DEAR DR. ROACH: I have an elderly friend who’s becoming blind from macular degeneration. After hearing of a particularly frustrating event she experienced due to vision loss, I remembered the great clarity that the yellow-lens (to reduce glare) glasses gave me, not just at night, but daytime also.
So, I sent her a pair to see if it would help, as a last-ditch effort. She called me crying, it had made such a difference! She has now had her prescription eyeglasses done with the yellow (blue-canceling?) lenses. Of course, we understand that this is just a temporary help, and won’t prevent the blindness from taking its course, but it has given her much better vision for a time. — I.L.B.
ANSWER: Age-related macular degeneration is the leading cause of vision loss in industrialized countries. It is a degeneration of the central part of the retina, called the macula, which is responsible for fine detail central vision. The underlying cause is not precisely known, and the course is progressive.
I was able to find a 2002 study that confirmed that yellow or orange lenses improved contrast sensitivity in people with early age-related macular degeneration, whereas red and gray lenses worsened it. Another study suggested that the perceived benefit (the subjective experience by the person) was enhanced, but that objective improvement in vision was not actually improved much at all.
In my opinion, perceived benefit is still worth a great deal, and since there is little effective treatment for the more common “dry” form of ARMD beyond vitamins and smoking cessation, I am publishing your letter in hopes that some people will get improvements in their vision, as your friend did, from this low-cost treatment with essentially no risk of side effects.
DEAR DR. ROACH: I am a healthy 73-year-old man who has always had a large prostate. Thirty years ago, my urologist described it more like the size of an orange rather than a walnut. Despite its size, it has never given me any problems — no UTIs, sudden urination, poor stream, waking me in the middle of the night, etc. Despite not having symptoms, about 10 years ago I was prescribed finasteride at a dose of 5 milligrams, and Rapaflo to “try to keep it in check.” In 2018 I had an ultrasound done of my prostate, and it was measured at 185 grams. It was measured again recently and is now 232 grams. My PSA is always in the 3.2-3.5 range.
At what point does a prostate get too large? Should I be concerned even without having any symptoms? To his credit, my urologist discussed my surgical options, along with the related side effects. I am reluctant to do anything if it’s not necessary. — J.J.
ANSWER: The normal prostate gland is about 20 grams, and only 4 percent of men will develop a prostate over 100 grams. Yours is well past that, though far short of the world record of 2,410 grams.
It is striking that the size of the prostate does not well correlate with a man’s symptoms. Since you have no symptoms and a low PSA level (especially considering the size), there is no indication to do anything surgically. The risk of surgical complications is higher in men with very enlarged prostate glands, so I would certainly be cautious about considering surgery.
Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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