up in the eye.

They will also notice rainbow coloured halos around lights and mild blurring of vision which resolve spontaneously.

Eventually they will have a full blown acute attack that does not resolve and the eye pressure will continue to rise to the point they will have throbbing eye pain and headache, nausea, vomiting, and giddiness.

Most patients' with severe attacks have to be brought in to the hospital in a wheelchair or stretcher due to the pain, says Dr Shamala. Usually, they would have lost significant amounts of nerve fibre due to the intermittent attacks, leading to some field defect which is irreversible, she adds.

Although there is no cure for glaucoma, treatment is available. For some, it may be as simple as administering eye drops, while for others, surgery may be needed.

Age-related macular degeneration (ARMD)

ARMD is caused by the degeneration of the eye, and the risk increases with age, particularly for those aged 60 years and above. It affects the macula region in the inner layer of the eye (retina), which is responsible for central vision.

ARMD occurs in two forms, which is dry ARMD and wet ARMD. Dry ARMD is the degeneration of the cells in the retina whereas wet AMD is caused by the growth of new but fragile blood vessels underneath the layer, causing distortion and damage to the retina especially when it bleeds or leaks fluid into the retinal layers.

At first, people experiencing ARMD will notice that some straight lines will look crooked or distorted. Their vision may also become blurry, as if they are looking through water.

Reading and driving becomes difficult as their central vision becomes increasingly blurred, and those who experience late stages of ARMD will see a dark smudge or even a black blot in the centre of their vision.

Currently, there is no specific treatment for dry ARMD. However, research suggests that some vegetables high in certain carotenoids, lutein and zeaxanthin, can prevent or slow down this process. Some vitamin supplements (eg. A, C, E) with high dose of antioxidants may also help, says Dr Shamala.

As loss of central vision happens very quickly with wet ARMD, treatment is needed. There are laser surgeries that could destroy fragile and leaky blood vessels and injections that could help slow down the degeneration process.

However, if the ARMD is in a very advanced stage, it is very difficult to treat or reverse the macula damage to restore vision, says Dr Shamala.

Caring for your eyes

The good thing about our eyes is that whenever we experience problems bringing things into focus, they will automatically adjust to compensate. So, even when one eye does not focus very well, the other takes over, and all is well until both eyes are affected.

"I would advise anyone who has any eye problem to see an ophthalmologist first. After assessing your eye, he or she will be able to tell you whether your eyes are healthy, and if you need prescription eyeglasses, you can go to your local optometrist," she says.

It is generally advisable for everyone when they reach the age of 30 to get their eyes checked and screened, she adds.

Some conditions can be detected early, and risk factors could be monitored so that when a person develops the disease, steps could be taken to slow down its progression.

Of course, other steps to take care of your eyes are important too, Dr Shamala stressed. Wearing polarised sunglasses could protect your eyes from harmful UV rays. Practising good hygiene, particularly when you are wearing contact lenses, could prevent eye infections.