Seniors and Vision Problems

As with much of our health, our vision also is affected by aging. Older adults typically face far more problems with their vision than do younger folks.

The main age-related vision problem is presbyopia, or the slow loss of ability to focus up close or read small print. This is a normal process, typically beginning after age 40, and can usually be corrected with reading glasses. Older eyes also may develop age-related vision illnesses, such as age-related macular degeneration, cataracts, retinal detachment and glaucoma. The lens also yellows slightly with age causing changes in color perception and reducing the transmission of the blue end of the spectrum. Other vision problems include dry eyes and a loss of contrast sensitivity, causing difficulty with night vision, especially while driving. A stroke or other circulatory problem can lead to vision damage.

These are vision disorders that affect older people:

• Age-related macular degeneration (AMD). In this disease, the central part of vision (the macula) gradually deteriorates, making it difficult to see things clearly. Activities like driving or reading become difficult. The wet form of AMD, the less common form of this condition, can be treated with laser therapy or medication. New drugs have been developed that slow or block the growth of new blood vessels and decrease the leakage of blood from existing blood vessels, thus preserving sight. These medications are injected into the eye. Pegaptanib (Macugen), a drug that is injected every six weeks, was approved in 2004; ranibizumab (Lucentis), which is injected monthly, was approved in 2006 and may be able to reverse some of the effects of macular degeneration. Currently, there is no treatment for dry AMD, but this condition progresses so slowly that its effects don’t change peoples’ lives. Laser treatment for dry AMD is being investigated.

• Diabetic retinopathy is a complication of diabetes. It damages the retina, the light sensitive area at the back of the eye. The damage is caused by changes in the blood vessels that supply the cells of the retina with oxygen and nutrition. At first, the vessels may leak, distorting vision. As the condition progresses, new blood vessels may grow and bring blood to the center of the eye. This can cause a loss of vision.

• Retinal detachment. In this condition, the layers of the retina become separated, resulting in vision loss.

• Cataracts. Cataracts are cloudy areas in part or all of the eye lens. The lens is usually clear, allowing light to pass through. Cataracts keep light from passing easily through the lens, and this causes loss of eyesight. These are extremely common among older adults and can cause a loss of contrast in eyesight, a dulling of colors and a progressive sensitivity to glare, especially from oncoming car and truck headlights. Cataracts also can cause difficulty in reading because of a haze that forms around your vision. Your health care provider can easily spot your cataracts, but the time for treatment is when your cataracts interfere with your ability to function in your daily life.

• Glaucoma. Glaucoma is a condition in which the optic nerve is damaged, causing vision loss. Glaucoma is caused by a poorly understood group of diseases. Most, but not all, of these diseases cause an increased intraocular pressure. Glaucoma causes a progressive loss of mid-peripheral vision, eventually leading to blindness. It has no easily recognized symptoms, so it's important to get regular eye exams to look for it. If you have a family history of glaucoma, have diabetes or are African American, you may be at greater risk for developing it. In any case, you should have a glaucoma check at least every two years after age 40. If you have glaucoma, it can be treated.

• Dry eyes is a common condition in older adults. It usually occurs because the eyes can't produce enough tears, and because the makeup of tears changes with age. Tears are made of oil, water and mucus, and as we age, the consistency of the oil changes, leading to evaporation and dry eyes. This can cause a constant tearing of the eyes that can result in somewhat blurred vision and the feeling as though there is grit or sand in the eyes. If lubricating eye drops don’t relieve the problem, see your eye care provider. There are other treatments. Occasionally, dry eyes are a symptom of another problem.

• Tearing, or having too many tears, also may be a problem in older adults. Tearing is caused by environmental conditions such as bright light, wind or temperature changes. Wearing sunglasses can help relieve tearing. An eye infection or a blocked tear duct also can cause tearing.

• Decreasing sensitivity to colors is caused by the lens of the eye becoming more dense and yellow. Colors may be harder to distinguish, particularly those in the blue end of the spectrum. This may be a normal change or could indicate a problem. If you notice it, be sure to talk to your eye care provider.

• Need for more light to do tasks. The pupil of the eye tends to become smaller with age, requiring more illumination to read at night or to read a menu in a poorly lit restaurant. You may also have difficulty seeing at night to drive. This may be a normal change or could indicate a problem. If you notice it, be sure to talk to your eye care provider.

• Floaters are spots or strings in your field of vision. They are tiny clumps of material floating in the gel-like substance that fills the inside of the eyeball. A few floaters are normal, and the number you notice can increase with aging. If you notice a sudden increase in the number, you should talk to your eye care provider, because it could be a sign of a retinal detachment.

What to Do

For your best eye health, get regular vision exams. To help prevent AMD, eat a diet rich in foods that contain vitamins A, C and E, beta carotene, lutein and the mineral zinc. Eat plenty of leafy green and deep yellow vegetables. If you have diabetes, help prevent diabetic retinopathy by controlling your blood sugar through a careful diet, routine exercise and regular eye exams. For any eye problem, see your provider immediately if you notice any change in your vision or experience any pain in your eye. When you are outside, wear a wide brimmed hat and sunglasses that protect against all forms of ultraviolet light.

Self-care Steps for Senior Vision Problems

For AMD

• Buy books and checks in large print.

• Buy a reading lamp with a flexible neck.

For Dry Eyes

• Use warm-to-hot compresses on your closed eyes for several minutes at a time, a few times a day.

• Use wetting eye drops called artificial tears that are made specifically to simulate your tears.

• Avoid forced air heat that blows directly on your face. Use a humidifier if the air in your home is less than 30 percent humidity. Move away from a vent or, if you're in a car, turn the vent away from your face.

• Increase the amount of oils in your diet by eating fish high in omega 3 fatty acids, such as salmon and other cold water fish from the North Atlantic, and by consuming cod liver oil and flaxseed oil, which can be added to foods.

For Poor Night Vision

• Limit night driving. Try to plan car trips in daylight.

• When driving at night, use yellow-colored clip-on eyeglasses, because they help with contrast.

• At home, read in a well-lit room or buy a reading lamp with a flexible neck so that you can move it into the best position for you.