A Real "Vision Thing"

By ANDREW PURVIS

One of the best fringe benefits of being President is getting regular and thorough medical examinations. In George Bush's case, it could prove to be an eye saver. The White House announced last week that his latest checkup had revealed a budding case of glaucoma in his left eye, a disease that can be $ controlled if caught early, but can otherwise lead to blindness. Bush thus joins some 2.5 million other Americans who suffer from this common problem, and his case underscores the value of discovering glaucoma before serious damage is done.

The President immediately began taking eyedrops to relieve his condition, and will continue to take them or some other kind of medication twice daily for the rest of his life. At 65, he has not lost any vision, and he is unlikely to have a serious loss of sight in the future. "I haven't felt a thing, felt it at all," said Bush, who was wearing sunglasses as he emerged from the checkup. The President, who passed all his other tests smartly, claimed that he felt "like a spring colt."

Glaucoma occurs with increasing frequency in people over the age of 40, affecting 9% of those 70 or older. It is most common in blacks and those with a family history of the disorder. Of the three main types of the disease, Bush has by far the most common. His open-angle glaucoma can be treated painlessly and effectively, if found early enough. The more severe acute closed-angle glaucoma, on the other hand, causes sharp pain and visual impairment and requires prompt laser surgery. The third type, which blinded Ray Charles and Stevie Wonder, occurs at birth or soon thereafter.

All forms result from accumulation of aqueous humor, a fluid that is generated behind the lens and then flows to the front of the eye, bringing nourishment and washing away waste products. In a normal eye, the humor drains as it is produced, maintaining a constant ebb and flow. But in those with glaucoma, the drainage canals are somehow blocked, leading to an increase in pressure. "Glaucoma is a plumbing problem," says H. Dunbar Hoskins of the San Francisco-based Foundation for Glaucoma Research. If left untreated, the pressure eventually harms the optic nerve. The reason for the buildup is not known.

Early treatment of open-angle glaucoma with eyedrop drugs like levobunolol hydrochloride, which Bush is taking, slows production of the aqueous humor and relieves the pressure. Eventually, however, many patients develop a tolerance for the drugs and must switch medications. Occasionally, surgery is needed, though in Bush's case probably not for many years. This glaucoma is easy to overlook, since it has no overt symptoms. But doctors are becoming more vigilant, and the American Academy of Ophthalmology now recommends that everyone over 40 be tested every two years.

In all other respects, Bush's health is "truly excellent," said White House physician Burton Lee. And the President's vision, it seems, is more likely to be a serious concern for his political critics than for his doctors.

With reporting by Michael Duffy/Washington and Paul Witteman/San Francisco