Glaucoma

More than 3 million people in the US have glaucoma.  That number is projected to grow to over 4 million by 2030.  Glaucoma is a leading cause of blindness in the US.  Let's talk more about glaucoma today; what it is and what you can do about it.

What is glaucoma?

Glaucoma refers to a group of eye diseases that cause increased pressure inside the eye.  Here are some facts about glaucoma:

• Glaucoma can cause blindness if left untreated.
• It is sometimes called "the sneak thief of sight" because it does not cause symptoms until sight is already lost and a person can lose as much as 40% of vision before they even notice it.  
• Once vision is lost due to glaucoma, it is permanently lost.
• Experts estimate that about half of people with glaucoma don't know they have it.
• In the US, about 120,000 people are blind from glaucoma.  The World Health Organization (WHO) estimates 4.5 million people worldwide are blind due to glaucoma.

What are the different types of glaucoma?

• Primary open-angle glaucoma - This is the most common form of glaucoma, accounting for at least 90% of cases.  Pressure inside the eye builds up slowly over time and is a lifelong condition.  
• Angle closure glaucoma (also called narrow angle glaucoma) - This is much less common.  It happens when the drainage canals of the eye are abnormally narrow, and they get blocked or covered suddenly.  This can cause acute build up of pressure in the eye.
• Congenital glaucoma - This is a rare condition that occurs in babies due to abnormal development of the drainage canals of the eye.  It can sometimes be corrected with microsurgery.
• Secondary glaucoma - This refers to glaucoma that is secondary to another medical problem.  For instance, glaucoma can develop as a result of trauma to the eye, or inflammatory conditions of the eye.  

Who is at risk for glaucoma?

Anyone can develop glaucoma at any age.  For open-angle glaucoma, the most common type, there are some groups of people at higher risk.  They include:

• African Americans - Glaucoma is 6-8 times more common in people of African descent.  It can also start at a much younger age in this group.
• People over 60
• Family history of glaucoma 
• Hispanics in older age groups

What are the symptoms of glaucoma?

With open-angle glaucoma, there are virtually no symptoms to warn you that you have it.  It does not cause pain or any other symptoms until it starts causing vision loss.  Vision loss usually starts in your peripheral vision, which is often not noticed initially.  You often unconsciously turn your head to compensate for peripheral vision loss without even realizing it.

Can glaucoma be cured?

There is no cure for glaucoma.  It is a lifelong condition but it can be treated and controlled. 

How is glaucoma treated?

Glaucoma is usually treated with eye drops, which reduce the pressure inside the eye.  Sometimes surgery is needed, particularly for angle-closure glaucoma or congenital glaucoma.  Surgery is also indicated if eye drops are not controlling eye pressure well enough.

Because glaucoma is chronic and not curable, it must be monitored and treated for life.

How does glaucoma cause vision loss?

The eye contains millions of nerve fibers that run from the retina on the back inside surface of the eye.  They all come together in the center of the retina at the optic disc where they meet the optic nerve.  These nerve fibers are very sensitive and are damaged by high pressure within the eye, resulting in loss of vision.

What can you do to protect your vision from the effects of glaucoma?

It is important to have regular eye exams.  Your eye doctor will check your eye pressures on each visit to screen for glaucoma.  If you have glaucoma, treatment can be started right away.

What are the recommendations for routine eye exams for adults?

If your eyes are healthy, your vision is good, and you do not have underlying health problems or family history of glaucoma, you should have a regular eye exam:

• Once in your 20s and twice in your 30s  
• Every 2 to 4 years ages 40 to 54
• Every 1 to 3 years ages 55 to 64 
• Every 1-2 years ages 65 or older 

If you have diabetes, high blood pressure, or a family history of eye disease, you should see an eye doctor for a complete exam now.  After the exam, your eye doctor will tell you how often you should have your eyes checked in the future, depending on your specific circumstances.

For more information about glaucoma and about regular eye exams, use these links:  

What is Glaucoma? | Glaucoma Research Foundation           

Eye Exam and Vision Testing Basics - American Academy of Ophthalmology (aao.org)

If you have any questions about glaucoma, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Blood Donation Urgently Needed

National Blood Donor Month has taken place each January since 1970.  Donating blood saves lives and improves health for many people.  It is especially important now.  Last week the American Red Cross warned that the US is facing a "dangerously low" blood supply.

Why is January National Blood Donor Awareness Month?

According to the American Red Cross (ARC), winter is one of the most difficult times of year to collect enough blood to meet the needs of patients.  The usual reasons for the winter slump include busy holiday schedules, bad weather, and seasonal illnesses such as the flu.  The pandemic has severely worsened the problem.

Just how low is the supply of blood?

Prior to the pandemic, most blood donation centers tried to maintain a five-day supply of blood.  Currently, in many regions of the country, they are operating on less than a half-day supply.

In regions where the blood supply is dangerously low, doctors are making tough decisions on who gets blood and how much because there just isn't enough.

Why is the blood supply so dangerously low now?

In addition to the usual winter slump, the pandemic has caused a number of other challenges when it comes to blood supply, due to both low donor turnout and high hospital use.  

The American Red Cross reported about 120,000 units of blood were collected for the 2021 fiscal year.  This is considerably less than pre-pandemic levels of about 215,000 units.

At the start of the pandemic, there were many canceled blood donation events.  Young people, such as high school and college students, are usually active blood donors through school blood drives.  The Red Cross gets about 25% of their blood donations through these events.  Many local blood banks get a larger percentage of their blood donations from these events.  Blood donation events have been significantly limited by the pandemic.  

During the COVID-19 pandemic, the ARC has also had chronic staff shortages, leading to fewer donations.  

Hospitals are also starting to see more severe cases of cancer, diagnosed at more advanced stages due to patients putting off screening during the pandemic.  These patients require more transfusions.

What can you do to help?

Roll up your sleeve and donate blood now!  A single blood donation can help save more than one life!

Blood cannot be stockpiled or manufactured; it can only be made available through the kindness of volunteer donors.

What are the eligibility criteria for donating blood?

For whole blood donation, you must meet the following criteria:

• Donation frequency: Every 56 days, up to 6 times a year
• You must be in good health and feeling well
• You must be at least 16 years old in most states (some states it's 17 years old)
• You must weigh at least 110 pounds
• Additional eligibility criteria apply, including certain medications, medical conditions, travel to certain countries, and personal history.  You can see the full eligibility information at Questions About Donating Blood | Red Cross Blood Services.

How can you donate blood?

• Schedule an appointment with the ARC or your local blood bank
• Find a blood drive in your area.  Community web sites often list events such as blood drives.
• Use this link to find a blood drive or schedule donation with the ARC in your area:  Schedule Your Blood Donation With The Red Cross (redcrossblood.org)

For more information about the ARC and the need for blood donations, use this link:

Donate Blood, Platelets or Plasma. Give Life | Red Cross Blood

If you have any questions about blood donation, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

COVID-19 Update - Part II

 Last week, we talked about the Omicron variant.  Hospitalizations and daily positive cases have continued to increase since last week. The CDC has recently changed its guidance for quarantine and isolation related to COVID-19.  This week I want to talk about those recommendations.

What is the difference between quarantine and isolation?

Quarantine is the period of time you stay away from others after you have had close contact with an infected person.  

Isolation is the period of time that you isolate yourself from others when you are sick, or when you know you have a COVID-19 infection, even if you don't have symptoms.

What is the latest guidance for quarantine and isolation?  When should you stay home?

Quarantine recommendations depend on your vaccination status because those who have been vaccinated have a lower risk of contracting COVID-19 and a lower risk of spreading it to others due to lower viral loads if they do get infected.

If you are NOT up to date on COVID-19 vaccinations and you are exposed to COVID-19, you should...

• Quarantine for at least 5 days  
  • Stay home for 5 days.  
  • Wear a well-fitted mask if you must be around others in your home.
• Get tested Even if you don't develop symptoms, get tested at least 5 days after you last had close contact with someone with COVID-19.
• Wear a well-fitting mask for 10 full days when you are around others, even in your own home.  Do not go to any place where you would not be able to wear a mask during the 10 days.
• Avoid travel
• Avoid being around people who are at high risk of severe COVID-19 
• Continue to watch for symptoms for 10 full days after your last contact with the individual who had COVID-19.  If you develop symptoms,
  • Isolate immediately and get tested.  
  • Continue to stay home until you know the results.
  • Wear a well-fitting mask around others in your home.

If you are fully vaccinated, including your booster and you were exposed to COVID-19, you do not need to quarantine for 5 days.  

• All of the other recommendations are the same as those who are not vaccinated.

Isolation Recommendations are the same regardless of vaccination status.  They vary depending on the symptoms that you have, and that difference is the length of isolation that is necessary.

All people who test positive for COVID-19 or have symptoms after a confirmed exposure should...

• Stay home for at least 5 full days and isolate from others in your home.  What to do after day 5 is discussed below.
• Wear a well-fitting mask for 10 full days when you are around others, in your home or in public spaces.
• Avoid travel
• Avoid being around people who are at high risk of severe COVID-19

How do you know when to end your isolation period?

If you had symptoms but were not severely ill, you may end isolation when...

• You have had no fever for at least 24 hours (without taking any medication that reduces fever, such as acetaminophen or ibuprofen) and,
• Your other symptoms are improving significantly.
• Remember that you still need to wear a mask for the full 10 days.

If you did NOT have any symptoms at all, you may end isolation when...

• The full 5 days of isolation are complete.
• Remember that you still need to wear a mask for the full 10 days.

If you were severely ill with COVID-19, you may have active virus for much longer. 
You should...

• Isolate for at least 10 days.
• Ask your doctor before ending your isolation.  

Mask Guidance

Due to the highly contagious Omicron variant, the CDC announced Wednesday that it is preparing to update its COVID-19 mask recommendations to emphasize the use of N95 and KN95 masks that better filter the virus.  Their website page providing mask guidance will be updated to reflect the different options and different levels of protection provided.  While the higher-quality masks provide better protection, some feel they can be less comfortable to wear, more expensive, and harder to find.  The CDC director, Rochelle Walensky, MD, added this comment to her announcement, "Any mask is better than no mask, and we do encourage all Americans to wear a well-fitting mask to protect themselves and prevent the spread of COVID-19." That recommendation is not going to change.

For more detailed information about quarantine and isolation for COVID-19, use this link... 

COVID-19 Quarantine and Isolation | CDC 

Here is a link to the mask guidance page.  It is not updated as I am writing this but may be by the time it gets to you...

Your Guide to Masks | CDC

Here are some other links to more of the latest information about COVID-19...

Omicron Variant: What You Need to Know | CDC

COVID-19 Testing: What You Need to Know | CDC

If you have any questions about the COVID-19 Omicron variant, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

COVID-19 Update - Omicron

The COVID-19 pandemic is still affecting us all two years after the virus was first discovered.  The US has now had more than 830,000 deaths caused by COVID-19 infection.  I thought I would share some of the latest information with you.

What should you know about the Omicron Variant?

Transmission Rate

The Omicron variant has been detected in most states and territories of the US, and it is rapidly becoming the dominant variant in the US and around the world.  However, in many parts of the US, the Delta variant is still causing a significant number of serious infections.  The Omicron variant of the SARS-CoV-2 virus, which causes COVID-19 illness, is the most contagious strain of coronavirus yet.  This is due to a combination of how quickly the virus replicates and how the changes in the spike protein make it more likely to stick to the cells lining our nose and upper respiratory tract.

On 1/3/22, the seven-day average of daily new cases of COVID-19 infection was 480,273, with the US reporting more than 1 million new cases on that same date.  On Tuesday 1/4/22, 112,941 Americans were hospitalized with COVID-19.  This number is significantly higher than the peak hospitalizations during early September (during the Delta surge) and is almost as high as the record high on 1/14/21 during the winter surge last year.  This is a serious indication of how transmissible this new variant is.

Erodes Immune Protection

Because of the significant changes in the spike protein of Omicron, this virus is more able to evade the antibodies that a person developed from a prior infection or from a vaccine.  In addition, many people have antibody levels that have decreased somewhat because it has been more than 6 months since their last vaccine or their prior infection.

There are two bits of good news though.  A booster dose of the COVID vaccines has been shown to be effective at preventing severe disease, hospitalization, and death from Omicron, likely due in part to boosting waning antibody levels.  In addition, a recent study suggests that the memory B cells (another part of the immune system’s weaponry) that develop from the vaccines show strong benefit against the Omicron variant, even though antibodies themselves are less effective.

Disease Severity

It appears that the Omicron variant is causing less severe disease in adults than earlier variants.  However, it may be too early to make a blanket statement about that.  Some adults are still developing severe, even life-threatening infections.  Early research suggests that the Omicron variant causes more upper-airway problems and fewer lung problems.

This variant appears to be causing more severe disease in children than prior variants, and the pediatric hospitalization rate has surged to its highest point.  Upper-airway complications from respiratory viruses are much more dangerous in children than adults, particularly young children. Now an average of more than 600 children are being admitted to the hospital each day due to COVID-19 infections.  There were more than 325,000 new cases among children during the week ending December 30th.

How can you protect against infection with the Omicron variant?

• Get vaccinated and boosted - The mRNA vaccines against COVID-19 are safe and effective.  The booster dose, now recommended 5 months after the second in the initial series, is essential to provide protection against Omicron.  Booster shots have now been recommended for ages 12 and up.  Children ages 5-11 who are moderately to severely immunocompromised should get an additional primary dose 28 days after their second shot.
• Wear a mask - Because the Omicron variant is so much more transmissible, masks are more important than ever.  Public health experts recommend wearing a higher quality mask any time you are in a place with lots of people or indoors with others for any extended period.  A cloth or surgical mask might be fine for a quick grocery trip at a time when there are few other shoppers, but for most outings when you will be exposed to others, especially indoors, you should be wearing a well-fitting N95 mask that covers your nose and mouth.  If you do not have N95 masks, you can wear a surgical mask under a cloth mask, making sure they are both well-fitting and covering your nose and mouth.
• Avoid large gatherings - Limit gatherings to 10 people, preferably fully vaccinated.  Avoid crowded areas, especially indoors.  If you do need to be in a crowded area, wear a mask to protect yourself.

Next week, we will talk more about recent COVID-19 information including additional details about some of the latest CDC recommendations.  Until then, if you have any questions about COVID-19, the vaccines, or any other aspect of the pandemic, please log into your account and send us a question.  We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor