Effective treatment of eye diseases prevents visual impairment, but lack of resources may compromise progress
Vision is perhaps the most important of the human senses. When visual acuity deteriorates, it significantly affects a person’s independent movement, functional ability and daily activities.
Hannu Uusitalo, Professor Emeritus of Ophthalmology at Tampere University, notes that visual function is one of the most important factors influencing quality of life.
“Research shows that a drop of two lines in visual acuity has a greater negative impact on quality of life than, for example, the onset of a new cardiovascular disease during a follow-up period,” he explains.
Deteriorating vision places a burden not only on individuals but also on society. Poor vision increases the risk of falls, accidents and injuries, which in turn raises the need for costly hospitalisation. Declining eyesight also increases the risk of unemployment and inability to work.
According to research conducted at Tampere University, impaired vision generates additional annual costs to society of up to three billion euros. Only 1.9 per cent of these costs arise directly from the treatment of eye diseases.
“People often ask whether we can afford to treat these conditions. But when you look at these figures, the real question is whether we can afford to leave them untreated,” Uusitalo points out.
Risk of visual impairment has declined
The good news is that the average visual acuity of Finns has improved significantly since 2000. At the same time, the risk of visual impairment has decreased and shifted to older age groups.
The main reason behind this positive development is that eye diseases affecting vision can now be identified and treated more effectively than before.
“The clearest positive change has been seen among people with diabetes. Although diabetes is a common chronic disease that is becoming more prevalent and is being diagnosed at increasingly younger ages, diabetic retinopathy is nevertheless less common than before and far less likely to lead to visual impairment,” Uusitalo explains.
Diabetic retinopathy is a retinal disease that can be prevented through effective diabetes management. According to Uusitalo, earlier diagnosis of diabetes and advances in drug therapies have reduced the risk of retinopathy. Regular retinal screening is also provided to all diabetes patients, resulting in improved diagnosis and treatment.
Another eye disease whose treatment has advanced significantly in recent years is age-related macular degeneration (AMD). As its name suggests, AMD is an age-related condition in which the retina gradually deteriorates. In the wet form of AMD, new and fragile blood vessels develop beneath the retina. These vessels leak fluid, causing swelling in the macula and damaging central vision.
Since the 2000s, new injectable medicines have become available for wet age-related macular degeneration (AMD). These drugs are administered directly into the eye and work by inhibiting the growth of abnormal new blood vessels.
“Although treatment does not always prevent visual impairment from developing, it can delay it significantly. As patients are generally older, treatment enables most of them to retain sufficiently good vision for the rest of their lives,” says Uusitalo.
Has treatment been scaled back too much?
One cause for concern also emerges from the statistics. Data from the Finnish Register of Visual Impairment shows that the proportion of visual impairment caused by glaucoma has increased in recent years. In 2024, as many as 14.5 per cent of new registrations were due to glaucoma, compared with around six per cent at the beginning of the 2000s.
“It appears that visual impairment caused by glaucoma has started to rise again over the past few years. Our research group is currently investigating this phenomenon and its possible causes in more detail,” says Uusitalo.
Glaucoma is a disease that damages the optic nerve and is treated with laser therapy, and eye drops that lower intraocular pressure. With timely and good treatment, vision loss caused by glaucoma can usually be prevented.
“Ophthalmology outpatient clinics are facing resource shortages, and treatment intervals seem to have been extended quite considerably. It may be that treatment and follow-up appointments are now being offered too infrequently,” Uusitalo says.
Glaucoma, like other eye diseases that affect vision, can remain asymptomatic for a long time, which is why it is important that everyone in middle age and beyond undergo regular eye examinations and vision checks.
For example, injections for wet AMD should be started as soon as possible after the disease develops. If the condition progresses to the point where scar tissue forms in the retina, treatment will no longer be effective. The same principle applies to glaucoma and many other eye diseases.
See an ophthalmologist at the latest when presbyopia develops
According to Uusitalo, people should book an appointment with an ophthalmologist no later than the stage when age-related long-sightedness (presbyopia) makes reading glasses or varifocals necessary. On average, this occurs at around the age of 45.
“At the first appointment, it would be sensible to discuss the individual's risk of eye disease and determine when the next examination should take place. If there is a family history of inherited eye conditions such as glaucoma or macular degeneration, examinations should be carried out more frequently,” Uusitalo points out.
It is also advisable to seek assessment and treatment if you notice changes in your vision. If your eyesight is no longer as sharp as it used to be, the dots above letters seem to disappear, bright light becomes uncomfortably dazzling, or you find it harder to see in dim conditions, these may be signs of an eye disease in its early stages.
“Quite often the cause is cataract, which can be treated with a straightforward operation. However, the underlying problem may sometimes be a more serious progressive eye disease that requires treatment,” Uusitalo says.
The Amsler grid, which can be used at home to detect wet AMD, is available, for example, on the Terveyskylä website.
The black dot in the centre of the grid is viewed by each eye in turn. Wet AMD may be indicated if the lines appear bent or distorted. In that case, you should seek medical attention without delay.
Look after your eyesight
- Eat a healthy diet, take regular exercise and get enough sleep. Regular health advice also applies to maintaining eye health.
- Manage cardiovascular risk factors carefully. High blood sugar, hypertension and elevated blood lipid levels all pose a threat to eye health as well.
- Have your eyes and vision checked regularly. You should consult an ophthalmologist no later than when presbyopia begins to cause problems, typically at around the age of 45.
- Smoking substantially increases the risk of eye diseases and deteriorating vision. In particular, people with a family history of macular degeneration should avoid smoking. When combined with genetic susceptibility to macular degeneration, smoking can raise the risk of developing the disease to almost 100 per cent.
- There is no need to avoid using your eyes, and keen readers, for example, do not need to cut back on reading for health reasons. However, people who work at computer screens should give their eyes a rest from time to time and spend a moment looking into the distance.
Author: Virpi Ekholm
