By James M. Maisel, M.D.
It is normal for the eyes to change as we age. Naturally-aging eyes experience reduced contrast sensitivity, which may make it difficult to differentiate similar colors and patterns. It is normal for them to experience some difficulty in adapting to changes in light and dark environments as well as glare. Floaters usually occur when the vitreous gel in the eye liquefies in patients in their 50s and 60s resulting in tiny specks in the vision. Depth perception and reduced ability to see colors are also common along with decreased tear production and dryness of the eyes. These mild symptoms usually are not indicative of severe eye problems.
Common Indicators of Eye Problems
An ophthalmologist should immediately be contacted if there are severe and persistent symptoms that include:
- Loss of vision;
- Sudden blurred or hazy vision;
- Double vision;
- Pain in or around the eye;
- Seeing flashes of light in one or both eyes;
- Halos around lights at night;
- Painful or intense sensitivity to light;
- Discharge or foreign body in the eye;
- Changes in the color of the iris or clarity of the cornea;
- New onset or sudden change in floaters or flashing lights; or
- Distortion or waviness of vision.
How Often Should Seniors Have Their Eyes Examined?
Senior citizens, 65 years or older, should have an ocular examination performed by an ophthalmologist every one to two years at a minimum, even without any existing risk factors. More frequent examinations are warranted, even if no ocular symptoms are present, for any individual at higher risk for developing eye disease. These risk factors may be based not only on ocular history, but also upon medical history such as the presence of diabetes mellitus, family medical history or race in which certain conditions are much more prevalent. Newly diagnosed diabetes mellitus is a common reason for a senior citizen to have a baseline examination at the prompting of an endocrinologist.
After conducting a comprehensive medical and ophthalmic history including the use of medications, an ophthalmologist will be able to tell you if there is any significant ocular disease detected and the frequency of examinations that will be required depending upon your risk, the severity of the condition, and other factors.
Proper Eye Care is Important
While many seniors expect general attrition in their eye sight, it is not uncommon for ophthalmologist to see patients in their 90s who have excellent vision in both eyes. Elderly patients frequently think that failing vision is normal. Minor changes in vision are normal, often do not pose significant threats to vision and can easily be overcome. Seniors may experience dimness of vision and require more light merely because their pupils do not dilate in the dark or because of progressive cataract or other problem as simple as presbyopia. It is important that seniors and their caregivers understand that proper eye care is a significant component of their overall health care.
Check Each Eye Separately
I have practiced as a retina specialist for over twenty years in Long Island, NY. Each spring I commonly have children bringing their snowbird parents into the office for an exam. A frequent occurrence is that they were unaware that their eye symptom was potentially a problem. Their family member immediately sought out eye care. Their parents had already seen an optometrist and ophthalmologist and were now referred for retina care, typically for macular degeneration, retinal detachment or a retinovascular problem that usually only affects one eye.
Many patients come to the office and have poor or no vision in one eye but are unaware of it until the fellow eye is covered for a comprehensive eye exam. The visual deficit is suddenly revealed.
Seniors especially may take slow onset of decreased vision for granted and learn to accommodate for it. This is commonly seen with cataracts that act as variant degrees of darker sunglasses in some cases. This problem can temporarily be overcome with bright lighting, and the individual gets used to always being somewhat in partial darkness.
Behavior Changes Can Indicate Vision Problems
Most people are reasonable about reporting problems, but certain behaviors may be indicative of visual loss in cases where there is denial. The following activities, as described by the American Foundation of the Blind, are indicators of vision loss, which may result in behavioral changes rather than straightforward ocular complaints.
If you are or someone you know experiences any of these signs, they should be evaluated to see whether or not there is an underlying eye problem.
Mobility and Movement
- Constantly bumping into objects;
- Having difficulty walking on regular or bumpy surfaces;
- Stepping hesitantly;
- Going up and down stairs slowly and cautiously;
- Shuffling feet;
- Brushing against walls while walking; or
- Missing objects by under reaching or overreaching.
Difficulty with Daily Activities
- Discontinuing or doing certain activities differently such as reading, watching television, driving, walking, or engaging in hobbies;
- Squinting or tilting the head to the side to focus on an object;
- Having difficulty identifying faces are objects;
- Having trouble locating personal objects even in a familiar environment;
- Reaching out for objects in an uncertain manner; or
- Experiencing trouble identifying colors, selecting clothing in unusual combination of colors or patterns.
Indicators During Eating and Drinking
- Having problems getting food onto a fork;
- Having difficulty cutting food or serving from a serving dish;
- Spilling food off the plate while eating;
- Pouring liquids over the top of a cupboard; or
- Knocking over glasses while reaching across the table for another item.
Issues with Reading and Writing
- Ceasing to read mail, newspapers, or books;
- Holding reading material very close to the face or at an angle;
- Writing less clearly and having trouble writing on a line; or
- Finding lighting, that was previously sufficient, inadequate for reading and other activities.
Home Vision Tests
It is fairly easy to check vision on a daily basis, one eye at a time. Using proper lighting, preferably in the same fashion each day, a person can check to see if they can read the same size small print.
An Amsler grid is similar to graph paper and is an excellent test of macular function. While covering one eye at reading distance, the appearance of the grid can be checked for distortion, line waviness, and missing or dark areas. This is a very sensitive test for visual function, but remarkably, there is a group of approximately 11% of patients with known macular disease that report their view of the grid as being normal. Abnormal results, however, are quite significant and should prompt an examination.
Not All Eye Disease Causes Visual Symptoms
When there is severe loss of peripheral vision in both eyes, visual function is quickly compromised. However, I have seen patients with advanced glaucoma and loss of peripheral vision who are unaware of the condition until they have had several car accidents. Conversely, patients with macular degeneration may be rendered legally blind at 20/200 or worse due to loss of the critical central portion of the visual field used for reading and fine visual tasks, yet they may be able to function quite well.
If the blind spot occupies the center of the visual field, the affected individual usually has difficulty identifying faces. Many people with eye problems simply insist that stronger glasses will help them, but if the retina (the equivalent of film in a camera) is damaged, the most expensive lens system in the world cannot compensate for this.
Mild Visual Symptoms to Be Aware of
Serious eye problems can be present with mild symptoms such as distortion and slight difficulty in reading in one eye. This can indicate the new onset of exudative age-related macular degeneration. This condition can rapidly progress with leaking blood vessels causing expanded loss of the central field of vision almost invariably over a period of one to three months without treatment.
It is not uncommon for a patient to come in with advanced macular degeneration in their non-dominant eye who is unaware of it. With the advent of Lucentis therapy for this condition, which can stabilize 90 percent of eyes with the wet form of macular degeneration and improve the vision in approximately one third, detection is all the more important. This is especially true with these newer treatments, which work better at the earlier stage of the leaking blood vessels.
Common Age-Related Eye Problems in Seniors
Age-related eye diseases are expected to dramatically increase as baby boomers age and live longer. By age 65, one in three Americans has some form of vision-limiting disease, including:
Unfortunately, many are unaware that they have a disease and believe that poor vision is a natural part of the aging process. It is important that seniors and their caregivers understand that proper eye care is a significant component of their overall health.
Fortunately, excellent treatments exist for most age-related eye problems. The risk of blindness can virtually be eliminated for those with diabetic retinopathy with laser photocoagulation treatment applied at certain stages of the disease. More advanced cases can often be salvaged with vitreous surgery. Cataract surgery is one of the most successful operations in medicine. Over 1 million Americans undergo the procedure yearly with the over 95 percent showing improvement in vision. The remaining 5 percent who do not show improvement often experience a stabilization in their vision.
Glaucoma is now more reliably diagnosed and tracked for progression using technologically advanced tools such as laser scanners and digital photography. Recent advances in pharmaceuticals control glaucoma eye pressure much more effectively for a broader number of patients. For those whose condition progresses, more laser and surgical methods, and drains and tubes give the ophthalmologist and glaucoma specialist a variety of tools to combat blindness.
Age-related macular degeneration affects the central or fine vision and increases dramatically with age. Only 1 percent or less of 65-year-olds have vision loss from this condition, but this number jumps to more than 20 percent for seniors in their eighties. Large studies and clinical experience have shown that we can effectively slow down the progression of the dry form of macular degeneration with simple measures such as a balanced vitamin preparation and by eating a diet rich in fish, fruits, vegetables, and nuts.
Ophthalmology has never had a better chance to maintain or improve vision. It is mandatory that seniors have their visual complaints taken seriously. Regular ophthalmic evaluation prevents blindness and timely intervention is key to maintaining good vision. Patients and family can help to accomplish this.
A Helpful Resource
EyeCare America, a Public Service Foundation of the America Academy of Ophthalmology operates the largest public service program in American medicine including individual eye care programs for seniors, glaucoma, and diabetes. Eligible callers can receive a referral to one of over 7,500 volunteer ophthalmologists.
The senior program provides comprehensive eye exams and treatments for any condition detected in the initial visit for up to one year at no out-of-pocket cost. Nationwide, EyeCare America Senior Program has helped in treating more than 200,000 cases of eye disease, and volunteer physicians have agreed to accept Medicare or other insurance as payment in full with no out-of-pocket expense to the patient. Individuals without insurance of any kind are not billed. This volunteer program encourages all seniors to have their eyes examined annually.
Dr. James Maisel, M.D., has practiced as a retina specialist for over 20 years.