Did you know?

• Two thirds of blindness and visual impairment occurs in women
• Three quarters of visual impairment is estimated to be preventable or correctable
• In the US, there are estimated to be over 1 million legally blind people, including over 700,000 women.
• Over 3.4 million Americans suffering from visual impairment, about 2.3 million are women.

Don’t wait for a problem to arise before you have your eyes examined. Studies show that of the common eye diseases, dry eye syndrome, autoimmune diseases, cataracts, and macular degeneration are intrinsically more prevalent in women than in men.

Dry Eyes and Women

Some people do not have enough tears on the surface of their eye to lubricate the eye and keep it comfortable; this is known as dry eye syndrome. It is a common complaint among middle-aged and older adults, especially women, and can be a cause of great discomfort and frustration to its sufferers. Dry eye is one of the leading causes of visits to eye care professionals.

Technically, dry eye syndrome is a group of disorders of the tear film due to insufficient tear production or excessive tear-film evaporation. This can cause irritation and damage to the ocular surface, especially the cornea (the clear, dome shaped tissue covering the iris and pupil), the conjunctiva, and the eyelids. The tear film is spread over the eye by blinking, and makes the surface of the eye smooth and clear. The film consists of three layers: An oily layer, produced by the Meibomian glands, forms the outermost surface; this reduces evaporation of the tears. The middle, watery (aqueous) layer makes up most of the film; it is produced by the lacrimal glands, and cleanses the eye by washing away foreign particles and irritants. The inner layer consists of mucus produced by the conjunctiva; it helps the tears adhere to the eye.

There is no single cause of dry eye. Deficiencies can occur in any of the components of the tear film layers covering the front surface of eye, due to defects in any of the glands synthesizing tear components (collectively called the lacrimal system). Meibomian gland dysfunction is a major factor. There appears to be an inflammatory component to dry eye syndrome.

The condition causes lots of suffering and a diminished quality of life. It can also impair functional visual acuity, leading to a decreased ability to read and to drive, especially at night. Furthermore, it increases the risk of eye infection.

Severe dry eye is sometimes caused by Sjögren’s syndrome, which is a chronic, multi-organ autoimmune disorder that also results in dry mouth and often arthritis. There are fewer than one million Sjögren’s syndrome cases in the US, but their symptoms are very serious, and the health of their eyes is at risk.

Who is at risk for dry eye?
The condition is extremely common in people over age 55 of both sexes. However, it is intrinsically two to three times more common in women than in men at any age - probably an effect of hormones.

It is estimated that 10 to 15 percent of middle-aged and older Americans feel some symptoms of dry eye; that means over 20 million people.

Why are women so much more susceptible to dry eye?
Research is showing that androgens (male hormones) are good for lacrimal and Meibomian gland structure and function. Men have a greater supply of these hormones throughout life, although the levels decrease in both sexes as people get older. Menopause itself, or lack of estrogen, does not appear to be a factor in the greater prevalence of dry eye in older women. In fact, recent research shows that hormone-replacement therapy makes dry eye worse, not better, and that taking estrogen increases the risk of having the condition by 70 percent.

Refractive surgery (such as LASIK) can cause dry eye in some people. Contact lenses often make symptoms worse, and dry eye sufferers usually have more difficulty wearing contacts. The condition is also more common in people with allergies. A wide variety of common medications (both prescription and over-the-counter) can reduce tear secretion and cause dry eye; this list includes some diuretics, beta-blockers, antihistamines, sleeping pills, anti-anxiety drugs, and pain relievers. Be sure to tell your eye care professional if you are taking any of these medicines.

What treatments are available for dry eye?
Artificial tears are the mainstay of treatment. Artificial tear solutions and ointments give some temporary relief, but do little to arrest or reverse any damaging conditions. Many brands are available. The preservatives in some eye drops can irritate the eye; preservative-free artificial tears may be required. Some new artificial tear solutions are formulated to normalize the electrolyte balance while lubricating the ocular surface; these should help to minimize irritation. Anti-inflammatory agents can help combat the inflammation associated with dry eye. Topical steroids are appropriate for short-term use, but can cause serious side effects when they are used for a long time. Discuss your situation with Dr. Keriotis to determine what treatment options are best for your situation.

Punctal Plugs

Tears constantly drain out of the eye, through a small channel (the punctum), into the nose. Dr. Keriotis may decide to close these channels either temporarily or permanently to keep tears on the surface of the eye. For some forms of dry eye, tiny plugs in these channels (a procedure called punctal occlusion) can boost tears by slowing the rate of drainage from the eye.

If an older person has already been diagnosed with dry eye, Medicare will pay for future visits to the eye doctor.

Autoimmune Diseases and Women

What are they?
The autoimmune diseases (also called rheumatoid diseases) are chronic, systemic illnesses that affect the whole body. They result from an attack by the patient’s immune system upon some parts of his or her own body. These diseases cause a lot of inflammation and destruction of cells in the tissues they attack.

Some of the more-prevalent autoimmune diseases—rheumatoid arthritis, Sjögren’s Syndrome, systemic lupus erythematosus, and multiple sclerosis—are associated with serious eye symptoms. Most of the autoimmune diseases are gender-associated and are usually much more common in women. For example, of the million or so Sjögren’s sufferers in the U.S., 90% are women.

What are Some of the Eye Symptoms of Autoimmune diseases?
Sjögren’s syndrome is the autoimmune disease that causes the most eye-related problems. Patients suffer from very severe dry eye syndrome because the immune system destroys the glands that produce the tear film that lubricates the surface of the eye.

All of the autoimmune diseases listed above (multiple sclerosis (MS), lupus, rheumatoid arthritis, and Sjögren’s) can be associated with optic nerve inflammation (optic neuritis), vasculitis in the eye, uveitis, and retinopathy. In fact, the first symptom of MS is often temporary blurring or loss of vision, usually in one eye. These symptoms are due to the inflammation caused by these diseases.

Age Related Macular Degeneration (AMD) & Women

Who is at risk for AMD?
The greatest risk factor is older age; people over age 60 are at much greater risk than other age groups: although the chance of having AMD is only one percent at age 55-64, this prevalence rises to four percent for those over 65, and 30% of the American population over age 75. The US population over 65 is expected to double in the next 30 years, so AMD will become even more of a problem as the baby-boomer generation ages.

Because women on average live longer than men, women are twice as likely as men to develop the condition. The lifetime risk for getting AMD is 6% for females and only 3% for males. Therefore, women need to be more aware of AMD, and older women should be sure to visit an ophthalmologist or optometrist at least every other year.

After increasing age, smoking is the strongest predictor of who will get AMD; this habit can double the risk of the disease. Family history is also important; people whose immediate family members (including grandparents) had AMD are at higher risk of developing the disease. Scientists are trying to find out which genes are responsible for this hereditary component.