Eye Exams for Older Adults

New prescription
Image by Plutor used under the creative commons attribution license.

The importance of eye exams

Older adults are at higher risk for eye disease and vision problems, so you'll want to take very seriously any unusual symptoms someone you're concerned about may be having with his vision. That's because early detection and treatment can greatly reduce the risk of partial or complete blindness. Routine eye exams are crucial, too, as some eye diseases arrive without any warning.

How often should an older adult's vision be screened?

For those 65 and older, the American Academy of Ophthalmology recommends complete eye exams every year or two. If a person hasn't seen an eye doctor recently, it's important to schedule an appointment. Even if he isn't having any symptoms or any trouble seeing, it's possible to have an eye disease. There are often no obvious early symptoms of glaucoma, for example, and the disease progresses slowly. In fact, experts estimate that almost half of those with glaucoma don't know they have it.

A person may need more frequent exams (perhaps even more often than once a year) if he has certain medical conditions, like diabetes or high blood pressure, which may put him at higher risk for some eye diseases. The eye doctor might want to see him more often, too, if he:

  • Takes certain medications.
  • Has had a serious eye injury in the past.
  • Is African American (because of the increased risk of glaucoma).
  • Has a personal or family history of eye disease.

Who should do the eye exam

If you need to find an eye care provider, you can start by asking a primary care physician for a referral. You can also visit the National Eye Institute's website , which provides resources for finding eye doctors. If the person in your care has age-related eye disease, you may want to work with an eye doctor who's a low-vision specialist.

What to expect at the eye exam

An eye exam isn't painful, but it can be intimidating, so the person you're caring for might appreciate your company and support. If he's becoming forgetful or fearful, he may be comforted by a brief explanation of what to expect, even if he's had many eye exams before.

During the exam, the doctor may:

  • Ask about his health and any signs or symptoms of problems.
  • Look at the outside of his eyes.
  • Test how well he can see, using an eye chart of letters (called a Snellen chart) that get smaller as he moves down the chart. The doctor will ask him to read the chart -- which is usually placed 20 feet away -- out loud, first using one eye and then the other.
  • Do a refraction assessment. This test examines how light waves are bent as they pass through the cornea and lens. Refractive problems can cause nearsightedness, farsightedness, astigmatism, and presbyopia. Some doctors use a computer to measure the angles, while others shine a light into the eye and take a measurement. Afterward, the doctor w ill ask a patient to look through a device while she flips through various lenses in front of his eyes, asking him to rate how he sees through them. When she does this, she's trying to find the best possible lens for his glasses. (If he has trouble telling which lens works better for him, that's fine -- he can just say so.)
  • Test for peripheral (side) vision. There are several ways to do this. The doctor may use a computer that flashes lights to the right and left, or she may have him sit in front of a screen and stare at its center. In either case, the patient will be asked to say when he sees objects in his peripheral vision. Or the doctor may simply sit in front of him and cover one of his eyes while moving his hand in and out of his visual field. Looking at the doctor, he indicates when he can and can't see the moving hand.
  • Test for color blindness, using pictures of multicolored dots that form numbers.
  • Have him move his eyes in specific directions to evaluate his eye muscles.
  • Examine the health of his eyes with a slit lamp. This magnifying machine gives the doctor a good look at the many parts of the eye, including the cornea, iris, retina, optic nerve, and mac ula. She may put an orange dye in his eyes during this part of the exam; this dye enables her to more easily detect tiny tears or scratches, infections, or foreign objects. Tears eventually wash the dye away.
  • Examine the back of his eyes. To do this, the doctor may dilate them using eyedrops; this makes the pupils bigger to allow her a better look. She'll shine a light through the pupil to the back of the eye or use a bright light mounted on her forehead. She may also use the slit lamp to see more details. The patient may see afterimages when this exam is over, but that's perfectly normal. It's also normal for his vision to be blurry for several hours after his eyes are dilated.
  • Test for glaucoma. To do this, the doctor needs to measure the pressure inside of his eye, using one of several methods, called tonometry. The most common is to use a puff of air to see how light reflections change as air hits the eye. For more about each method of testing for glaucoma, visit the National Library of Medicine .
  • Give other tests as needed, depending upon the person's medical and eye history.

Eye symptoms to watch for

Even if the person in your care is diligent about scheduled eye appointments, you'll also want to make sure that he sees the doctor between visits if he has any unusual symptoms. These symptoms may or may not signify that something serious is going on.

  • Seeing floaters (tiny particles that drift across the field of vision) or flashes of light may mean nothin g at all or it may mean that he's experiencing a retinal detachment.
  • Tearing may be a sign of allergies or something in the eye, or it may indicate that a serious infection or corneal abrasion.
  • Vision loss might be due to a migraine, macular degeneration, or a number of other diseases or problems. Or he may simply need a stronger glasses prescription.

Err on the side of caution and have him contact the eye doctor if he notices any of these symptoms or anything else out of the ordinary, including:

  • A change in the appearance of his eye, such as bulging, crossed eyes, a change in iris color, a bump on his eyelid, or redness or swelling in or around his eye.
  • A change in his ability to see, including double vision, difficulty focusing, cloudy or blurry vision, seeing halos around lights, sensitivity to light or glare, poor night vision, seeing flashes of light, spots, or "cobwebs," sudden loss of vision (including central, peripheral, or side vision or a dark spot in the center of his field of vision), straight lines appearing wavy, inability to make out detail, need for more light than usual, trouble distinguishing colors.
  • A change in how his eyes feel, such as any excess tearing, discharge, itching, or burning, eye pain, tiredness, or inability to close his eyelid.

Things you might notice if an older adult is having trouble with his eyes

  • He's squinting or blin king more than usual, or he tilts his head to see things.
  • He seems sensitive to light or glare.
  • His eyelids or eyes have changed in appearance.
  • His eye often twitches.
  • He's bumping into or tripping over things, moving hesitantly, or walking close to the walls.
  • He holds things close to his eyes to see them.
  • He has trouble distinguishing faces or reading signs.
  • He often wears clothes that are mismatched or stained.

over 2 years ago, said...

General description of what each part of the eye exam is for. My 91 year old husband is about 17 years post cataract surgery and is always asking if things look "hazy" to me. Maybe we need to see his surgeon again and see if he needs a Yag laser treatment?


over 4 years ago, said...

Great article - lots of actual information, facts and helpful ideas. Thank you