Are you risking eye damage by putting off that eye care visit?

Early stages of vision-robbing diseases often have no symptoms.

Once you reach age 65, you need comprehensive, dilated eye exams every one or two years — more often if you have eye problems. But doctors say the pandemic is keeping some people from getting eye care.

"Some people are delaying treatment, trying to avoid crowds or health facilities like hospitals. They're not getting their eye pressure checked, and they're not using their eye medications," says Dr. Roberto Pineda, an ophthalmologist and eye surgeon at Harvard-affiliated Massachusetts Eye and Ear.

What's the risk?

Vision loss usually occurs gradually and painlessly, and most people don't notice until after the damage has been done. Putting off eye care increases the risk for undetected or uncontrolled eye conditions, eye damage, and vision loss, especially from glaucoma.

"With delayed eye care, we're seeing more severe cases of glaucoma and more people coming to the emergency room with advanced vision loss," says Dr. Lucy Shen, an ophthalmologist who specializes in glaucoma treatment at Massachusetts Eye and Ear.

Sometimes the eye pressure changes that damage vision in glaucoma happen quickly.

"Two of my patients had worsening glaucoma. Their eye pressures were normal in March. They should have come back in June, but canceled. When they came back in September, they had very high eye pressures and needed surgery," Dr. Shen says.

Other risks

Delayed eye care also allows other eye problems to go unchecked. The following eye conditions have few or minor symptoms at first and may only be detected by eye exams.

An eye stroke. Like the heart or brain, the eye can suffer damage from obstruction of a blood vessel. One type of eye stroke occurs when blood flow leaving the retina (the light-sensing component in the back of the eye) is disrupted. It can cause temporary or permanent vision loss. People with high blood pressure, diabetes, glaucoma, and cardiovascular disease are at greater risk for this condition.

Diabetic retinopathy. Diabetes can cause blood vessels in the retina to become "leaky," leading to temporary vision loss. "Sometimes the blood will clear on its own. If it doesn't, you may need surgery. If the old blood or new blood vessels block the drain in your eye, you can get increased eye pressure and glaucoma," Dr. Shen says.

Age-related macular degeneration. This condition gradually destroys the macula, the retina's central portion. It's the part of the eye that provides central vision needed for seeing objects clearly.

Symptoms and intervention

You may not be able to tell if an eye condition has developed or is progressing unless it's advanced and you experience symptoms, which can include

• blind spots in your peripheral or central vision
• severe pain in the eye or forehead
• severe light sensitivity
• blurred or reduced vision
• temporary vision loss
• headache along with vision change
• eye redness
• halos around lights
• spots or cobwebs in your field of vision.

"Check your vision in one eye at a time. If you have symptoms in only one eye, that's a sign of a problem," Dr. Shen says. But don't wait until symptoms occur to see your doctor; keep scheduled eye appointments. Your doctor can dilate (widen) your pupils and look into the back of each eye to examine the health of the retina and optic nerve. Your eye care team can also check your eye pressure, make sure your eye muscles are functioning properly, and check for vision changes.

If necessary, the doctor can prescribe medicines, give injections, or perform procedures to halt disease progression. If eye disease advances, medications will need to be adjusted. In some cases, you may need surgery.

Seeking care

If you're worried about COVID-19 exposure in a health setting, Dr. Shen suggests calling your doctor's office to talk about it. "If you just cancel and you don't reschedule, that's when we often see advanced disease," she notes.

By talking to your eye care team, you'll find out about precautions the office is taking to ensure your safety — such as disinfecting equipment, wearing masks, screening patients for COVID before arrival, limiting waiting room times, limiting the number of people in waiting rooms and keeping them six feet apart, and offering hybrid visits. "You come in, get some vision tests with the technician, and then we do the rest of the exam on the phone or by video after I've looked at the test results," Dr. Shen says. "But even with concerns about COVID, we still encourage you to come in for an exam. Early interventions can lead to much better outcomes."

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