Eye problems in senior citizens are common. While some diseases are a part of the natural aging of eyes, other problems are specific to the eye that are more common or get worse with aging. In addition, systemic illnesses can cause eye diseases that worsen with age. As some eye problems in seniors may develop without warning, it is important to pay attention to your vision and get regular eye exams as you age.
Age-Related Macular Degeneration
Age-related macular degeneration (AMD) is a disease of aging of the macula of the retina, a small spot in the middle of the retina in the back of the eye you need for sharp vision. It doesn't often lead to complete blindness, however, as the blurred or blank area of your vision gets bigger, your ability to see deteriorates.
AMD can affect one or both eyes. According to the National Eye Institute (NEI) of the National Institutes of Health (NIH), it is a common eye disease in people over age 50 but is more likely to occur after age 60. The risk factors for AMD include:
- Caucasian race
- Family history of AMD
- High blood pressure
- High cholesterol
According to the NEI information, AMD affects the center of your vision but spares the side (peripheral) parts. Symptoms can include:
- Blurred or dull the center of vision which may get bigger and go completely blank
- Difficulty seeing faces
- Problem distinguishing colors
- Floaters which are black spots or small specks that appear when you blink or move your eyes
- Difficulty reading, driving or watching TV
Findings on an eye exam include:
- Yellowish deposits (drusen) in the retina around the macula
- Atrophy and whitening of the macula
- Overgrowth of small blood vessels in the macula.
- Scarring of the macula from healing of the effects of the blood vessel problems
The NEI article advises that people with AMD to:
- Avoid smoking, which is a risk factor
- Get enough exercise
- Eat dark green, leafy vegetables and eggs for lutein and zeaxanthin, or foods with beta carotene
- Eat fish for omega-3 fatty acids
You can take a supplement instead that has the above nutrients and includes vitamins C and E, zinc and copper. Two NEI studies suggest that this can help slow progression of advanced AMD. Look for the AREDS (Age-related Eye Disease Studies) label to know that you are choosing the right brand.
- Make sure your house is lit appropriately so you can see as well as possible.
- For safety pay attention how you place things around your house as well as the safety of your daily activities.
- Because of the diminished central vision take care while driving.
- Consider use of hand-held magnifiers for everyday tasks to focus and see things clearer.
- An eye doctor might also suggest laser treatment for some people who leaks fluid or blood from vessels under the macula.
Cataracts cause whitening or cloudiness on the lens of the eye. This prevents light from getting through to the retina. Cataracts start out small and grow slowly. They can affect one or both eyes.
Cataracts can begin between age 40-50 but are more common, and worsen vision after age 60, according to the NEI. By age 80 at least 50% of Americans over age 80 have them, according to the National Institute of Health statistics. Risk factors for cataracts include:
- Family history
- Steroid use
- Eye trauma
- Radiation exposure
- Exposure to ultraviolet rays from the sun or tanning beds
Symptoms of cataracts include:
- A dulling or haziness of vision in the location of the cataract
- Double vision
- Fading or yellowing of colors
- Reduced night vision
- A sensitivity to lights
- Halos around lights and glaring of lights, which impacts night driving
Cataracts usually start small and grow slowly but they cause increasing difficulty with vision when they affect a bigger area of the lens.
On the eye exam there are varying degrees of cloudiness, whitening, yellowing or browning of the lens, or radial spokes in the lens.
To function with cataracts:
- Use glasses to help sharpen your vision.
- Pay attention to safety around the house and in daily activities.
- Use brighter home lights if your vision is dim; use softer lights if you have bright lights sensitivity and glare.
- Wearing sun glasses outside to help decrease the light sensitivity and sun glare.
- If the condition is advancing, you might have to avoid driving at night because of the poor night vision and the glaring effects of lights.
If adjusting lights or eye glasses don't help, you may need surgery to remove and replace the lens. Cataract surgery is safe and effective and is done as outpatient and is paid for by Medicare.
Glaucoma is a group of disorders which lead to damage of the optic nerve and diminished vision. High pressure inside the eye damages the optic nerve which is how light signals get to your brain so you can see. It usually involves both eyes, but it can affect just one.
The NEI states that glaucoma is a common cause of blindness in the United States, especially for individuals over the age of 60. It is more common in African Americans after age 40 and Mexican Americans after age 60. Risk factors for glaucoma include:
- Family history
- Eye injury
- Eye infection or inflammation
Symptoms and Signs
According to the NEI, Glaucoma can be present for years without affecting vision in any way. If it remains undetected and untreated, it can cause a loss of parts of your field of vision, usually the side parts first, then later the center of your vision. Because of this seniors, especially those at risk, should get regular eye exams and eye pressure measurements every one to two years.
Management of glaucoma includes:
- Paying attention to safety such as placement of objects around the house, daily activities and driving
- Using prescription eye drops or oral medicines to lower eye pressure.
- Protecting your eyes from injury that may lead to glaucoma.
- Laser surgery or conventional surgery to relieve eye pressure
Diabetic Retinopathy is caused by the effects of high blood sugar which leads to abnormalities in the small blood vessels (capillaries) of the retina. Vision problems worsen as the blood vessel disease advances and new blood vessels grow (proliferate). The disease can start in younger people and advance with age. It can also be present at the time of the initial diagnosis of diabetes in seniors.
The NEI states that 40-45% of diabetics have some degree of retinopathy. Pregnant women are particularly at risk for worsening disease. Diabetic retinopathy affects type 1 and type 2 diabetics and is a common cause of blindness in middle-aged Americans, according to the NEI. The disease is more common in African Americans and can be more common and severe in diabetics with:
- Long-standing diabetes
- Diabetic kidney disease
- Abnormal cholesterol and triglycerides
- High blood pressure
It often accompanies cataracts and glaucoma as part of the combination of "diabetic eye disease."
Diabetic retinopathy can advance without symptoms or vision loss. Vision problems can be mild and later worsen as retinal changes progress. Symptoms include:
- Distorted or blurred vision
- Floaters (dark specks of lines that float across your vision)
- Loss of patches of the visual field
- Loss of vision
- Blurring or loss of central vision if the macula is affected
Vision changes are caused by abnormalities of the blood vessels in the retina. The NEI describes changes in the blood vessels and retina changes that include:
- Aneurysms in blood vessels
- Hemorrhage in blood vessels
- Optic nerve damage
- Leakage of fluid (exudates) or blood in the retina and eye
- Over-growth (proliferation) of the blood vessels which can lead to severe loss of vision
- Swelling of the retina because of fluid collection (edema), including the macula, the cause of loss of central vision.
- Detachment of the retina from its underlying tissues because of water in the retina
There is no cure for diabetic retinopathy so the best thing is to prevent the disease by keeping blood sugar in good control with a good diet, exercise and diabetes medicines as needed. Management of the disease includes:
- Regular eye exams to diagnose and treat eye changes early to protect vision
- Corrective glasses as needed
- Consider brighter indoor lighting if your vision is dim
- Attention to household and driving safety if you have difficulty seeing
According to the American Academy of Ophthalmology, there are also eye medicines you can take. Surgical treatment options include photocoagulation of abnormal blood vessels. Laser therapy is also available for other retinal changes and the macular edema.
Hypertensive retinopathy is a disease of the retina caused by high blood pressure. The higher the pressure the more the potential for damage to small blood vessels in the eye and in turn the retina and the macula. The blood vessel changes in the retina reflect the effect of high blood pressure on other blood vessels in the body and can become narrow or blocked.
According to the American Academy of Ophthalmology the severity of hypertensive retinopathy depends the duration of the high blood pressure. The eye changes will therefore be more advanced in seniors with long-standing, poorly-treated high blood pressure. Other factors that can worsen the problem include:
- High cholesterol
Symptoms of hypertensive retinopathy include:
- Dim or blurred vision
- Double vision
- Loss of vision can occur if the damage is severe and irreversible.
High blood pressure can cause visible signs on eye exam:
- Leaking of fluid and hemorrhage from small blood vessels in the retina
- Narrowing of the blood vessels
- Fluid in the tissues of the retina
- Swelling of the optic nerve and the macula
- Keeping blood pressure low with medicines can revert some of the early retinal changes but not the damage to the optic nerve and macula.
- Eye glasses can help to improve blurred vision in less severe disease.
- Because of the dim, blurred vision and decreased vision, proper lighting in the home will help prevent falls and other accidents.
Your eye doctor might suggest surgery with photocoagulation or laser treatment of the blood vessel problems in more advanced disease.
Presbyopia is a problem of the natural aging of the lens of the eye, unrelated to any specific disease. The lens becomes more rigid and you gradually lose your ability to see close or small objects. This eye problem is increasingly more common after age 40, according to the American Academy of Ophthalmology.
Symptoms and Signs
Presbyopia may make you have:
- Difficulty with seeing to read a book , threading a needle, sewing, cooking, or reading road signs or the dashboard instruments in your car
- Light and glare sensitivity
- Loss of side vision and depth perception
Without corrective glasses you might find yourself holding a book and other objects at arms length to see them.
Living with presbyopia includes:
- Use of reading glasses which might include bifocals to help you see close and distant objects
- Magnifiers mounted on reading glasses or hand held for close up work such sewing, reading, cooking
- Magnifiers mounted to the monitor for computer work
- Large print books or audio tapes
- Large numbered clocks and watches
- Using softer indoor lights, and wearing sunglasses while in the sun, can help the light and glare sensitivity
- Using brighter lights indoors to see better (if the person with presbyopia isn't sensitive to glare and lights)
Dry eyes come from not making enough tears or from an abnormal quality of tears. Tears lubricate your eyes and help keep them healthy. Chronic dryness can damage the eyes, especially the cornea.
Dry eyes, according to the American Optometric Association, is a common condition in the elderly and can interfere with vision but rarely cause blindness. In addition to aging other risk factors for dry eyes include:
- Environmental factors such as wind, sun, dryness, heat, cold, smoke
- Medicines such as antihistamines, blood pressure medicines and antidepressants
- Medical conditions such as thyroid disease, diabetes, arthritis, Sjogren's syndrome and other autoimmune diseases
Symptoms and Signs
Symptoms of dry eyes can occur in both eyes and include:
- Blurred and decreased vision
- Excess tearing to try to compensate
- Inflammation and redness
Chronic dry eyes can lead to ulcers or scarring of the cornea and the lining of the eyelids and eye (conjunctiva).
You can improve your dry eyes by:
- Use of a humidifier in the house or your bedroom to keep moisture in the air
- Using eye drops with artificial tears in the eyes
- Taking nutritional supplements such as flaxseed oil
Check with your doctor for specific product recommedations.
In retinal detachment, according to the Harvard Journal of Ophthalmology, the retina separates from its underlying tissue at the back of your eye. This may start as small tears in the retina and advance to a bigger detachment.
Most often retinal detachment is spontaneous and more common in near-sighted people and seniors over age 50 according to the Harvard journal article. It can also be caused by problems such as:
- Family history of retinal detachment
- Trauma to the eyes, including rubbing them hard
- Eye inflammation
Symptoms and Signs
Symptoms can include:
- Light flashes
- Eye pain
- Dark patches in front of your eyes depending on the size of the detachment
- Blurred or double vision.
If you notice any of they symptoms or signs see a doctor promptly for evaluation and treatment to prevent progression of the detachment and blindness. Treatment may include surgical procedures depending on the extent of the problem.
Giant Cell Arteritis
According to the National Institutes of Health (NIH) giant cell or temporal arteritis is caused by inflammation or blockage of small arteries on the side (temple) of the head. It may be an autoimmune disease and can lead to blindness in the elderly.
The NIH states that giant cell arteritis is more common in those who are over age 50 and have for those who have a family history. It is less common in people of African descent.
Symptoms and Signs
Symptoms of giant cell arteritis include:
- Tenderness or pain in the temples face and head
- Blurred vision
- Reduced vision
- Double vision
- Sudden and permanent loss of vision if the arteritis advances
Treatment of giant cell arteritis includes taking steroids by mouth. If you have chronic or recurrent tenderness or pain in your temples, face or head, accompanied by difficulty with your vision, consult with your doctor. Early diagnosis and treatment of giant cell arteritis can prevent permanent loss of your vision.
Low vision according to the American Academy of Ophthalmology (AOA) is caused by a significant decrease in your vision that can't be helped with glasses, magnifiers, medicines or surgery. Severe or profound low vision can significantly limit a person's ability to function.
The risk of low vision increases with aging though it is not caused by aging. The NEI notes that low vision can be the result of diseases of the eye such as:
- Age-related macular degeneration
- Diabetic Retinopathy
- Eye Injuries
Symptoms and Signs
With low vision various parts of your ability to see can be affected. Symptoms of low vision include:
- Diminished or blurred vision and your ability to see gets more limited as the problem worsens
- Loss of parts of the field of vision such that parts are blanked out
- Difficulty telling the contrast between objects that are similar in color, for example milk in a white cup
- Problem with depth perception; objects may look nearer or farther than they actually are
- Difficulty with daily tasks such as reading, writing, driving and recognizing faces
People with uncorrectable low vision can learn to function to their best ability with vision aids and other resources according the American Optometric Association. There are also rehabilitative services, including government programs covered by Medicare.
Other Problems of Aging Eyes
The Cleveland Clinic notes that other general eye problems can occur more frequently in seniors because of the aging or increased vulnerability of the eyes.
Problems of the Cornea
Problems of the cornea that occur because of increased susceptibility of the eyes in seniors include:
- Infection or inflammation
- Dry eyes
- Injury from head or eye trauma
- Exposure to environmental toxins and conditions
Symptoms include reduced vision, halo around lights, teary eyes and eye pain.
Management includes protecting the eyes from trauma and exposure with protective or corrective eyeglasses. In addition use of eye drops and covering the eye until it heals can protect the cornea.
These dark spots or small lines that can come with aging eyes don't always signify disease. Sometimes, however, they could be a sign of retinal detachment and retinal problems because of diabetes or high blood pressure, so you should see your doctor if they appear suddenly.
Floaters drift across your vision when you blink or look around. They are especially noticeable in a lit room or on a sunny day.
Seniors are more prone to inflammation or infection of lining of the eyelids and eyes. Symptoms include redness, itching, burning, teary eyes or pain. Management includes avoiding exposing eyes to infectious or toxic substances. Use of eye drops and an eye patch can protect the eye while it heals.
In addition to dry eyes, seniors are prone to teary eyes. This usually comes from sensitivity to light, wind, temp and infection or because of blocked tear ducts. Dry eyes can also cause the eye to increase tears to try to compensate. Use of sunglasses to protect the eyes can be helpful.
Coping With Vision Problems
Vision problems are common in senior citizens, so it is important to to get regular eye exams at least every one to two years, especially after age 60. This is even more important if you have a disease that can cause eye problems or you are at risk for eye problems.
It is vital to evaluate your environment at home or outside, such as lighting and obstacles, if your vision is diminished. Also adjust your activities to ensure that you can function safely if your vision has changed with age. Lastly, check out resources and services that can help you function at your best with the changes in your vision.