The Aging Eye
Wrinkles on our skin, weakening bones, and slowing of our metabolism with subsequent weight gain are all very familiar aging changes. Attempts to slow down or minimize the impact of these changes is a multi-billion dollar industry. But do you know what happens to your eyes as you age? Of the five senses, many people are most afraid of losing their vision as they get older. Despite this, many are not aware of what they can do to care for their ocular health and neglect getting routine eye care as they age.
The most obvious aging change that occurs in the early 40s is called presbyopia, which affects the ability of the eye to focus up close. A tell-tale sign of presbyopia kicking in is the feeling that holding reading material further away or increasing the font size makes it easier to see. Eventually, your arms just aren’t long enough, and either reading glasses or bifocals are required. It may be a surprise that many people in their 40s start wearing contact lenses for the first time with the onset of presbyopia. For people who have been glasses-free their entire lives, the sudden dependence on glasses can be very troubling. Monovision or multifocal contact lenses are the solution for those who are looking to minimize their need for near vision glasses. If you are affected by presbyopia, see an eye doctor who can make sure that you are seeing your best and are using the most appropriate prescription.
Drying of the eyes is another very common aging change. As we age, the ability of our eyes to produce the tears and good quality oils that are necessary for a healthy ocular surface diminishes. This can lead to chronic grittiness, burning, and light sensitivity. Dry eye can also cause excessive tearing, which is very counterintuitive to what most of us imagine is a “dry” eye. When dry eye is severe enough, it can cause blurred vision, ocular pain, and significantly affect quality of life. In its milder forms, it can be a daily frustration and can cause contact lens intolerance. According to a recent estimate, Americans spend about a third of a billion (yes, billion!) dollars on over-the-counter eye drops each year. Over-the-counter eye drops can provide temporary relief from dry eye symptoms, but generally do not alter the course of dry eye disease – and in some cases, can exacerbate dry eye with chronic use. There are a multitude of treatment options for dry eye other than over-the-counter drops, so if you are suffering from dry eye symptoms, seek out the advice of an eye doctor who has a special interest in treating it.
Cataracts begin to affect vision for most people in their 60s or beyond. A cataract develops when the lens of the eye becomes cloudy. They are an expected and normal aging change that happen to just about everyone. Symptoms often develop slowly and can include blurry, hazy, or dim vision. People with cataracts often describe their vision as similar to looking through smudged glasses or a dirty windshield. Cataracts can also cause difficulty with seeing at night due to glare and halos. UV exposure and smoking are important risk factors for developing them. In the early stages, cataracts can cause changes in the glasses or contact lens prescription, and simply making those adjustments is enough to keep vision sharp. In more advanced stages, if the cataract is affecting your ability to perform daily tasks, a cataract surgeon can remove it and replace it with a clear lens implant. Cataract surgery is one of the most commonly done surgeries in America; it is an outpatient procedure and improvement in vision is generally appreciated soon afterwards.
Aging increases your risk for other ocular conditions that can be potentially devastating to your vision. One such condition is glaucoma. Glaucoma is a group of diseases that damages the optic nerve, the cable that carries visual information from the eye to the brain. The most common type of glaucoma develops as a result of increased pressure inside of the eye. Glaucoma is sometimes called the “silent thief of sight” because it can cause irreversible damage to the eye before there is any vision loss, and it doesn’t cause any symptoms, such as eye pain. Glaucoma causes a loss of peripheral vision, resulting in tunnel vision, and ultimately can lead to blindness. There are treatments to delay vision loss, but there is no cure for glaucoma. Treatments include eye drops, lasers, and surgery. More than 2.7 million people in America have glaucoma, and there are many people who have the condition, but don’t realize it. Being screened regularly for glaucoma by way of having an annual eye examination is a very important preventive measure to protect your eyes from vision loss as a result of undetected glaucoma. With early detection and treatment, it is possible to slow its progression and preserve vision. Anybody can develop glaucoma; however, you are at higher risk if you have a family history, are African American or Hispanic, have high levels of either farsightedness or nearsightedness, have a history of an eye injury, have low blood pressure, or are diabetic.
Age-related macular degeneration (AMD) is another ocular condition that is highly associated with aging and has potential to cause significant reduction in central vision. Macular degeneration is the leading cause of vision loss, affecting more than 10 million Americans. The retina is the delicate layer of nerve cells lining the back wall of the eyeball. This layer senses light and sends signals to the brain via the optic nerve so that visual images can be formed. AMD damages the macula, the central part of the retina, which can make tasks involving central vision such as reading fine print or distinguishing facial details much more difficult. The dry type is the most common form. Many people with dry AMD do not know that they have it because it often does not affect vision in the early stages. It can cause subtle changes in vision, such as making straight lines appear wavy or causing small parts of letters or words to be missing. Needing more light to see comfortably is also common in those with AMD. The wet type causes sudden, severe loss of central vision from leaking blood vessels growing in or under the retina. It can cause a large dark spot in the center of your vision and significantly distorted and blurred vision. Dry AMD can develop into wet AMD, so it’s important to know if you have it, even if you do not have any symptoms. If you have dry AMD, you may be monitored more closely and may be given specific recommendations about lifestyle changes or nutritional advice that may reduce your risk for developing wet AMD. AMD is more common in caucasians and in those with a family history. Smoking doubles the risk, and UV exposure, obesity, and poorly controlled cardiovascular disease or high blood pressure are also important risk factors for AMD development. If you have macular degeneration or have many risk factors for developing it, your eye doctor will likely recommend nutritional supplementation in the form of vitamins and minerals, including zinc, vitamins C and E, and the carotenoids lutein and zeaxanthin. There is no cure for AMD; however, prompt treatment and taking preventive measures can help to delay visual impairment and improve your prognosis.
Aging affects just about every structure of the eye. Visiting your eye doctor on an annual basis is the best thing that you can do to protect your eyesight for the future. He or she will be able to assess your risks for developing potentially devastating ocular conditions and if needed, initiate prompt treatment. If it has been awhile since you have seen your eye doctor, schedule an appointment today.
Samantha K. McPherson, OD, FAAO
Founder of Dry Eye Center of NC, a subspecialty clinic of McPherson Family Eye Care.