Healthy Aging

healthy aging

Aging and Vision

People have debated for generations about the most valuable of the five senses. Without entering that debate, it is safe to say that vision is very important.

Blindness affects approximately three million people older than 40. A progressive loss of vision is normal as we age. It is normal to not be able to see as well as we used to as we grow older, but a significant loss of vision may be abnormal.

What are the common problems with vision and age?

Normal loss of visual acuity means that images cannot be seen as sharply over time. This loss of vision is normal and common and is called presbyopia, which is the slow loss of ability to read small print or see close objects clearly. If you are older than 40 and need to move a newspaper away from your face to read it, or if you need magnification to read, you are experiencing normal vision loss. The most common treatment for this vision loss is glasses and using brighter lighting.

Cataracts result in the gradual impairment of light getting through the lens (see Figure 1 for lens). Cataracts are the greatest pathologic problem of the eye among aging people. Diabetes, cigarette smoking, excessive alcohol use, and prolonged or excessive exposure to ultraviolet light are risk factors for cataracts. The lenses become “cloudy” with a yellowish or brownish color protein deposition that adds a brownish tint to vision.  Ultimately, vision becomes blurred and is ultimately impaired. Symptoms include cloudy or blurry vision, poor night vision and glare from headlights, lamps or sunlight, Other symptoms include a “halo” around lights, double vision or multiple images in one eye. If undiagnosed or left untreated, blindness can develop. Initial therapy includes new glasses, anti-glare sunglasses, brighter lighting and magnifying glasses. Surgery is the most common approach to cataracts and involves the extraction or removal of the cloudy lens. Insertion of a clear plastic lens is effective in 90 percent of patients.

Age-related macular degeneration (AMD) is the most common cause of blindness in Americans older than 50. AMD blurs the sharp central vision used for reading, driving, sewing and other straight ahead vision.  Symptoms include straight lines becoming wavy (wet AMD – macular hemorrhage) or central blurring (dry AMD - macular exudates). As less of the macula (see figure for macula) functions effectively, central vision decreases and cannot be restored. Risk factors for AMD include smoking, obesity, Caucasian race, female gender and family history. A variety of treatments exist for AMD, including vitamins, antioxidants and zinc supplementation, intra-eye injection of monoclonal antibodies, and laser surgery. Each therapy must be tailored to the particular patient and the particular pathology (wet or dry AMD).

Glaucoma is multiple processes that go wrong, not a single problem.  Approximately 2.2 million patients have this problem. Risk increases with age and is prevalent in African-American, Mexican-Americans and people who have a family history. Glaucoma occurs when the fluid that normally leaves the eye is diminished. As when fluid in any “closed” system increases, such as the eye, so does the pressure. Pressure builds up within the eye and compresses the optic nerve, which sends vision signals to the brain. As a result, vision is impaired. Symptoms include the loss of peripheral vision, which causes people to feel like they are “looking through a tunnel.” Ultimately, if untreated, central vision may also be lost to blindness. Treatment includes specific medicines and surgery. Therapy is effective in preventing progression of the disease, but optic nerve destruction cannot be treated. Early diagnosis is essential.

Diabetic retinopathy is a common problem that increases with age and the longevity of patients with diabetes. Of people with diabetes who are older than 40, approximately 40 percent have retinopathy. Approximately 8 percent have vision threatened retinopathy. Diabetes causes retinal problems that progress to hemorrhage. These problems can lead to vision impairment due to retraction of the retina and, ultimately, blindness. Treatment is limited to vision-enhancing devices that lead to magnification. Enhanced lighting is also a strategy with other vision problems. There is no treatment once blindness occurs.

Diagnosis

The diagnosis of eye problems is easy. People older than 60 should undergo a complete eye examination at least every two years. The exam measures for reading acuity, measures pressure in the eye, and thoroughly examines the retina through dilated eyes. Most eye-related problems are treatable. And, the earlier a diagnosis is made, the more successful the treatment. The bottom line is that part of healthy aging involves undergoing regular eye exams — a responsibility that each of us must take for our overall welfare.

Figure 1

Eye illustration

From: NIH Senior Health

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