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Aging adults and eye health

by Carolyn Rogalsky

By age 65, one in three Americans has some form of vision-impairing eye disease. Many of them are progressive and may be associated with chronic diseases like diabetes or rheumatoid arthritis. By detecting and treating these eye disease early through annual, dilated eye exams, seniors can preserve good vision as they grow older.

Every aging adult can expect some deterioration of vision, but serious eye problems associated with old age are caused by a disorder, not by aging itself. By age 65, one in three Americans has some form of vision-impairing eye disease. Many of them are progressive and may be associated with chronic diseases like diabetes or rheumatoid arthritis. The most common of these treatable eye conditions include glaucoma, diabetic retinopathy, macular degeneration, cataracts, and disorders of tear production, or dry eye.

While any vision change can impact your quality of life, these disorders, if untreated, can also compromise your health. Regular annual eye examinations by an ophthalmologist are your best protection. By detecting and treating eye disease early through annual, dilated eye exams, seniors can preserve good vision as they grow older. Have your doctor screen you for the following.

Cataracts

Cataracts are the most common cause of vision loss among older people. A cataract is a clouding of the eye's lens. The clouding blocks light from entering the eye and as the cataract grows, you experience progressive, painless vision loss.

Symptoms may include:

  • Blurred vision
  • Colors appear more yellow, less vibrant
  • Sensitivity to glare; appearance of rings of light (halos) around objects
  • Double vision

Although the cause of cataracts is unknown, some risk factors may include long-term exposure to sunlight, smoking, high cholesterol, diabetes and eye injury.

Treatment: Until vision is significantly impaired, cataracts usually require no treatment. A cataract can be removed in a short surgical procedure to replace the affected lens with a plastic one. By age 80, more than half of all Americans either have a cataract or have had cataract surgery.

Glaucoma

Glaucoma is an eye disease in which the fluid pressure inside the eyes slowly builds up, causing damage to the optic nerve and leading to vision loss--or even blindness, if untreated. Early detection is critical.

Symptoms may include:

  • Blind spots, or areas of vision loss over months to years
  • Subtle loss of contrast between objects and their background
  • Difficulty driving at night
  • Loss of side or peripheral vision

As the condition can be hereditary, people with a family history are at a higher risk, as are all older adults, African-Americans and Hispanic-Americans.

Treatment:
If detected early, glaucoma can be treated with prescription eye drops, laser therapy or surgery. Treatment options are always evolving--as are screening tests for early detection.

Age-Related Macular Degeneration (AMD)

Macular degeneration is deterioration of the macula--the central and most sensitive part of the retina. Among the elderly, it is the most common cause of irreversible central vision loss.

There are two types of macular degeneration: dry (non-neovascular) and wet (neovascular). The dry variety affects 90 percent of those with macular degeneration and progresses slowly and usually occurs in both eyes. The less common wet type can come on suddenly due to leaking blood vessels that have grown in, or under, the retina and can cause more severe vision loss than the dry form.

Symptoms may include:

  • Mild distortion in vision. For instance, straight lines may appear wavy; a central blind spot can occur. (Dry macular degeneration).
  • Abrupt and severe distortion of central vision--a large, dark spot appearing in the center of vision (scotoma). (Wet macular degeneration)
  • Difficulty reading, driving, seeing faces, watching TV (Advanced dry or wet)

Risk factors for developing macular degeneration may include high cholesterol, untreated high blood pressure, diabetes and smoking, all of which result in poor circulation to the retina, nutritional deficiencies, excessive exposure to UV light, and genetics.

Treatment: Although there is no cure for macular degeneration, there are many treatments. One evolving treatment--photodynamic therapy--may slow the progression of wet macular degeneration. The National Eye Institute's recent Age-Related Eye Disease Study also showed promising results for patients who took specified doses of antioxidant vitamins and zinc: they lowered the risk of developing more advanced stages of macular degeneration by approximately 25 percent.

Diabetic Retinopathy

Diabetic retinopathy is one of the complications of advanced or long-term diabetes. It is caused by leaking blood vessels that damage the entire retina, including the macula. While the effects of diabetic retinopathy vary, near vision can be distorted, and parts of the visual field may be blurred or obstructed.

Symptoms may include:

  • Blurred vision
  • Near vision distortion (difficulty reading)

The most important way that people with diabetes can protect their vision is by monitoring blood glucose levels strictly and visiting an eye doctor who specializes in the treatment of diabetic retinopathy regularly (in addition to being followed medically by a diabetes specialist and a dietitian).

Treatment: Keeping your blood sugar under control can prevent diabetic retinopathy or slow its progress. Laser surgery can sometimes prevent it from getting worse.

Dry Eye

Dry eye occurs when tear glands slow down. Elderly people frequently experience this disorder--nearly five million Americans 50 years of age and older are estimated to have dry eye. It's more common among women.

Symptoms may include:

  • Itching, burning eyes
  • Some vision loss

Dry eye is a side effect of some prescription drugs. A dry climate or exposure to cigarette smoke can worsen the condition.

Treatment: The use of a home humidifier, special eye drops (artificial tears), or ointments can help. In serious cases, special contact lenses may be recommended.

Tips to Preserve Eye Health

  • See your general physician regularly to check for diseases like diabetes and high blood pressure. These diseases can cause eye problems if not treated.
  • When outdoors, protect your eyes by wearing sunglasses that block ultraviolet (UV) radiation and a hat with a wide brim.

Have your eyes checked regularly by an ophthalmologist or optometrist. People over age 65 should have yearly eye exams. The exam should include dilation of your pupils to check the health of your inner eye.