Aging brings wisdom, experience, and often, a host of changes -- including those that affect our vision. "By the time...
Aging brings wisdom, experience, and often, a host of changes -- including those that affect our vision.
"By the time most people reach their forties, the eye begins to undergo physiological changes that can impact clarity, focus, comfort and overall visual function," explains Dr. Sandra Belmont, an ophthalmologist and corneal specialist at Manhattan Eye Ear and Throat Hospital/Northwell and at the New York Eye and Ear Infirmary of Mount Sinai. She points out that "these issues can range from benign and easily corrected to serious conditions that may threaten sight if untreated."
Read on to learn about the most common eye diseases and conditions that can develop as we age, and how they are treated.
One of the most noticeable is a change in how we see close-up objects. Called presbyopia
, this condition is different from garden-variety farsightedness and results from a loss of flexibility of the lens in the eye -- the lens gets more rigid and it's simply more difficult to focus on objects near to you. It's a relatively easy problem to correct -- many of us simply reach for a pair of "cheater" reading glasses or a flashlight to help navigate the fine print of restaurant menus and other small type in low-lit areas. Others find it might be time for that first pair of prescription glasses.
Technically, presbyopia is the gradual loss of the eye's ability to focus on nearby objects. It's a universal age-related condition that typically becomes noticeable in the early to mid-forties. Presbyopia results from a loss of flexibility in the lens inside the eye, behind the pupil and the iris, and weakening of the ciliary muscles that help the lens change shape to focus. As it progresses, you will notice a difficulty reading small print, eyestrain or headaches after close work, and a need to hold reading materials farther and farther away to focus. Eventually this will lead to a need for reading glasses, bifocals or progressive lenses.
"When patients qualify, we can perform laser vision correction to correct for presbyopia for those who would prefer not using contact lenses or glasses altogether," notes Belmont. She reiterates that laser vision correction, or LASIK eye surgery, is a safe effective and painless, one-time procedure to eliminate the need for distance and reading glasses.
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Cataracts
Cataracts are a clouding of the eye's natural lens. Cataracts typically progress slowly, causing blurred vision over time. Left untreated, the lens will gradually become opaque because of protein clumping and oxidative damage. Symptoms may include a gradual or progressive decrease in vision. Many people begin to notice that their glasses are no longer helping to correct their visions. They also will frequently notice problems from the glare of bright lights, particularly when driving at night.
By age 80, more than half of Americans either have a cataract or have had cataract surgery. Early-stage cataract may be managed with stronger eyeglasses, magnifying lenses and improved lighting. As it progresses, surgical removal of the cataract will be necessary. Using a surgical procedure, your ophthalmologist can remove the clouded lens and replace it with a specially designed artificial lens.
"Currently, laser-assisted cataract surgery provides a safer, more precise and efficient alternative to the older, all manual, cataract extraction," Belmont says.
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Glaucoma
Glaucoma is a group of eye diseases that damage the optic nerve, often associated with high intraocular pressure. Glaucoma can lead to irreversible vision loss as the optic nerve. Glaucoma may not be noticeable at first because it typically affects your peripheral vision first. Due to the early stages of glaucoma having no symptoms, Belmont dubs the condition "the thief of sight."
"As it progresses, glaucoma leads to a loss of peripheral vision resulting in tunnel vision and complete vision loss in advanced cases," Belmont says. "Treatment options include the use of eye drops to lower intraocular pressure or oral medications."
In some cases, laser therapy will be necessary to assist in the drainage of fluid from the eye. Proper management and vigilance are required to help prevent vision loss.
Age-related macular degeneration (AMD)
AMD affects the macula, the central part of the retina, leading to a loss of central vision. It's the leading cause of blindness in people over 60. There are two forms of macular degeneration -- dry (non-neovascular or non-exudative) and wet (neovascular or exudative).
The American Macular Degeneration Foundation reports that about 90% of all cases of age-related macular degeneration are the dry form, in which the cells of the macula atrophy, and drusen -- small piles of waste from the cells -- may build up on the retina, resulting in a slow progression of vision loss. In wet AMD, abnormal blood vessel growth damages the macula.
Symptoms include straight lines appearing wavy and blurred or reduced central vision as the condition progresses.
Patients with the wet form may need injections of medicine into the eye, which would be completed as a clinic procedure. Some with the dry form may be able the manage the disease with eye drops and vitamins that support vision, such as lutein, vitamin C and vitamin E. Other treatment options to slow down the progress of dry AMD include quitting smoking and a healthy diet that includes plenty of leafy greens.
Diabetic retinopathy is an eye disease that affects the tissues in the back of the eye -- called the retina -- which process light and vision for the brain. A complication of diabetes, diabetic retinopathy damages the small blood vessels in the retina, potentially leading to blindness if untreated. High blood sugar levels can cause the retinal blood vessels to leak, swell, grow abnormally or be blocked. If that happens, the lack of normal blood and oxygen flow can cause a loss of tissue function that seriously affects vision.
Many times, diabetic retinopathy has no symptoms until it's too late -- and that's why regular eye exams are so important. Symptoms include seeing floaters or dark spots, blurred vision and eventual vision loss. Treatments include controlling blood sugar, anti-VEGF injections, focal/grid laser therapy and in severe cases, vitrectomy surgery, which involves removing vitreous gel from the eye to access and treat the condition.
Blepharitis
Blepharitis is a chronic inflammation of the eyelids, typically affecting the base of the eyelashes and the meibomian glands, which are glands in the upper and lower lids that are responsible for producing the oils that are secreted to prevent evaporation of the tear film. If left untreated, patients will develop red, swollen, itchy eyelids, crusting or dandruff-like flakes on the base of the lashes, and/or a gritty or burning sensation and blurry vision. The symptoms of blepharitis can be reduced through lid hygiene, warm compresses or eyelid scrubs with diluted baby shampoo or commercial wipes. Topical antibiotics may be needed in more severe cases, along with omega-3 supplements to reduce inflammation.
I perform several painless, in-office procedures without any downtime to help restore a healthy lid margin. These include manual expression of the meibomian glands, radio frequency and thermal pulsation and eyelid exfoliation. Blepharitis can also lead to evaporative dry eye.
Evaporative dry eye
This condition occurs when tears evaporate too quickly due to an imbalance in tear composition, particularly the lipid layer. It often coexists with a meibomian gland dysfunction (a key component of blepharitis). When the meibomian glands fail to function properly, the tear film becomes unstable, which can lead to damage of the ocular surface. Patients with evaporative dry eye will experience dry, itchy or burning eyes, a foreign body sensation, fluctuation or blurred vision, redness and light sensitivity. Evaporative dry eye can be managed with use of artificial tears and lubricating gels.
Treatments include warm compresses and lid massage to express the glands, omega-3 supplements, medicated eye drops and punctal plugs.
"For more advanced cases, I perform several in-office procedures, including manual expression, radio frequency and thermal pulsation and eyelid exfoliation," says Belmont.
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Floaters and posterior vitreous detachment (PVD)
Floaters are small clumps of gel or cells in the vitreous humor that cast shadows on the retina. PVD occurs when the vitreous pulls away from the retina, often with aging. Here the vitreous body can begin to liquify and shrink. The retina may also experience tugging consequently, leading to a retinal tear.
Symptoms include a sudden increase in floaters, flashes of light and a shadow or curtain over part of the vision which is an urgent concern. Strict monitoring is necessary in most cases. In severe cases a vitrectomy can help disable the floaters. Retinal laser repair may also be performed to address retinal tears or detachment.
Color vision changes
Subtle changes in color perception are common as we age, typically becoming noticeable in a person 50s or 60s. These develop as the lens inside the eye starts to yellow with age, which filters out blue light. The cone cells in the retina may also lose sensitivity. Patients will notice difficulty distinguishing similar colors (especially blues or purples) a faded or muted light perception. Color corrective lenses may help in milder cases. As the lens inside the eye yellows and a cataract develops, cataract surgery will restore vision by replacing the yellowed lens in the patient's eye.
Reduced night vision
Difficulty seeing in low-light conditions is also common with age due to slower pupil response and changes in the retina. As we age the pupil becomes less responsive and the rods in the retina decline in function. Patients will experience trouble driving at night, difficulty adjusting to darkness and glare or halos from lights. Anti-reflective glasses may help, and a diet rich in vitamin A. Where a clouded lens is contributing, cataract surgery will help.
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Belmont states that "while not all age-related vision problems can be prevented, many can be managed or their progression slowed with proper care."
-- The management and maintenance of blepharitis and macular degeneration with annual ongoing in-office treatments
Vision changes after forty are a natural part of aging, but they need not diminish your quality of life. From presbyopia and cataracts to blepharitis and dry eye, understanding the underlying causes and available treatments is the first step toward preserving your vision.
Modern ophthalmology offers a wealth of solutions -- from simple glasses to advanced surgeries and innovative therapies. Partnering with your eye care provider for regular checkups and prompt treatment ensures you maintain not just your eyesight but your overall well-being.
"If you're experiencing any changes in your vision or discomfort in your eyes, don't delay. Early intervention often makes all the difference in protecting your sight for the years ahead," Belmont says.