E4 sight from E1
times a day to avoid a damaging buildup of internal eye pressure. Then I got lucky. The miracle of laser surgery worked for me. There was eye damage, but it was under control. Inmy 70s, I slowly began to be
aware of what I believed was the increasingly shoddy paper and ink in books and magazines. It seemed to me that many of the published works I read had fad- ing print. I was surprised at how difficult reading became, even in very good light. It turned out that macular
degeneration, in a vicious assault on my left retina, had joined the arrested glaucoma and was dev- astating that eye. And it turned out that there’s very little that can be done about this cruel disease. Recently macular degeneration has began to spread into my “good” eye, which, had been pretty poor anyway because of worseningmyopia andmy age. These days on waking, before I
EZ EE
KLMNO It’s time for politicians to see the light
go to the door for the newspaper and the headline test, I don my reading glasses and stand in front of a diagnostic Amsler grid taped tomy refrigerator. The grid is a postcard-size rect-
angle of horizontal and vertical lines with a small dot at its center. I close first one eye, then the other. If the lines aren’t wavy or broken, my eye disease hasn’t ravaged me further during the night.
Now I need to notice every-
thing around me with enormous care and attention. Signs are no longer what they
seem. Numbers deceive me: “6” and “8” are indistinguishable, as are “5” and “3.” The light-and-dark contrast on
street signs in New York City, where I live, vanishes completely at dusk, and on cloudy days the “WALK” and “DON’T WALK” signs at crosswalks disappear. Steep and dangerous subway stairs are badly lit, and subway
elevators are often out of order. Many shops and splendid buildings don’t wear addresses, and house numbers are often tiny or nonexistent. Broken pave- ments make walking on the city’s streets a life-threatening venture. There ismuchto be noticed when one barely sees. In daylight I function easily
enough. I shop, I explore, I go to work.That’s right, to work. I’man English professor emerita at the only community college in Man- hattan, a remarkable contempo- rary melting pot of higher educa- tion. After dark, though, I’m almost sightless. New York turns into a maze of threatening shadows amid dim streetlights. My doctors scrupulously moni-
tor my disease, and they try to buoy my spirits. “You have the good kind of macular degenera- tion,” my ophthalmologist says. “Dry.” He’s not being ironic. He really means it. “Even if the macular degenera- tion gets worse, you'll probably
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see enough to be able to take care of yourself,” concludes my retina specialist. I wait for the dilating drops he gave me to stop distort- ing the world so I can findmyway home. “It won’t be as dark as it is for some. You’ll manage,” he says. Often in past years I’ve
thoughtabout others likemewho devoted their lives to celebrating the intricaciesandwonders of the worldin words.Someofthemhad never seen that world at all, while others saw it only until they were plunged into darkness: Homer; JohnMilton;BenitoPérezGaldós, the so-called Spanish Tolstoy; Jorge Luis Borges; James Joyce; Helen Keller; James Thurber — all blind or blinded writers. How splendidly brave they
were! Brilliant, yes, but how brave! To be a blind writer is to live in
an an invented world. While the writing hours of my life are all spent in such imagined places, I do always return to the visible world around me, which has been my touchstone. How ever shall I manage if it disappears? And it is disappearing. It’s
quite strange for me to go to the playground with my grandchil- dren and hover so close to them every single minute for fear of losing sight of them. It’s also strange to sit at a festive dinner table withmy family and gaze on blurry faces. It’s strange to be at the opera
andhear but only vaguely see. I’ve been going to the outdoor Shake- speare every summer for years,
but at last year’s “Twelfth Night” in Central Park, I sawonlyMalvo- lio’s yellow stockings, and not his cross-garters. I hear the city still, although I
often don’t see its changes. And I blunder regularly. The other night at dinner, I poured a large amount of coarse salt onto my pasta, mistaking it for grated cheese. So I’m keenly aware that life
will surely get stranger for me, even though it will not be “as dark as it is for some.”
Modern medicine has done the
best that it can to repair me, and I’mtruly grateful. Now I wantmy city—all cities
— to do the best they can for me and other citizens. For those of us who flourish
amid motley crowds and metro- politan excitement, the city offers mobility and a vibrant life. We who are elderly, we who don't see so well, we who can’t walk so quickly—wealsohavesomething to offer.We’re going, going . . . but not gone. We “old olds,” who live and vote in American cities in such large numbers, need cities to be welcoming places for those who aren’t keen of sight or fleet- footed, and for those who are headed the way we are going. But to put our talents and skills
and experiences to use, we need urban policies that take us into account. I’ve voted in every election for
which I was eligible. Throughmy magnifying glass, I do my best to read about all the issues, great andsmall. But I’mstill waiting for the candidates and policymakers who look past the cliches and
TUESDAY, OCTOBER 5, 2010
barriers of ageism and see the white-haired lady on the subway. I want them to recognize her,
and to want her to be part of the city. I want candidates and policy-
makers who are willing to look at the world through legally blind eyes and see what needs to be fixed. They would welcome the growing population of “old olds.” They would recognize that we need top-notch health care—but also safe, accessible public trans- portation so that we can keep our doctor appointments, proper ur- ban lighting and clean, well- maintained streets. And might I also mention safe, accessible pub- lic restrooms and functional pub- lic drinking fountains? Furthermore, I want a consis-
tent code for businesses and houses that designates a mini- mumsize for address numbers. In sum, I want to be able to
locate places and walk and ride and breathe safely inmyowncity. The right candidates will gain
my vote and my ardent support, and I promise to use my voice, includingmy voiceonthe page, to recruit others. My peers and I might not walk quickly or see well, but there aremoreandmore of us “old olds” heading for the polls each year—and we will not stay away!
health-science@washpost.com
Klass is the author of 17 novels and two memoirs. This essay was excerpted from September’s edition of Health Affairs magazine; it can be read in full at
www.healthaffairs.org.
6 Age-related macular degenera-
tion is the leading cause of vision loss in adults older than 50. AMD destroys the light-sensi-
tive cells in themacula, the part of the retina that provides sharp vision of things directly in front of the face. People with AMD may see a blurred spot in the center of their field of vision, and theymay eventually not be able to recog- nize faces, drive a car or do close activities such as reading. AMD almost always begins in
what is called a dry form. The deterioration of the macula pro- gresses slowly, often with no symptoms in the early stages; only a comprehensive dilated eye exam can detect dryAMD.
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advanced stage, nothing can pre- vent vision loss. Taking a high- dose formulation of antioxidants and zinc has been shown to delay and possibly prevent intermedi- ate AMD from progressing to the advanced stage. About 10 percent of dry AMD
sufferers develop the wet form, which is considered more severe. New blood vessels beneath the macula leak blood and fluid, damaging the macula quickly. As people age, their risk for
AMD increases, and health ex- perts recommend people have an annual dilated eye exam. Other risk factors include: smoking, race and family history. Research
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Macular degeneration risk may be controllable
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certain lifestyle choices may help reduce an individual’s risk of de- veloping AMD; they recommend that people exercise, avoid smok- ing, maintain normal blood pres- sure and cholesterol levels, and eat a diet rich in fish and vegeta- bles. For more about AMD, contact
the Washington National Eye Center, the Wilmer Eye Institute at Johns Hopkins, the Founda- tion Fighting Blindness in Co- lumbia and the American Health Assistance Foundation in Clarks- burg.
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