Cataracts, Glaucoma, Macular Degeneration ‘The Big 3’

A closer look at the three most often talked about eye diseases written by Dr. Zachary Vonderach, edited by Abraham Zlatin, O.D.

#1 Cataracts

Cataracts are the most common ocular disease of The Big 3 simply because everyone gets cataracts. If we live long enough, we will develop a cataract. Cataracts are not generally dangerous to have in the eye. This condition is not treated until it is more advanced and visually significant. A cataract is when the natural lens inside of our eye, starts to turn yellow or opaque over time. Cataracts gradually get more severe over time, and it becomes
more difficult to see through the opacity which we interpret as a blur. Cataracts can also cause glare, especially when driving at night.
Another essential thing to know is that cataracts will cause your prescription to change from year to year which is an added reason to have cataracts monitored at least annually. A dilated exam allows a view of the entire lens to evaluate the total cataract. The treatment for cataracts is surgical removal which is the most common surgery performed in the USA.

Funny Patient Stories

A patient with significant cataracts was referred for cataract surgery. Before surgery, his vision was significantly reduced. At his post-op appointment, he was asked how he liked his new vision. He  replied, “I don’t like it because it’s too clear and now I can see that my wife has a mustache.”


It is estimated that over 3 million Americans have glaucoma but only half of those know they have it.

#2 Glaucoma

Glaucoma is a disease of the optic nerve. When we think of glaucoma we often correctly associate it with the eye pressure. Having elevated eye pressure increases the chances that your optic nerve will suffer from glaucoma damage but just because one has high eye pressure doesn't mean that they have or will have glaucoma just like having normal eye pressure doesn't mean one doesn't have glaucoma. Think of the optic nerve as a cable that connects the eye to the brain. The optic nerve is what combines the two. In patients with glaucoma, the nerve, or the cord, is gradually damaged. Optic nerve damage from glaucoma is generally painless and gradual making it impossible for glaucoma patients to notice progression. As the nerve is damaged, irreversible vision loss occurs starting with the peripheral vision and works its way centrally if the nerve is continually damaged. The goal for every glaucoma patient is to protect the optic nerve. If a patient can lower their eye pressure, it takes some of the stress off the optic nerve and can prevent further damage. Remember, normal eye pressure runs between 10 and 23.

#3 Macular Degeneration

Unlike glaucoma which affects our peripheral vision first, macular degeneration affects our central vision. The loss of central vision is because our macula is responsible for our 20/20 vision. As we collect birthdays, alterations in the retina may begin to happen, allowing for waste deposits to accumulate in the macula. These waste deposits obstruct visual cells (rods and cones), which decreases vision. You may know that macular degeneration comes in two forms: dry and wet. Although there is no treatment, dry macular degeneration requires close monitoring and lifestyle modifications may reduce the chance of progression to wet form. Wet from essentially means that the dry form has become severe to the point that it has caused the retina to bleed. Treatment for wet AMD only aims to prevent further vision loss not necessarily improve vision.
The Big 3 eye diseases are not exclusive to patients over the age of 60 although prevalence increases with age. With all three diseases, early detection is crucial which is why we love to see all our patients yearly.

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Smokers have a four times greater risk of developing macular degeneration than nonsmokers.

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