Age-related vision changes may happen as you get older. But eye problems aren't something you should simply write off as normal.
Some problems stem from new or worsening vision disorders. As you get older, these might happen gradually. Others happen suddenly, quickly causing blindness. That is why regular exams with an eye doctor are so important. It is also important to recognize potential signs of eye disease such as sudden changes in floaters, flashes, blurred or lost vision, or pain. Finally, complete exams of the retina for these conditions should always include using drops to dilate the pupil.
You can take steps to lower your risk of age-related vision problems. Or, if you have changes, you can slow their progression.
Age-Related Macular Degeneration (AMD)
With AMD, the macula, a central part of the tissue that lines the back of your eye (the retina), becomes damaged. This makes tasks involving central vision – reading fine print, recognizing faces, or driving your car, for example – much harder. But you still have side vision.
For early AMD, the dry type affects nine out of 10 people with macular degeneration. It causes more gradual, subtle vision loss from the breakdown of cells in the retina. For example, you may see parts of letters or straight lines may appear wavy. The dry type of AMD can develop into the wet type or may progress to an advanced scar called geographic atropy..
Other symptoms include:
- Hazy vision
- Needing extra light or having trouble when going from bright to low light
- Trouble reading or recognizing people's faces
- Colors appearing less vivid
The wet type of AMD causes sudden, severe loss of central vision from leaking blood vessels growing in or under the retina. You may see a large dark spot in the center of your vision. If you have these blind spots, see an eye doctor right away.
Other symptoms include:
- Distorted vision
- Objects appearing a different size for each eye
- Colors appearing less vivid or differently in each eye
You may be more likely to get AMD if you smoke, have a family history of AMD, or are obese.
Other risk factors include genetics, exposure to ultraviolet (UV) light, and a lack of nutrients reaching the retina.
There is no cure for AMD, but there are options that may slow the progression of wet macular degeneration and even recover early lost vision.
- Anti-VEGF treatment limits the growth of new blood vessels in the eye that can threaten vision and allow fluid or blood to resolve.
- VEGF with or without Ang-2 inhibitors help stabilize these fragile new blood vessels so they don't leak.
- Thermal laser treatment uses heat to disrupt the disease.
- Photodynamic therapy (cold laser) closes blood vessels in the eye that are leaking and damaging vision, but, again, is rarely used for AMD.
Dietary supplements can also help. A recent study found that a vitamin and mineral mixture known as AREDS2 is the most effective. It can slow the progression of AMD by about 25%, research shows. Unlike the original AREDS formula, AREDS2 includes antioxidants lutein and zeaxanthin and does not have beta carotene. Ask your doctor if supplements might help you.
When dietary supplements are used, you should not smoke.
Glaucoma
Glaucoma is a group of eye diseases that causes vision loss. High pressure inside the eye or poor circulation causes damage to the optic nerve. This nerve carries images from the eye to the brain.
The more common forms of glaucoma develop slowly and show no clear symptoms early on. You may not know you have it. But glaucoma can cause blindness. Age makes it more likely, as do these things:
- A family history of glaucoma
- African or Hispanic ancestry
- High levels of farsightedness or nearsightedness
- Past eye injury
- High eye pressure or low blood pressure
- Diabetes
Treatments include eye drops, other medication, laser treatment, and surgery.
Cataracts
With a cataract, the lens of the eye becomes cloudy and your vision gets blurry. They're often associated with aging. Virtually all Americans have them by the time they reach 80 and some cataracts affect vision for patients in their 60’s..
Symptoms of a cataract often develop slowly and can include:
- Blurry, cloudy, or dim vision – a little like looking through a dirty windshield
- Double vision with one eye
- Trouble seeing at night or in dim light
- Halos around lights
- Sensitivity to light and glare
- Faded or yellow colors, or trouble telling the difference between blues and greens
- Trouble seeing an object against a background of the same color
These things raise your risk of having cataracts:
- Lots of exposure to sunlight
- Smoking
- High cholesterol or high blood pressure
- Diabetes
- Previous eye injury or surgery
- Family history of cataracts
At earlier stages, simply changing your eyeglass or contacts prescription is all you need. Using brighter lights for reading or a magnifying glass may also help.
If halos or glare are problems, limit night driving. Glare can also happen during the day, so make sure your vision prescription is up to date. You can also ask if special tinting could lessen glare.
If a cataract begins to interfere with your day-to-day life, an ophthalmologist specializing in cataract surgery can remove the cloudy lens and replace it with a clear lens implant.
Other Retinal Diseases
Diabetic retinopathy is a complication of uncontrolled diabetes. It happens when blood vessels either grow in the retina or leak fluid or bleed. You may have blurred vision and trouble reading, among other symptoms. These changes may occur much earlier then typical AMD.
Anti-VEGF treatment has now replaced Laser treatment for most diabetic patients. Anti-VEGF seals the abnormal blood vessels and prevents bleeding or leaking. Laser can "zap" leakage in later stages of the disease, sometimes preventing more serious complications. But the best way to protect vision is to monitor and maintain normal blood sugar levels. The most important test for your eye specialist to understand your diabetes control is the HgA1c blood test.
Retinal vessel occlusion is a common complication of diabetes or glaucoma. It happens when a vein in the retina becomes blocked. It's also more likely if you have high blood pressure or a narrowing of the arteries.
Depending upon the type of blockage you have, you may have subtle, painless, moderate vision loss that comes and goes. Or you may have sudden, severe vision loss and pain that requires medical care right away.
You should see your doctor right away for either.
Management includes close observation and treatment of any complications.
