Common Vision Problems

6 Sight Scares -- and What You Can Do

Our eyes are our windows to the world. They are the Technicolor tools we use to discover new things in life and experience visual sensory input. So it's no wonder that we are concerned about impaired or lost vision as we age.

Conventional wisdom holds that eyesight is bound to deteriorate as we get older. Eyesight does tend to get worse with time; there are challenges to our vision based on the years we rack up on the planet.

The good news is that with all the vision treatments available today, there are options for preserving -- and, in some case, restoring -- our sight well into our later years. Before you accept poor eyesight as a fait accompli, make sure you've looked into how you can help your old eyes remain your windows to the world. There may be ways that you haven't considered.

Here's what you should know to prevent, treat, and, when possible, avoid these six eye ailments that are common among older people.

Vision Problem: Dry Eye

What is it?
Dry eye occurs when your tears aren't able to provide adequate moisture for your eyes. The most common symptoms include eye irritation, the sensation of a foreign body in the eye, difficulty reading after a few minutes, and, paradoxically, watery eyes. Your eyes may sting or burn, and you may experience dry eye in specific situations, such as on an airplane, in an air-conditioned room, while riding a bike, or after looking at a computer screen for a few hours.

Dry eye is "the result of deficient tear production or increased evaporation of tears, and it usually occurs later in life, typically after the age of 50," says Dr. George A. Williams, professor and chair of the Department of Ophthalmology at Oakland University's William Beaumont School of Medicine.

The primary reason is due to inflammation of the tear glands. Dry eye is often associated with inflammatory diseases such as arthritis and lupus.

Is there a typical age of onset?
"Dry eye is a relatively common problem in the elderly, occurring in approximately 15 percent of people over the age of 65," says Williams.

What can older people do to prevent it?
"If you're older and you take medications, you might be at higher risk," says Dr. Emily Chew, deputy director of the Division of Epidemiology and Clinical Applications at the National Eye Institute (NEI) in Bethesda, Maryland. "Don't avoid medications, but focus on tear replacements in the form of eye drops, which can be taken as frequently as needed."

In addition to eye drops, other treatments for dry eye include lifestyle changes and diet. Recently, evidence has suggested that omega fatty acids, which are present in fish such as salmon and tuna as well as in some nuts, may be helpful in preventing and treating dry eye.

For more serious cases of dry eye, surgery may be an option. How concerned should an older person be about getting this? "It's bothersome, but not worrisome," says Chew. "You won't lose vision over this."


What is it?
A leading cause of blindness, glaucoma is "not just one eye disease but a group of eye conditions resulting in optic nerve damage, which may result in vision loss and blindness," says Oakland University's George Williams.

Abnormally high intraocular (inside the eye) pressure usually, but not always, causes this damage. There is no specific level of pressure that signifies glaucoma, and there are no visual symptoms early on, so diagnosing glaucoma can be challenging. It can damage your vision so gradually that you may not notice any loss of eyesight until it's reached an advanced stage.

Is there a typical age of onset?
"Glaucoma can occur at any age, but it is a significant cause of visual loss in older people," says Williams. "Glaucoma can usually only be detected by a comprehensive eye examination. People 60 years of age and older should have a yearly eye examination to detect glaucoma. A glaucoma screening examination is a benefit covered by Medicare."

What can older people do to prevent it?
"Diet does not appear to play a role in glaucoma," says NEI's Emily Chew. "Nobody knows why you get this, but there's probably a genetic component. If there's a family history, you should get checked as early as your thirties or forties."

Since symptoms may not appear until late stages of the disease, older people should get regular eye exams. Make sure your eye doctor measures your intraocular pressure. Early diagnosis and treatment can minimize or prevent optic nerve damage and limit glaucoma-related vision loss. You may also have more treatment options; they can include medical, laser, and surgical treatments, depending on the type and severity of the glaucoma.


What are they?
A cataract is a clouding of the normally clear lens of your eye. Can you imagine looking at your life through a fogged-up window? That's how some describe what it feels like trying to see with cataracts. Of course, this makes common tasks like driving a car or reading small type very difficult.

"The reasons for cataract formation are not completely understood. Diabetes is one risk factor for cataracts," says ophthalmologist George Williams.

Most cataracts develop slowly, so you may not experience a negative impact on your vision right away.

Is there a typical age of onset? Cataracts usually occur after the age of 60. "Not only do old-age cataracts, the most common type, appear after 60," says Emily Chew of the National Eye Institute. "But also the likelihood of getting them goes up as you get older."

"Cataracts are very common in people over 65," adds Williams.

What can older people do to prevent them?
"There isn't anything one can do to prevent cataracts," says Chew. Diet does not appear to play a major role in cataract formation. A recent study demonstrated that a combination of vitamin A, vitamin C, vitamin E, omega fatty acids, and zinc did not have any effect on cataract formation.

"They sneak up on you, so you need to get checked." Chew adds. "They are also very common -- but treatment is safe, so get them treated as soon as possible."

Cataract surgery, for example, is generally a safe, effective procedure. In fact, cataract surgery is the most commonly performed surgery in the Medicare population, with nearly two million operations performed each year.

"If you have other eye issues, such as diabetes or macular degeneration, you should keep your expectations in check after cataract surgery," says Chew. "Your vision might not come back to normal. Careful follow-up is important."

Age-Related Macular Degeneration (AMD)

What is it?
Age-related macular degeneration (AMD) is a common eye condition among people age 50 and older.

In fact, it is the leading cause of severe visual loss in people over the age of 50 in the United States. Nearly 15 million people in the U.S. have the dry form, and 1.7 million people have the wet form. Approximately 200,000 new cases of wet age-related macular degeneration occur every year.

Dry AMD is the most common form, affecting 90% of people with the condition. It occurs when the light-sensitive cells in the macula slowly break down, gradually blurring central vision and possibly causing, over time, vision loss in the affected eye. Dry AMD does not cause complete blindness, however. While it can be difficult to do things requiring sharp vision (e.g., drive your car, read a book), affected people can see using their peripheral vision.

Wet AMD is more severe but less common, affecting only about 10% of people with the condition. It occurs when abnormal -- and often fragile -- blood vessels behind the retina start to grow under the macula and leak blood and fluid. This causes the macula to swell. Damage, such as scarring of the retina, can happen quickly. Eye care professionals can slow down or stop the progression of wet AMD if it is detected before severe vision loss occurs.

Is there a typical age of onset?
"The most common type of macular degeneration is age-related macular degeneration, which usually begins after the age of 60," says ophthalmologist George Williams of Oakland University. "However, visual loss from macular degeneration usually occurs after the age of 70."

What can older people do to prevent it?
"The causes of age-related macular degeneration involve a complex interplay among genetics, age, diet, and smoking," says Williams. "In genetically susceptible people, smoking increases the risk of visual loss by several times."

To help boost your chances of avoiding AMD, experts recommend the following healthy living best practices:

  • Avoid smoking

  • Exercise

  • Maintain normal blood pressure and cholesterol levels

  • Eat a healthy diet rich in green, leafy vegetables and fish

For wet AMD, early diagnosis and treatment can delay progression, and the sooner it's detected, the better chance you have of keeping your vision.

"Supplements that contain a combination of vitamins C and E, lutein, and zinc can decrease the progression of age-related macular degeneration, especially with the wet form," says the National Eye Institute's Emily Chew. Some studies show that the success factor for stopping the progression is up to 30 percent for people at moderate stage of macular degeneration. A comprehensive eye examination is required to determine who can benefit from vitamin therapy.

Other treatments to stop wet AMD vision loss include injections of drugs to block the growth of new abnormal blood vessels, photodynamic therapy, and laser surgery. It's important to note that these aren't cures.

"For the dry form, there's not much treatment," says Chew. "Some studies show that people who eat fish and green leafy vegetables reduce the risk of developing wet or dry by 25 percent or more."

How concerned should an older person be about getting AMD? "It is a game changer, since you could go blind from it," says Chew. "But there are good treatments now, so there's hope for helping people managing it better."

Diabetic Retinopathy

What is it?
Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness among American adults. The primary cause is the effect of high blood sugar on the retinal blood vessels.

In some people with diabetic retinopathy, blood vessels may swell and leak fluid. In others, abnormal new blood vessels grow on the surface of the retina, the light-sensitive tissue at the back of the eye.

Over time, diabetic retinopathy can cause vision loss. It usually affects both eyes.

Is there a typical age of onset?
"The age of onset of diabetic retinopathy is directly related to the age of onset of diabetes," says George Williams of Oakland University. "In type 1 or insulin-dependent diabetes, retinopathy is rarely seen before five years. However, with each passing year the risk of diabetic retinopathy increases. The onset of type 2 diabetes is often difficult to determine, and some people present with diabetic retinopathy as the first sign of diabetes."

What can older people do to prevent it?
"Everyone with diabetes should have regular, comprehensive eye examinations," says Williams. "Anyone diagnosed with type 2 or adult-onset diabetes should have a comprehensive eye examination soon after diagnosis. Between 40 to 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy. If you have it, your doctor can recommend treatment to help prevent its progression." Such remedies are focused on later stages of the disease and include scatter laser treatment, which helps to shrink the abnormal blood vessels, and a surgical procedure called a vitrectomy, in which blood is removed from the center of your eye.

Emily Chew of the NEI also stresses the importance of lifestyle factors in combating diabetic retinopathy. "Exams are important to detect warning signs that might not be readily evident," she says. "But you can reduce risk of getting diabetic eye disease by as much as 70 percent by controlling lifestyle factors. Losing weight; not smoking; keeping blood pressure, cholesterol, and blood sugar in check; and living healthier will help you stay in control of diabetes."

Low Vision

What is it?
Are you having trouble reading, writing, sewing, fixing things around your home, or seeing names of stores as you drive by them? Having such vision challenges might indicate that you have low vision, which is usually caused by eye diseases or health conditions, including age-related macular degeneration (AMD), cataracts, diabetes, and glaucoma. Eye injuries and birth defects can also cause low vision.

Is there a typical age of onset?
While vision loss can affect anyone at any age, low vision is most common for those over age 65.

What can older people do to prevent it?
"It's likelier if you have other age-related eye conditions that you'll develop low vision," says the National Eye Institute's Emily Chew. "If you suspect low vision, you best bets are to get an eye exam and see a low-vision specialist."

There are no specific foods and/or preventive measures older people can take to ward it off, other than doing whatever you can to avoid or minimize the effects of eye conditions such as age-related macular degeneration (AMD), cataracts, diabetes, and glaucoma.

Unfortunately, no matter the cause, lost vision cannot be restored. All one can hope to do is manage low vision with help from tools such as telescopic glasses, lenses that filter light, magnifying glasses, handheld and freestanding magnifiers, closed-circuit television/video magnification, and reading prisms.

about 2 years ago, said...

Have you ever considered making 'eye problem' articles in a larger font, so that those of us with eye problems could read them easier? Please?

almost 3 years ago, said...

The advice about what to do for your self if your vision is impaired, very helpful thanks