By Gary Heiting, OD
Just as our physical strength decreases with age, our eyes also exhibit an age-related decline in performance — particularly as we reach our 60s and beyond.
Some age-related eye changes, such as presbyopia, are perfectly normal and don’t signify any sort of disease process. While cataracts can be considered an age-related disease, they are extremely common among seniors and can be readily corrected with cataract surgery.
Some of us, however, will experience more serious age-related eye diseases that have greater potential for affecting our quality of life as we grow older. These conditions include glaucoma, macular degeneration and diabetic retinopathy.
After you pass the milestone age of 40, you’ll notice it’s more difficult to focus on objects up close because of presbyopia. This is a perfectly normal loss of focusing ability due to hardening of the lens inside your eye.
When you first notice presbyopia affecting near vision at around age 40, you may be able to compensate by holding your reading material farther away. But presbyopia worsens as you age, and you will need vision correction at some point. For a time, you can compensate for this gradual decline in focusing ability by just holding reading material farther away from your eyes. But eventually you will need reading glasses, multifocal contact lenses or multifocal eyeglasses. Some corrective surgery options for presbyopia also are available, such as monovision LASIK, conductive keratoplasty and the recently FDA-approved Kamra corneal inlay.
As you continue to age through your 50s and beyond, presbyopia becomes more advanced. You may notice the need for more frequent changes in eyeglass or contact lens prescriptions. You may also find that a single prescription is no longer the best solution for all your visual needs. As an example, you may need one pair of eyeglasses for normal tasks and another that emphasizes intermediate ranges for working more comfortably at the computer. Cataracts. Even though cataracts are considered an age-related eye disease, they are so common among seniors that they can also be classified as a normal aging change.
According to Mayo Clinic, about half of all 65-year-old Americans have some degree of cataract formation in their eyes. As you enter your 70s, the percentage is even higher. It’s estimated that by 2020 more than 30 million Americans will have cataracts. Thankfully, modern cataract surgery is extremely safe and so effective that 100 percent of vision lost to cataract formation usually is restored. If you are noticing vision changes due to cataracts, don’t hesitate to discuss symptoms with your eye doctor. It’s often better to have cataracts removed before they advance too far. Also, you do have options now for trying multifocal lens implants or accommodating intraocular lenses that potentially can restore all ranges of vision, thus reducing your need for reading glasses.
Macular degeneration (also called age-related macular degeneration or AMD) is the leading cause of blindness among American seniors.
Despite some age-related vision changes that are inevitable, you may be able to keep your eyes healthy for a lifetime.
According to the National Eye Institute (NEI), more than two million Americans currently have age-related macular degeneration, and due to the aging of the U.S. population, that number is expected to more than double to 5.4 million by 2050.
Glaucoma. Your risk of developing glaucoma increases with each decade after age 40, from around 1 percent in your 40s to up to 12 percent in your 80s. The number of Americans with glaucoma will increase by 50 percent (to 3.6 million) by 2020.
Diabetic retinopathy. According to the NEI, approximately 10.2 million Americans over age 40 are known to have diabetes. Many experts believe that up to 30 percent of people who have diabetes have not yet been diagnosed.
Among known diabetics over age 40, NEI estimates that 40 percent have some degree of diabetic retinopathy, and one of every 12 people with diabetes in this age group has advanced, vision-threatening retinopathy.
How Aging Affects Other Eye Structures:
While normally we think of aging as it relates to conditions such as presbyopia and cataracts, more subtle changes in our vision and eye structures also take place as we grow older. These changes include:
• Reduced pupil size. As we age, muscles that control our pupil size and reaction to light lose some strength. This causes the pupil to become smaller and less responsive to changes in ambient lighting.
• Because of these changes, people in their 60s need three times more ambient light for comfortable reading than those in their 20s.
• Also, seniors are more likely to be dazzled by bright sunlight and glare when emerging from a dimly lit building such as a movie theater. Eyeglasses with photochromic lenses and anti-reflective coating can help reduce this problem.
As we age, we naturally lose some of the visual abilities we had when we were younger:
• Dry eyes. As we age, our bodies produce fewer tears. This is particularly true for women after menopause. If you begin to experience a burning sensation, stinging, or other eye discomfort related to dry eyes, use artificial tears as needed throughout the day for comfort, or consult your eye doctor for other options such as prescription dry eye medications.
• Loss of peripheral vision. Aging also causes a normal loss of peripheral vision, with the size of our visual field decreasing by approximately one to three degrees per decade of life.
• By the time you reach your 70s and 80s, you may have a peripheral visual field loss of 20 to 30 degrees.
• Because the loss of visual field increases the risk for automobile accidents, make sure you are more cautious when driving.
• To increase your range of vision, turn your head and look both ways when approaching intersections. You also can read more tips about vision, aging and driving safety.
• Decreased color vision. Cells in the retina that are responsible for normal color vision decline in sensitivity as we age, causing colors to become less bright and the contrast between different colors to be less noticeable.
• In particular, blue colors may appear faded or “washed out.” While there is no treatment for this normal, age-related loss of color perception, you should be aware of this loss if your profession (e.g. artist, seamstress or electrician) requires fine color discrimination.
• Vitreous detachment. As we age, the gel-like vitreous inside the eye begins to liquefy and pull away from the retina, causing “spots and floaters” and (sometimes) flashes of light. This condition, called vitreous detachment, is usually harmless.
• But floaters and flashes of light can also signal the beginning of a detached retina — a serious problem that can cause blindness if not treated immediately. If you experience flashes and floaters, see your eye doctor immediately to determine the cause.
What to do about Age related vision changes:
In your 40s:
You can’t escape presbyopia (difficulty with near vision focus).
Have routine eye exams at least every two years, and explore vision correction options.
Be aware of increased risk of dry eye & computer vision syndrome.
Eat a healthy diet high in omega-3 fatty acids and antioxidants.
In your 50s:
Risks increase for cataracts, glaucoma & macular degeneration (AMD).
Have routine eye exams.
Presbyopia becomes more advanced.
Multiple eyewear solutions might be needed for presbyopia at this age.
Risk of dry eye increases for women after menopause.
Tell your eye doctor about medications (some can cause visual side effects, including dry eye).
In your 60s:
Risks increase for common age-related eye diseases (see 50s above).
Besides regular eye exams, have annual physicals to identify underlying conditions such as diabetes that might cause eye problems.
Ability to see in low lighting decreases.
Use brighter lights for reading. Allow more time to adjust to changing light conditions.
Age-related eye changes cause visual disturbances such as spots & floaters.
If eye floaters appear suddenly, see your eye doctor immediately (this might be a retinal detachment).
In your 70s & 80s:
Most people in this age group already have or will develop cataracts.
Cataract surgery is the only option for correcting cataracts.
Color vision declines, and visual fields begin to narrow.
Ask your eye doctor about eyewear or lenses for increasing contrast vision. Use extra caution while driving.
What You Can Do About Age-Related Vision Changes:
A healthy diet and wise lifestyle choices, such as not smoking, are your best natural defenses against vision loss as you age.
Also, you need to have regular eye exams with a caring and knowledgeable optometrist or ophthalmologist. Be sure to discuss with your eye doctor all concerns you have about your eyes and vision. Tell him or her about any history of eye problems in your family, as well as any other health problems you may have. Your eye doctor should know what medications you take (including non-prescription vitamins, herbs and supplements). This will help with appropriate recommendations to keep your eyes healthy and functioning at their optimum level throughout your lifetime.
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