Evidence Based

Aging and Eyesight

Many changes take place in our eyes as we get older. Some of these changes are normal, while others are serious eye diseases that require medical attention. While we are not able to stop or reverse the aging process, many of these eye conditions are treatable. 

Age-Related Eye Problems

In this section, we will review eye problems associated with older age and their treatment options.

Presbyopia

Presbyopia means losing the ability to see up close. This process begins in your forties and continues until the mid-sixties.

graphic showing normal eye and presbyopia

Typically, the natural lens inside our eye changes shape as your eyes focus on objects near or far away. Attached to the lens are ciliary muscles that can flex or relax to control the shape of the lens. 

Presbyopia occurs when the natural lens inside our eyes starts to stiffen with age. At this point, the ciliary muscles can no longer change the shape of the lens easily. As a result, your eyes have a hard time focusing at near.

Treatment For Presbyopia

Treatment options for presbyopia include:

  • Reading glasses. If you do not have any problems with your distance vision, you may only need to wear glasses to read.
  • Bifocal or progressive glasses. If you also need distance vision correction, your eye doctor can prescribe lenses that combine your distance and reading prescription into one pair of glasses.
  • Contact lenses, including multifocal or monovision contacts. Multifocal contacts combine your distance and reading prescription into each contact lens. Monovision means wearing one contact lens to see far, and one lens to see up close.
  • Laser eye surgery. Similar to contact lenses, the surgeon can perform a monovision LASIK or PRK procedure to correct your vision.

Cataracts

Cataracts are a normal part of aging that occurs after age sixty. They develop when the natural lens in our eyes become cloudy and yellow, which causes the vision to go blurry. Most people develop cataracts in both eyes, but each cataract may grow at a different rate. 

cataracts

Cataracts usually progress slowly, so vision changes may not be noticeable until the cataracts are large enough. Symptoms of cataracts include: 

  • Blurry vision at near or far
  • Glare
  • Poor night vision
  • Decreased contrast sensitivity 

About 50 percent of the general population have cataracts by age 75. 

Some people develop cataracts earlier on in life for other reasons, such as from diabetes or steroid medication use. In this article, we are focusing on age-related cataracts. 

If a cataract is in its early stages, many patients do not experience any visual symptoms, and no treatment is necessary. Your eye doctor can test your vision to see if the cataracts are affecting your eyesight. If the effects are mild, your doctor may recommend monitoring your cataracts.

Treatment For Cataracts

As the cataract progresses, the quality of vision starts to decline. If you are symptomatic, your eye doctor can refer you to a cataract surgeon.

During cataract surgery, the surgeon removes your cataract through a small incision on the front of your eye. The surgeon then inserts an artificial lens implant into your eye. This implant is permanent and also corrects your vision. Once the cataract is removed, it cannot grow back. After surgery, many patients find that they do not need glasses or only use them on occasion. 

Can Eyesight Improve With Age?

In the early stages of cataract development, some patients notice that their eyesight improves. We call this phenomenon “second sight.” 

As the cataract thickens, this changes the way your eyes focus. People who are farsighted and use reading glasses find that their near vision improves. This benefit does not apply to nearsighted people. These patients generally notice that their nearsightedness worsens as cataracts develop.

Unfortunately, second sight is only temporary. Once the cataract grows denser, the overall vision worsens.

Glaucoma

Glaucoma is an eye disease that causes irreversible damage to the optic nerves. This type of damage causes vision loss but is not painful. 

In the earlier stages of glaucoma, you will not have any symptoms. The only way to know if you have glaucoma is to have your eye doctor diagnose you.

As glaucoma progresses, people may notice peripheral vision (side vision) loss. Patients with advanced glaucoma experience tunnel vision, making it hard to see things that are not directly in front of you. In severe cases, glaucoma causes total blindness.

graphic showing the development of glaucoma

Unlike cataracts, not everyone develops glaucoma as they get older. However, your risk of glaucoma increases over time. There is also a genetic component involved with glaucoma, so knowing your family history is important.

Studies estimate that about 3.5 percent of the world’s population between the ages of 40 to 80 have glaucoma.

Treatment For Glaucoma

There is no cure for glaucoma, and any vision loss that occurs is not reversible. Instead, treatments focus on slowing down the progression of glaucoma so that patients do not lose any more vision. Patients who respond well to treatment often maintain good vision.

The primary form of glaucoma treatment is using medicated eye drops to lower your eye pressure. Research shows that lowering eye pressure helps stabilize glaucoma. You will need to take eye drops daily to maintain your eye pressure. 

Other forms of glaucoma treatment include laser and other surgical procedures to lower the eye pressure. Patients who do not respond well to medication or are not compliant with taking medication may need glaucoma surgery.

Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is a progressive eye disease that can cause severe vision loss. 

AMD is a leading cause of blindness in older adults, with a majority of patients over age 65.

The macula is the structure inside your eye that is responsible for your visual acuity. You depend on the macula to see clearly and to distinguish fine details, such as the words you are reading in this article.

There are various types of macular degeneration:

  • Dry AMD is a milder, earlier form of macular degeneration. In dry AMD, the tissue in the macula thins out, while waste deposits called drusen start to accumulate in the macula. Patients with dry AMD may not experience significant vision loss and maintain healthy vision in many cases. 
  • Geographic atrophy is a later stage of dry AMD. Patients who develop geographic atrophy have severe thinning of the macular tissue and can experience significant vision loss.
  • Wet AMD is a late-stage, advanced form of macular degeneration. Some patients with dry AMD may develop wet AMD later on. In this stage, abnormal blood vessels grow underneath the macula. If these vessels start to leak, patients may experience a sudden and severe decrease in vision.

Treatment For Age-Related Macular Degeneration

There is no specific medical treatment for patients with dry macular degeneration. Your eye doctor may recommend that you take particular vitamin supplements that may slow the progression of your dry AMD.

This supplement is called the AREDS 2 formula, which includes these nutrients:

  • 400 International Units of vitamin E
  • 500 milligrams of vitamin C
  • 80 milligrams of zinc 
  • 2 milligrams of copper 
  • 10 milligrams of lutein 
  • 2 milligrams of zeaxanthin
  • No beta-carotene

The most common treatment for wet AMD is anti-vascular endothelial growth factor therapy (anti-VEGF therapy). Anti-VEGF drugs are injected into the eye to slow the growth of abnormal blood vessels. With treatment, patients with wet AMD may see an improvement in their vision.

Vision Aids For Severe Vision Loss

Patients with advanced glaucoma and age-related macular degeneration may experience severe and irreversible vision loss. They lose the ability to perform daily activities such as reading, driving, cooking, and grooming. Some people also have difficulty walking without bumping into objects or tripping on curbs and stairs.

Low vision aids help optimize any remaining vision these patients have. A low vision clinic can fit patients with these devices and teach them how to use low vision aids properly. These devices include: 

  • Telescopes help patients function for distance-related tasks such as watching television or reading street signs. They can be mounted onto glasses or hand-held.
  • Magnifiers help people see objects up close, such as reading a newspaper or checking a medication label. Stand magnifiers or hand-held magnifiers are available.
  • Electronic video magnifier systems are advanced low vision devices to help patients read documents more efficiently.
Author: Melody Huang, O.D. | UPDATED April 22, 2020
Resources

“Cataract Data and Statistics.” National Eye Institute, U.S. Department of Health and Human Services, 17 July 2019, www.nei.nih.gov/learn-about-eye-health/resources-for-health-educators/eye-health-data-and-statistics/cataract-data-and-statistics

Chew, Emily Y., et al. “Secondary Analyses of the Effects of Lutein/Zeaxanthin on Age-Related Macular Degeneration Progression.” JAMA Ophthalmology, vol. 132, no. 2, 2014, pp. 142–149., doi:10.1001/jamaophthalmol.2013.7376.

Tham, Yih-Chung, et al. “Global Prevalence of Glaucoma and Projections of Glaucoma Burden through 2040.” Ophthalmology, vol. 121, no. 11, Nov. 2014, pp. 2081–2090., doi:10.1016/j.ophtha.2014.05.013.

Vasconcelos, Galton, and Luciene C Fernandes. “Low-Vision Aids.” American Academy of Ophthalmology, 24 Nov. 2015, www.aao.org/eye-health/diseases/low-vision-aids

Wong, Wan Ling, et al. “Global Prevalence of Age-Related Macular Degeneration and Disease Burden Projection for 2020 and 2040: a Systematic Review and Meta-Analysis.” The Lancet Global Health, vol. 2, no. 2, 3 Jan. 2014, pp. e106–e116., doi:10.1016/s2214-109x(13)70145-1.Yorston, David. “Anti-VEGF drugs in the prevention of blindness.” Community eye health vol. 27,87 (2014): 44-6.

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