It all started four years ago when Chance Flaherty, then 14, could not read the Jumbotron at a Celtics game. Nor could he see the numbers on the back of the

players’ jerseys. His mother, Shelley, acted quickly and

took Chance to an optometrist for an eye exam. But she wasn’t prepared for what the optometrist told her. It was not the nearsight-edness that caused alarm. The pressure in both his eyes was elevated. The optometrist knew that increased eye pressure, or glau-coma, tends to run in families.

As a result, he recommended that the entire family make appointments as well. Everyone tested normal. But not Demetri, Chance’s twin brother.

He was experiencing vision problems of his own. He was in the ninth grade at Com-munity Charter School of Cambridge when things began to go awry. Demetri admitted that he had trouble seeing the black board at times, but a simple change of seats remedied the short-term problem.

The results of Demetri’s eye exam dem-onstrated a long-term problem. Not only was he nearsighted, but the pressure in both of his eyes also exceeded the normal limit, the right eye worse than the left. Instead of the average eye pressure of 11 to 21 mm Hg (millimeters of mercury) his pressure exceeded 30. It was later determined that both Demetri and Chance had primary open angle glaucoma

— the most common form of the disease.Without much warning or fanfare more

than two million people in the United States slowly begin to lose their sight. And they don’t even know it. According to experts, by the time they notice a change, more than 50 percent of their vision has been perma-nently lost.

Most often the fi rst symptom is the loss of peripheral or side vision. That’s why it escapes notice. You don’t need peripheral

vision to watch TV, work on the computer or read. But there’s another reason for the lack of awareness, according to Dr. Douglas J. Rhee, an ophthalmologist at Massachusetts Eye and Ear Infi rmary. “The brain does funny things,” Rhee said. But it’s not trying to play tricks; it is actually being protective. Glaucoma causes blind spots in our vision, so the brain fi lls them in for us, Rhee explained.

Yet, without treatment, glaucoma — the second leading cause of blindness in this

country — slowly advances. Eventually, the scope of vision is so limited, it’s as though one is looking through a tunnel or telescope. Ultimately, the disease can result in perma-nent and total vision loss.

No one — not even babies and children — is safe from glaucoma. African Americans and Hispanics are affl icted more. And earlier. Glaucoma often strikes blacks around the age of 40. Asians are also affl icted, but tend to suf-fer from a less common form of glaucoma.

By 60, everyone is fair game.Glaucoma results from increased eye pres-

sure. The eye is fi lled with and nourished by a clear fl uid that continually fl ows, but must drain to accommodate a fresh incoming supply. In most types of glaucoma the fl uid does not drain properly causing eye pressure to rise.

Elevated pressures can eventually destroy the optic nerve, a bundle of more than one mil-lion nerve fi bers that connects the retina (tissue at the back of the eye) with the brain. A healthy optic nerve is necessary for good vision.

Glaucoma is not one disease. Rather, it is a family of several different types. Congen-ital glaucoma is rare and develops in infants and young children. Secondary glaucoma results from another cause, such as an eye injury or long-term use of corticosteroids.

In low tension glaucoma, which affects up to one third of people with the disease, eye pressure remains within the average range, but still results in optic nerve damage.

Demetri, continued to page 4

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(From left to right): Demetri Flaherty, grandmother, Nancy Beckford, mother, Shelley Flaherty and twin brother, Chance Flaherty. Demetri, Nancy and Chance have been diagnosed with glaucoma, which tends to run in families. (Ernesto Arroyo photo)

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Petra Ebisemiju, a 67-year-old retired school nurse, didn’t know much about glaucoma before she was diagnosed with the disease. But she knows a lot now and is absolutely right when she says it is a “tricky little disease.”

For Ebisemiju, the disease started in her left eye about 10 years ago. She went for her yearly eye exam and the doctor told her that her pressure was elevated. “I didn’t know what pres-sure he was talking about,” she said.

She soon learned. Ebisemiju was diagnosed with angle closure glaucoma, a less common form of the condition. Ac-cording to the Glaucoma Foundation, angle closure glaucoma is one more typically seen among Asian Americans.

But Ebisemiju had another characteristic often associated with that form of glaucoma. She is farsighted.

By the time she saw the ophthalmologist she said the doctor told her she had lost 95 percent of the vision in her left eye. That news really threw Ebisemiju. Even her driver’s license indicates normal vision. “I can see straight ahead, but I can’t see,” she said. “That’s very shocking.” But she couldn’t see to the side.

Talk about being quirky. Though glaucoma is typically characterized by high pressure in the eye, about one third of those affl icted have normal pressure, according to the Balti-more Eye Study.

That’s why checking pressure in an eye exam tells only half the story, according to Dr. Douglas J. Rhee, an ophthal-mologist specializing in glaucoma at Massachusetts Eye and Ear Infi rmary. “The fi rst step should be the appearance of the optic nerve,” he said.

In glaucoma the optic nerve shows an indentation or cupping that results when the pressure is too high for the nerve to tolerate. Nerve damage is identifi ed through dilation of the pupil. A test called tonometry measures the pressure in the eye. Side vision is examined to check for blind spots that people may not even notice.

People should be aware of the risk factors of glaucoma said Rhee. “The biggest one is age,” he explained. Also, 40 percent of those affl icted have relatives with the same disease. Nearsightedness and high blood pressure are factors. So is race.

Petra, continued to page 4

Petra Ebisemiju says that although her driver’s li-cense indicates normal vision, an eye specialist told her she has lost 95 percent of the vision in her left eye due to glaucoma. (Ernesto Arroyo photo)

Still at risk - even with 20/20

GlaucomaEARLY DETECTION OF VISION LOSS KEY TO AVOIDING “THIEF OF SIGHT”

Every year millions of people start losing their sight…

AND DON’T EVEN KNOW IT!Don’t be one of them. Have a comprehensive dilated eye exam.

JANUARY IS NATIONAL GLAUCOMA AWARENESS MONTH

USING EYE DROPS

If your doctor prescribes eye drops, carefully follow instructions for using them. Glaucoma can worsen considerably if you skip days or use the drops or other medications incorrectly. Call your doctor with any questions or problems.

These tips from the Glaucoma Research Foundation may help, too.

• Wash your hands.• Sit, stand or lie down.• Tilt your head backward and gently pull down the skin below the eyelid.• Put one drop into the pocket formed without touching the dropper to your eye or skin. • Slowly release your lower lid and gently close your eye. No squinting or squeezing!• Lightly press the inner corner of your eye for two or three minutes to allow the drop to be absorbed. • Gently blot away excess.

What if your hands shake?Rest a part of the hand holding the dropper or bottle

against your face. Approaching your eye from the side may make this easier.

What if it’s hard to hold the bottle? Try winding a paper towel around the bottle to make

it bigger. Or ask your doctor about assistive devices to help you put in your eye drops.

For additional tips, check www.glaucoma.org/treatment/eyedrop-tips.php.

for cataracts) by age 80.A comprehensive dilated eye exam is the best way to

catch these often silent eye problems before they do too much damage. Ask your doctor or eye care professional how often to have this exam given your health, family history and age.

WHAT DAY-TO-DAY PROBLEMS CAN LOW VISION CAUSE?

Low vision affects independence and safety. Everyday tasks like reading, cooking and navigating beyond your front door becomes diffi cult. Driving may be unsafe. Simple acts like recognizing a loved one, reading a street sign or coordi-nating an outfi t may be impossible.

HOW CAN YOU COPE WITH LOW VISION?Lighting, glare and contrast affect low vision. These

tips from the Glaucoma Research Foundation and other experts can help.

• Turn it down. Ease glare with amber or dark yellow lenses and caps with visors. Try covering shiny surfaces with fabric.

• Turn it up. Add lighting where necessary, especially on stairways and in often-used areas like the kitchen, bathroom and closet. Aim for an even glow throughout a room, plus extra task lighting.

• Use contrasts. Try contrasting colors on placemat and plate, stair landings, chopping boards (white onion, dark board) and even furniture (dark chair against light wall). Put colored tape on stair edges and pot handles. Pour coffee into a white mug.

• Consider helpful products. Some examples are power-ful magnifi ers; devices and software to enlarge type, read text aloud and transcribe spoken words; large-button phones and remotes.

• Visit a low vision clinic. Rehabilitation specialists can help you decide on priorities, learn strategies for getting the most from your sight plus other senses and choose aids to help you accomplish tasks and enjoy life. Check with your health care plan or state services for visually impaired people.

Gray winter days can leave you longing for brightness. But if wintry dimness rarely seems to lift, it would be wise to consider your an-swers to these fi ve questions.

WHEN WEARING YOUR USUAL GLASSES OR CONTACT LENSES, IF ANY:

• Are you having trouble recognizing faces of friends and relatives?

• Is it hard to distinguish clothing colors when dressing? • Have close-up tasks like cooking, reading, sewing or

fi x-it work become trickier to manage due to your sight? • Do lights seem dimmer than in the past at work or

home? • Is it hard to pick out signs for streets, buses or stores?

A ‘yes’ response to any of the questions may be a sign of low vision. “If you notice problems like these, or other changes in your vision, it’s important to check with an eye care profes-sional,” said Dr. Jan Cook, medical director of Innovation & Leadership at Blue Cross Blue Shield of Massachusetts. “Correct diagnosis and treatment may be able to improve certain aspects of your eyesight and keep your vision from growing worse.”

WHAT IS LOW VISION?Impaired eyesight that can’t be corrected with glasses,

contacts, surgery or medicine is called low vision. It makes everyday tasks harder to do.

While many older people have low vision, it’s not a nor-mal part of aging. It stems from certain eye disorders.

WHICH EYE DISORDERS CAN LEAD TO LOW VISION?

Four common eye disorders that can lead to low vision are:• Age-related macular degeneration (AMD). The mac-

ula is a structure in the middle of the retina, the light-sensitive tissue at the back of the eye that turns images into signals shuttled to the brain through the optic nerve. AMD slowly destroys the sharp central vision vital to tasks like reading or driving and for clearly seeing any object. AMD may be wet (abnormal blood vessel growth damages the macula rapidly), or dry (light-sensitive cells in the macula break down slowly, causing a blurry spot in the center of your vision)

• Diabetic retinopathy. A major cause of adult blind-

ness, this complication of diabetes damages blood vessels in the retina. Gaining good control of blood sugar helps slow the onset, or progress, of this disorder.

• Glaucoma. Conditions causing increased pressure in the eye may harm the optic nerve, thus prompting partial or complete loss of vision. Lowering this pressure in various ways can slow or stop the progress of glaucoma. If you are over age 60 — or over age 40 and African American — or if you have certain illnesses or a family history of glau-

coma, you’re at higher risk. Having diabetes nearly doubles the normal risk for developing glaucoma, according to the National Eye Institute.

• Cataract. Clouding of the lens in the eye, which focuses light on the retina, causes blurred, dulled vision. Risk for cataracts is increased by diabetes, smoking, prolonged sun exposure, family history and eye injuries. Aging factors in, too. More than half of Americans have cataracts (or surgery

THE DAY-TO-DAY CHALLENGE OF LIVING WITH LOW VISION

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1. Is glaucoma pre-ventable?

No, but early detec-tion and treatment of glaucoma can help pre-vent irreversible blindness from this disease. There is good evidence showing that lowering eye pressure can help stop or slow progression of glaucoma. Eye pressure is currently the only modifi able risk factor for glaucoma, and eye pressure can be con-trolled with medications, laser or conventional surgery.

2. Why is the incidence more common in blacks and other

people of color?Epidemiological studies have shown that open angle glaucoma

— the most common form of glaucoma — occurs four to eight times more often in blacks than in whites. It also occurs at a younger age in blacks compared to whites. In addition, glaucoma is more common in Hispanics compared to whites, but less common than in blacks. However, the reason why it occurs more frequently in these popula-tions is still unknown.

3. Why does the risk increase with age?It is well known that older age is a known risk factor for glau-

coma, especially in persons over the age of 60. The reason for this in-creased risk is likely multi-factorial. There are a number of structural and physiological changes that occur within the aging eye that can predispose older persons to glaucoma.

4. Can a person with glaucoma do something to improve his or her sight?

That depends. Patients with glaucoma can also have other eye conditions such as cataracts that cause poor vision. Poor vision from cataracts can be improved with glasses or surgery. However, vision loss resulting from glaucoma is irreversible, and early detection and treatment are critical in preventing blindness from this disease. Persons with glaucoma often have poor peripheral vision and contrast sensitivity, the ability to distinguish objects from similarly colored or shaded backgrounds. Vision rehabilitation specialists can offer mobil-ity training and optical aids that assist persons with glaucoma perform their daily activities.

5. Why does being nearsighted increase the risk for glaucoma?More evidence now shows that nearsightedness, or myopia, is

a risk factor for glaucoma, especially for persons with a moderate to high degree of myopia. People with signifi cant nearsightedness often have longer eyes and other structural features of their eyes that can make the optic nerve more susceptible to damage that can result in glaucoma.

6. When glaucoma runs in a family, does it strike at a younger age?Glaucoma can occur at a younger age in patients who have a

strong family history of the disease. In a small subset of patients, there are known gene mutations associated with glaucoma that manifests in young adulthood. In general, individuals with a parent or sibling with known glaucoma are at a signifi cantly higher risk for having the disease and should be screened for glaucoma.

7. How often should people have their eyes examined to check for glaucoma?

An annual eye exam which includes dilation of the pupil is usually suffi cient to screen those without a diagnosis of glaucoma, but have a family history or other risk factors for the disease. Patients already diagnosed with glaucoma are seen on a regular basis, usually every 3-6 months, to monitor eye pressure and vision.

8. Why is pupil dilation recommended during an eye exam?Pupil dilation during an eye exam allows for a complete evalu-

ation of the lens, retina and optic nerve — the parts of the eye that allow us to see images. A thorough examination of the eyes enables eye doctors to diagnose and monitor common eye diseases such as cataracts, glaucoma, macular degeneration and diabetic retinopathy. Detection and treatment for these diseases can help prevent blindness.

9. Is it possible for a person with glaucoma to have 20/20 vision?Yes. Visual acuity is a measure of how well a person can see at

various distances. A person with glaucoma can have 20/20 vision be-cause glaucoma typically affects peripheral vision before it affects the central vision used to read. Most patients therefore do not realize they have glaucoma until the disease is in its advanced stages. Formal visual fi eld testing, which evaluates peripheral or side vision, can identify the degree of vision loss to glaucoma even if central vision is intact. Patients who have lost a signifi cant portion of their peripheral vision to glaucoma can have diffi culty with night driving and mobility.

Angela V. Turalba, M.D.Glaucoma ServiceMassachusetts Eye and Ear Infi rmary

Questions & Answers

The information presented in BE HEALTHY is for educational purposes only, and is not intended to take the place of consultation with your private physician. We recommend that you take advantage of screenings appropriate to your age, sex, and risk factors and make timely visits to your primary care physician.

A CL

OSER

LOOK

Fluid that nourishes the eye drains through a spongy meshwork where the cornea and iris meet. In glaucoma, the fl uid passes too slowly causing an increase in eye pressure. If left untreated, the pressure can damage the optic nerve and result in vision loss.

ARE YOU AT RISK FOR GLAUCOMA? ACTUALLY, EVERYONE IS, BUT SOME GROUPS ARE AT HIGHER RISK THAN OTHERS.

• African Americans and Hispanics

• People over age 60

• Those who have family members with glaucoma

• People who are very nearsighted

• Those who have sustained eye injuries,

particularly blunt trauma

• People with thin central cornea (the front part

of the eye)

• Those on prolonged high doses of

corticosteroids

• People with certain medical conditions, such

as high blood pressure

Image courtesy of Medicine Health Department

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A more severe form is acute closed-angle glaucoma. It results from a sudden and complete blockage causing severe eye pain, blurred vision, headaches and nausea. This form of glaucoma is a medical emergency and requires immediate treatment.

The most common form of glaucoma — primary open-angle glaucoma — is frequently referred to as the silent thief of sight. In Demetri’s case, even the doctor was surprised. “The doctor didn’t want to believe it,” Demetri said. “You’re too young.” A second opinion, however, confi rmed the initial diagnosis.

Demetri’s reaction was one of disbelief as well. “I was surprised,” he said. “I didn’t know it existed.”

Demetri had a long haul ahead of him. The eye drops he was prescribed worked — but not well enough. He said that his pressure dropped but not to the levels that doctors were hoping. Two years ago he had laser surgery to open up the drainage in his right eye.

So far so good. The surgery combined with three types of eye drops he takes daily is keeping his pressure in check despite some minor side effects. “Sometimes the medicine stings,” he said. “And my eyes are always red.”

He admitted it took some doing to master the eye drops. “You have to be careful that the nozzle does not touch the eye,” he explained. And you have to tilt your head back just right. Air bubbles, he said, can be deceiving. They feel wet, but contain air instead of medicine.

Demetri perfected his technique by practicing with his grandmother. She also has glaucoma and was caught by surprise as well. Nancy Beckford, 54, was playing around with a friend some years back. They were singing along with the Hall and Oates song “Private Eyes.” As she sang “we’re watching you,” Beckford playfully closed her left eye

to simulate a watchful eye. “It was blurry around the edges of my

vision,” she said, describing impaired periph-eral vision. “It wasn’t clear.” An eye exam confi rmed the diagnosis.

Though it is not possible to prevent glaucoma, the disease can be detected early before it causes serious damage. A com-prehensive eye exam does the trick. The American Academy of Ophthalmology rec-ommends that at age 40 adults with no signs or risk factors for eye disease should have a comprehensive baseline screening. But Rhee is quick to point out that people of high risk

— especially blacks and those with a family history — should start earlier. Intervals for follow-up examinations will be based on the fi ndings. Usually exams are recommended every one or two years.

Timing is the key. Vision lost from glau-coma cannot be regained.

Demetri has not escaped the disease unscathed. He has lost some peripheral as well as central vision in his right eye, but his left eye compensates.

According to Demetri, his condition hasn’t slowed him down. Nor has it forced him to change his study of interest. Despite his impaired vision, he’s a freshman at Mas-sachusetts College of Arts and Design with an interest in industrial design.

“You get used to it,” he said.

Demetri, continued from page 1

It may not be possible to prevent glaucoma, but it is easy to diagnose and treat. The American Academy of Ophthalmology recommends — begin-ning at age 40 — having eye exams every one to two years. Those with increased risk should begin earlier.

A COMPREHENSIVE EYE EXAMINATION INCLUDES:

• DilationDrops are placed in

the eyes to dilate, or

widen the pupils to

look for signs of dam-

age to the retina and

optic nerve.

• TonometryA test that measures

eye pressure. Numb-

ing drops may be

applied. (See below)

• Visual fi eld testMeasures your side or

peripheral vision. Loss

of side vision is the fi rst

sign of glaucoma.

• Visual acuity testAn eye chart mea-

sures how well you see

at various distances.

People can have good

acuity, but still have

glaucoma.

THE BEST ATTACK AGAINST GLAUCOMA

LIKE LOOKING THROUGH A TUNNEL

Glaucoma initially affects peripheral or side vision, but can impair tunnel vision if left untreated. Vision lost from glaucoma cannot be regained.

SUPPORT GROUP MEETINGDATE: Saturday, February 4th TIME: 10 a.m. LOCATION: Mass Eye and Ear Infi rmary243 Charles Street, Boston8th fl oor board room

Please RSVP Catherine Duffek 617-797-6476

Comments on Be Healthy? Contact Health Editor Karen Miller at kmiller@bannerpub.com.

“People of African descent and Hispanics are high risk,” Rhee said. Though glaucoma is the second cause of preventable blindness in this country, it is the primary cause of blindness in blacks. And in the world, for that matter. The reasons for this disparity are unknown.

But there is hope. “We have good treat-ment,” Rhee said. And the treatments — medi-cine, laser surgery and incisional surgery — all work well. The type and timing of each depends on the individual’s condition. Most of the time the fi rst line of attack is medicine, but for some, surgery is the fi rst step.

It is important to distinguish between visu-al acuity and glaucoma, as Ebisemiju quickly learned. Being nearsighted or farsighted is not the same as glaucoma. A person can have 20/20 vision. They can see clearly an object that is 20 feet away, but still have reduced periph-eral and tunnel vision and optic nerve damage.

A person can be prescribed glasses or contact lenses to improve acuity, but that prescription will not improve one’s glaucoma. “Likewise, If you need glasses, that doesn’t mean that your eyes are unhealthy,” Rhee said.

As the baby boomers age, they will undoubtedly cause an increase in the inci-dence of glaucoma. In response the Glau-coma Foundation teamed with the Alliance for Aging Research and Merck to develop TAKE (Take Action to Know your Eyes) on Glaucoma to teach consumers about the risk of glaucoma, the necessity of comprehensive eye exams, including dilation and proper management if diagnosed.

No one needs to tell Bishop John M. Borders, III, the senior pastor at Morningstar Baptist Church, about eye examinations. He is on a personal mission to save his eyesight. His problems started during childhood.

“I was hit in the eye during a rock fi ght when I was a little boy,” he explained.

What Borders did not know at the time is that blunt trauma to the eye can cause glaucoma immediately or years later. The trauma, which can result in an accumulation of blood and debris, clogs the drainage canals

of the eye.Traumatic glaucoma has halted many a

sports career. Kirby Puckett of the Minnesota Twins had his career cut short after being hit in the eye with a baseball.

Years after the accident, headaches and pain in the eye led Borders to have an eye examination. He did not have an easy time of it. His eye pressure could not be well maintained with eye drops.

“The pressure would go down and get back up,” he said. Since the medication was not working well, he had laser surgery, but that was not the answer either.

He had to undergo several surgeries as

well as procedures to break up scarring that resulted from the surgeries. The development of cataracts further complicated his recovery.

But a miracle was in the works. After multiple surgeries and follow-up treatment, Border’s eye pressure has remained normal — and without the benefi t of eye drops. He goes back every six months for a check up. The only tell-tale sign of his condition is a drooping eyelid.

“It’s a miracle that I can see,” said Borders.Ebisemiju must take three different types

of eye drops daily. She had surgery to improve the drainage in her left eye. Now the pressure in her right eye is slowly increasing, but her hope is that medications will stabilize it.

In spite of everything, the glaucoma has not changed her lifestyle except for one thing — driving. People passing from behind on her left are particularly troublesome. “When you fi nally see them, they’re right there,” she explained. “That’s scary.”

She has given up on driving at night. “It’s hard to read the signs,” she said.

Petra, continued from page 1

Douglas J. Rhee, M.D.Glaucoma SpecialistMassachusetts Eye and Ear Infi rmary

Bishop John M. Borders, IIISenior PastorMorning Star Baptist Church

Photos courtesy of National Eye Institute

Photo courtesy of the National Eye Institute

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