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Thinking objectively about elder eye care and visual decline

by Isabel Fawcett, SPHR

As in all other areas in life, eldercare comes with its own challenges needing to be prioritized. For some elders, chronic illnesses and advancing age may include diseases of the eyes. Thankfully, there is a medical spotlight focused on identifying and treating chronic eye diseases such as macular degeneration, cataracts and glaucoma. Even absent diseases of the eyes in elders, age-related vision decline and functioning is undeniable. What then?

"What Do You Expect?"

In my early 20's, I sat reading in an ophthalmology group practice waiting area. I had been scheduled for a routine eye doctor appointment.

Suddenly, the serenity of the waiting area was shattered by a clearly exasperated voice. One of the ophthalmologist's back in the patient area had broken the medical office karma. The doctor's exasperation, intonation, and harsh words were loud and clear, even outside in the patient waiting area. "What do you expect, for God's sake? You're 94! That's as good as it gets for you at 94. It's better than being blind! At least you're not dead!"

In Spanish there is a saying, "Tragame tierra!" (English translation, Earth, please swallow me now- please!) When the earth did not open up to swallow me, I held my breath, embarrassed for the 94-year-old patient, whom I did not know nor had I seen. I didn't have to see the gentleman to be devastated by an insensitive ophthalmologist's words to an elder. We all get there one day, I thought, as I held my breath for what seemed like an eternity. The elder's replies were muffled even as the doctor's voice escalated in humiliating undertones.

Just as well that I never saw the elderly patient. I got the doctor's hard-hitting message, loud and clear. For more than a week, I was troubled by the implications of the doctor's delivery and overarching message about the inevitable decline in elders' eyesight.

Now that I am a caregiver to an octogenarian, I am thankful for Mom's superior ophthalmology care. On the one hand, I was entirely surprised that on the heels of Mom's cataract surgery in each of her eyes, not only did her vision improve as her ophthalmologist told her it would, but she seldom needs her prescription bifocals even years after her surgeries were performed. Her vision remains stable.

Stable vision is not 20/20 eyesight, yet it is great given some of the harsh realities that otherwise manifest with advancing age.

Practical Eye Care Considerations for Elders and Their Caregivers

"The Decisions Necessary When Elders Need New Glasses or Hearing Aids Are Complex" was written by EldercareLink's Editor-in-Chief, Carol Bradley Bursack. Ms. Bursack's article speaks to complicating care circumstances for elders' eyes, ears and teeth. What works, what doesn't, and, most importantly, "when to ditch the guilt." All fall under much larger issues relative to elders' eyesight and decline with advancing age.

There are some practical decisions to consider relative to eye care for elders, more so if there is any chronic health condition involved.

1. Even if an elder has no known eye diseases, as one ages, choosing a skilled ophthalmologist instead of an optometrist may be worth it. Ophthalmologists, unlike optometrists, are medical doctors (M.D.'s). In many states, optometrists are authorized to treat many of the same medical conditions of the eyes as M.D.'s do, but not all. If in doubt, check with your state's board of medical practitioners, or comparable medical association. By choosing an ophthalmologist sooner rather than later in life, diseases of the eye such as cataracts and macular degeneration may be more timely identified and addressed.

2. If an eye doctor has made a declarative statement that an elder's vision is as good as it will be, absent seeking a second opinion, a magnifying glass or pharmacy readers may be all that is left for the elder and his or her caregiver to consider. Even those may not work. If they do not work for an elder's declining eyesight, I trust that you and I will be kinder, gentler and demonstrate greater common sense than that infamous ophthalmologist I heard in my 20's. Encouragement and soft words are all that's needed if or when that day of increasingly diminishing eyesight comes for any of us.

3. Elders may need to visit professional opticians often. That's ok. Elders are like anyone else who occasionally sits on, sleeps on, loses, and occasionally may step on their eyeglasses. Only you know your elder's tendencies and history with the care of eyeglasses and personal belongings. It may be worthwhile to select twistable, bendable, near-indestructible eyeglasses. Think about eyeglasses in terms of their durability, anti-reflective coating elder needs, and the scratch-resistance of lenses. Don't be afraid to ask a professional optician as many questions as you need to better assist your elder's vision care.

4. Dimmers and candlelit rooms may be romantic, but declining vision is better served by good lighting. With age, eyes may take longer to adapt in dark and/or poor lighting conditions. Think this through if your elder decides to go with automatically adjusting light-sensitive lenses. It may take an elder's eyes a little bit longer than it takes his or her self-adjusting lenses to automatically transition to changes in lighting.

5. Post-laser surgery recovery may include greater light sensitivity. Being too close to a bright lamp, for example, may not be the best seat in the house for an elder even if the person needs extra lighting to read and see.

Caregivers' Eyes: Open Wide

Perhaps the very best care strategy for our elders' vision issues is careful observation and planning by their caregivers. We can help soften one of the many physical and psychologically devastating assaults of advancing age for our elders.