VA researchers recently published two studies showing that the rate of eye disease may be increasing in the VA system, and that Veterans with serious mental illness have a higher rate of eye diseases than other Veterans.
The research team at the VA Capitol Health Care Network Mental Illness Research, Education and Clinical Center and the University of Maryland School of Medicine believe these studies highlight important trends among Veteran patients. Vision Research Month, observed during June, is an appropriate time to focus on these health issues.
The first study, published in the November–December 2016 issue of General Hospital Psychiatry, showed that VA patients with serious mental illness have an even higher rate of dry eye, cataract and glaucoma than the general Veteran population. Both glaucoma and cataract are leading causes of blindness worldwide.
The second study, published in the January 2017 edition of the American Journal of Ophthalmology, found that the rate of eye disease, specifically glaucoma and cataract, increased in the VA Capitol Health Care Network from 2007 to 2011. (The study did not include data from later time points.) The increases were seen mainly in the 50–65 and over-65 age groups.
Glaucoma is a leading cause of irreversible blindness worldwide. Patients can have the disease for years without knowing it, but once the patient notices the disease, it is often too late. Glaucoma causes damage to the optic nerve, the nerve that carries the information from the eyeball to the brain. It is generally a very slow disease, taking years or even decades to cause noticeable changes in vision. People at higher risk for the disease include those older than 55, individuals of African American or Hispanic origin, and those with a family history of the disease. Because there are no symptoms of the disease early on, eye screening is needed to detect it. However, if the disease is caught early, treatment can prevent vision loss. Treatment for the disease includes eye drops, laser treatment, or in more advanced cases, eye surgery. Those who are at higher risk for the disease should consider regular screening.
Cataract is another leading cause of vision loss. A cataract happens when the lens of the eye becomes cloudy over time. This happens in all individuals with aging, and it is estimated that half of all people age 80 or older will have had cataract surgery or need cataract surgery.
Patients with cataract will notice blurriness of vision at distance, or glare that may be most bothersome when driving at night. Patients with diabetes or those on long-term steroids for medical conditions may develop cataracts earlier in life. Cataracts can be removed with a relatively simple surgery that often takes 20 minutes or less.
VA patients, particularly those above the age of 55 and those in high-risk groups, should consider getting their eyes examined to screen for major eye diseases such as cataract and glaucoma to prevent vision loss. We hope our work raises awareness of the growing need for eye care in the VA system, particularly among high-risk groups as well as those with serious mental illness. If the rate of eye disease continues to increase with the aging Veteran population, more resources may need to be allocated towards eye care. In addition to more clinic capacity, greater availability and facilities for cataract surgery should also be addressed.
Osamah Saeedi, M.D., is an associate professor of ophthalmology at the University of Maryland School of Medicine in Baltimore. Dr. Saeedi completed medical school and an ophthalmology residency at the University of Texas – Southwestern Medical Center, and a glaucoma fellowship at the Wilmer Eye Institute, Johns Hopkins University. He is the recipient of an NIH Career Development Award and has grant funding from numerous other organizations, including the American Glaucoma Society.
Julie Kreyenbuhl, Pharm.D., Ph.D., is associate director of the Research Core for the VA Capitol Health Care Network Mental Illness Research, Education and Clinical Center, and an associate professor within the University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research. Her research focus is on the pharmacoepidemiology of serious mental illness, and she has contributed extensively to the development of evidence-based treatment guidelines for schizophrenia. Dr. Kreyenbuhl has received funding for her research from VA, the National Institutes of Health, and private foundations, and has authored or co-authored over 85 publications in peer-reviewed scientific journals.