Many changes take place in our eyes as we get older.
Many 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, most of these eye conditions are treatable.
Beginning at age 40, ophthalmologists recommend getting regular eye exams every year (even if you have healthy eyes) in order to maintain eye health and detect any age-related vision problems.
Common Age-Related Eye Diseases
In this section, we will review eye problems associated with older age and their treatment options.
Presbyopia means losing the ability to see up close. This process begins in your forties and continues until the mid-sixties.
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 starts to stiffen in our aging eyes. 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.
You may begin to have trouble reading small print, or experiencing eye strain in the early stages of presbyopia.
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 eyeglasses.
- Contact lenses, including multifocal contact lenses 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 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 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
- 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 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.
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.
Diabetic retinopathy is caused by damage to the blood vessels of the retina (the light sensitive area at the back of your eye). It can affect anyone with type 1 or type 2 diabetes. The longer you have a diabetic condition and the less controlled your blood sugar levels are, the higher your risk for diabetic retinopathy.
The first stage of diabetic eye disease is known as NPDR (non-proliferative diabetic retinopathy). Small blood vessels begin to leak, which causes the retina to swell. Once the retina begins trying to grow new blood vessels, the condition has progressed to PDR (proliferative diabetic retinopathy), which is a serious problem.
Symptoms of diabetic eye disease include:
- Blurred vision
- Specks or strings floating in your central vision (floaters)
- Changing vision
- Poor color vision
- Dark or empty spots in your vision
Treatment for Diabetic Retinopathy
The best way to prevent loss of vision is by controlling your blood sugar and blood pressure. Anti-VEGF medication, including Avastin, Eylea, and Lucentis also helps reduce swelling of the macula. Laser surgery and vitrectomy are surgical options that can help restore your vision if you have advanced PDR.
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.
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