July 2005

Age-related macular degeneration is the leading cause of irreversible legal blindness in the elderly. Although nothing can reverse the associated vision loss, treatments are available that can slow the rate of progression of this condition. These options include supplemental high-dose vitamin therapy, diet and lifestyle changes, laser photocoagulation, photodynamic therapy, and intravitreal injection of anti-angiogenic medications. Early diagnosis and initiation of appropriate treatment are critical.

Glaucoma is a leading cause of blindness in the United States. The 2 main types of glaucoma are open-angle and narrow-angle. Glaucoma damages the optic nerve, typically resulting in loss of peripheral vision, which eventually progresses to involve the central visual field. Because patients with glaucoma are usually asymptomatic, primary care physicians can play a vital role in recognizing this silent cause of blindness. The goal of treatment, which consists of eye drops, laser trabeculoplasty, or surgery, is to lower intraocular pressure. Eye drops are effective but can have local as well as systemic side effects. Early recognition in the primary care setting and timely referral to ophthalmologists can prevent permanent vision loss.

The red eye is the most common ocular disorder seen by primary care physicians and ophthalmologists. Often benign and self-limiting, some diseases associated with a red eye can nevertheless threaten eyesight or even life. Disorders that cause rapid blindness include infectious corneal ulcers, angle-closure glaucoma, traumatic or postoperative endophthalmitis, hyperacute gonococcal conjunctivitis, chemical injuries, and ocular trauma. The many clinical images accompanying the conditions discussed will enhance recognition of the important symptoms and signs of each disease, enabling the primary care physician to appropriately manage the patient with a red eye and refer urgent cases to an ophthalmologist.