It’s natural to worry about losing your vision.
After all, three of the leading causes of blindness in the U.S.—cataracts, glaucoma, and age-related macular degeneration—all become more common as we age.
But some drug, supplement, and lens makers, and even some doctors, take advantage of that fear, recommending treatments that are expensive, unnecessary, and even risky.
Here’s what you need to know.
The only way to cure cataracts—a clouding of the lens of the eye that impairs vision—is with surgery to replace the bad lens with an artificial one.
Though the procedure is very safe and effective, some doctors recommend needless tests or push newer types of lenses that pose risks.
Skip unneeded presurgery tests. Cataract surgery, usually performed as an outpatient procedure, requires only a local anesthetic to numb your eye.
Research shows that for most people the only pre-op requirements are that you be free of infection and have normal blood pressure and heart rate. Yet many doctors routinely order other tests, including blood counts and electrocardiograms, as would be necessary before a major procedure. That’s overkill, according to the American Academy of Ophthalmology.
Those tests can come with high co-pays and lead to false alarms that may delay surgery or force you to undergo additional tests, such as a chest X-ray or an ultrasound. So ask whether your doctor plans to recommend such tests and, if so, whether you can skip them.
Be wary of premium lenses. In standard cataract surgery, doctors remove the clouded lens and replace it with an artificial monofocal lens, which provides clear images at either near or far vision. There are multifocal lenses that do both, so you don’t also have to wear glasses.
But multifocal lenses cost up to $4,000—and usually aren’t covered by insurance. More worrisome, a 2012 review found that while the lenses provided better near vision, they also produced more complaints of halos and glare. Other research shows that people with multifocal lenses are also more likely to need repeat surgery.
One time you might consider a premium intraocular lens: if you have an astigmatism, or an irregularly shaped cornea.
Special lenses, called toric lenses, can correct that problem, says David Sholiton, M.D., an ophthalmologist at the Cleveland Clinic. And studies reveal that most people who get them are satisfied. But you will probably have to pay $1,000 or more out of your own pocket because insurance rarely covers them.
More than 2.2 million Americans have glaucoma, but only half know it. That makes screening important.
Treatment is key, too, because glaucoma can lead to permanent vision loss. But treatment, which often requires several different daily eye drops, can be expensive and complicated.
Get the right tests. Glaucoma often goes undiagnosed because it causes no symptoms until vision declines, at which point treatment no longer helps. So people ages 40 to 60 should consider being examined by an ophthalmologist or optometrist every three to five years; those older than 60 need an eye exam every one to two years.
Know you may need more than one test. Though many eye doctors screen for the disease with tonometry—a test that measures eye pressure—that’s not enough. Relying only on intraocular pressure when screening for glaucoma could miss up to half of all cases, research suggests, says ophthalmologist Andrew Iwach, M.D., executive director of the Glaucoma Center of San Francisco.
So the exam should also include an ophthalmoscopy, which involves examining your optic nerve. If you have elevated eye pressure but no other signs of glaucoma, you might not need to start treatment, which can be expensive. Instead, your doctor might screen you more often.
Go for generics. The most common treatment for glaucoma is eye drops known as prostaglandin analogs (PGAs), which lower eye pressure. Generic versions of most of those drugs are much cheaper than the brand-name versions. And perhaps because of the lower cost, patients taking them tend to do a better job of using the drops on schedule, which is important, according to an April 2015 study in the journal Ophthalmology.
Know you may need more than one drug. Many people need several drugs to control glaucoma, which usually means adding a beta-blocker drop. In that case, ask your doctor about drugs that combine medications, minimizing the number of drops.
Use proper eye drop technique. Tilt your head back and pull down the lower lid with your finger to form a pocket. Hold the dropper tip close to the eye without touching it, and squeeze one drop into the pocket. Close your eye for 2 to 3 minutes, tip your head down, and gently press on the inner corner of the eye. Try not to blink. If you need more than one drop in the same eye, wait at least 5 minutes between drops to let the first drop absorb.
Age-related macular degeneration, a leading cause of vision loss in the U.S. for people 50 and older, damages the macula, the small area near the center of your retina, causing vision loss in the center of your visual field.
The advanced disease comes in two main forms: dry AMD, the more common variety, which is treated mainly with dietary supplements; and wet AMD, the more serious form, which requires monthly injections from an ophthalmologist with one of three drugs. There are controversies about both the supplements and the drugs.
Get the right supplement. Research funded by the National Institutes of Health has shown that a specific blend of vitamins and minerals known as AREDS (vitamins C and E, plus copper, lutein, zeaxanthin, and zinc) cuts the risk—by about 25 percent—that dry AMD will progress.
“It’s really the only treatment,” says Neil Bressler, M.D., chief of the retina division at Johns Hopkins University in Baltimore.
But not all eye supplements contain the proper formulation.
In January 2015, CVS was sued for incorrectly marketing its Advanced Eye Health supplement as comparable to the formula used in published studies. And in an analysis of 11 eye-health supplements in the March 2015 issue of Ophthalmology, only four contained the right mix: PreserVision Eye Vitamin AREDS Formula, PreserVision Eye Vitamin Lutein Formula, PreserVision AREDS2 Formula, and ICAPS AREDS.
Be wary if your doctor suggests a genetic test to determine which supplement is best for you. Remember: The supplements have been shown to help treat only people diagnosed with AMD. Don’t bother taking any supplement with the hope that it will prevent the disease.
Consider inexpensive drugs. Each of the three drugs used to treat wet AMD—aflibercept (Eylea), bevacizumab (Avastin), and ranibizumab (Lucentis)—work equally well in slowing vision loss.
But Avastin costs just $50 per month, compared with $2,000 for the others. So experts recommend Avastin as the first choice for most people with wet AMD. But some doctors resist that advice.
First, Avastin is officially approved only as a cancer drug and doesn’t come in appropriate doses for AMD. So doctors need to get the medicine from a compounding pharmacy, which combines, alters, or—in this case—repackages ingredients. That poses some risk of contamination, and there have been reports of people being harmed by bacteria that got into Avastin. So some doctors, especially those without access to a reliable compounding pharmacy, may hesitate to prescribe the drug.
Some other physicians may have a financial reason for skipping Avastin: Medicare reimburses doctors less for it. That might help your doctor’s wallet, but it can hurt yours: People without supplemental Medicare may pay up to $400 out of pocket for Lucentis, compared with just $10 for Avastin.
Our advice: Consider Avastin, especially if you don’t have supplemental Medicare coverage. But ask whether your doctor’s compounding pharmacy is accredited by the Pharmacy Compounding Accreditation Board, which means it must adhere to quality standards.