Our eyesight will change as we grow older, increasing the risk of eye diseases and conditions. Some of these changes may cause permanent vision loss. However, Dr. Bobby Cheng, Senior Consultant Surgeon Ophthalmologist, shares that most age-related vision changes can be treated with eye drops, medicine, and outpatient surgery. We find out more.
Typically, our vision will change as we age. The common changes are losing the ability to see up close (presbyopia) due to the aging lenses or to differentiate colors, and needing more time to adjust to varying degrees of light. These are often easily corrected with new prescription eyeglasses, improved lighting, and reading with giant print.
“Aging of the eye is a natural process, just like with any other organ of the body. The change usually starts in the late 30s to early 40s. The older the patient, the higher the risk of developing eye diseases such as cataracts, age-related macular degeneration, glaucoma, and dry eyes,” Dr. Cheng says.
"Cataract formation is a common part of the normal aging process. It is a clouding of the eye’s normally clear lens, leading to a progressive impairment in vision. It results from the clumping of proteins within the lens, which then distorts or blocks the passage of light as it enters the eye, thus affecting vision,” he explains.
"There is no way to prevent the development of age-related cataracts, but measures can be put in place to help avoid or slow down progression," he adds.
Some of these measures include good control of blood glucose levels in people with diabetes, using sunglasses outdoors, and to stop smoking.
The rate of progression varies among individuals, where for one degeneration may occur faster than another.
Typical cataract symptoms include blurred vision, like looking through a translucent piece of glass, reduced ability to distinguish colors, and poorer vision even in bright light. It is possible for individuals to see haloes around lights and glare, especially when driving at night.
"As long as vision remains satisfactory to the patient, no treatment is necessary," Dr. Cheng explains. "Your eye doctor may recommend stronger eyeglasses or medicated eyedrops as temporary measures."
However, he said surgery might be considered when poor vision interferes with or disrupts normal daily activities, such as frequently bumping into objects or brushing walls while walking, or missing objects by under-reaching or overreaching for them.
“However, it is also not a must to wait until the cataract is 'ripe' as advances in microsurgery have made it very safe to remove even cataracts in the early stages,” he adds.
"Currently, the preferred surgical procedure is phacoemulsification. This involves the insertion of an ultrasonic instrument through a small incision in the cornea to break up or emulsify the cataract. The pieces are vacuumed out via the same channel, leaving the capsule of the lens behind. An artificial lens implant is then inserted," he explains.
Phacoemulsification is usually performed as a day (ambulatory) procedure, with a faster recovery from previous surgical methods. Complications are uncommon.
Many elderly patients assume that the gradual loss of vision is a natural consequence of aging and do not seek prompt medical attention.
However, distorted vision, difficulty reading or recognizing faces, or a ‘blind spot’ in the center of your visual field require immediate evaluation by an ophthalmologist because this can indicate an early presentation of age-related macular degeneration (AMD).
The macular is the tiny spot in the retina's center, which contains millions of light receptors that help produce central or 'straight-ahead' vision.
"Progressive deterioration and changes in the macula usually occur with age. It is one of the common causes of vision loss among the elderly aged 60 and above," Dr. Cheng says.
"Visual damage caused by AMD can be permanent. Early detection is important and screening is recommended for all above 50, especially those with a family history of the disease, smoke, or have hypertension or heart disease,” he adds.
Prompt and early treatment may help to reduce the risk of serious visual loss. In cases of significant macula damage, there are ways to cope with and use the remaining sight. For example, reading books with giant print, ensuring sufficient lighting for activities, avoiding driving at night or in heavy traffic, and removing obstacles in the home, such as throw rugs or other tripping hazards," he advises.
"Glaucoma is the second leading cause of blindness in the world, mainly affecting the elderly," Dr. Cheng says.
The condition usually occurs when an increase in fluid pressure within the eye (intraocular pressure or IOP) damages the optic nerve which transmits nerve impulses for sight to the brain.
The nerve fibers in the retina may also be affected. As these changes are permanent, the loss of vision is irreversible. Most people with glaucoma have no early symptoms or pain from that increased pressure.
"Glaucoma can have devastating consequences when diagnosed at an advanced stage. However, the earlier it is detected, the better the management to reduce the IOP and the better the chances of slowing down visual loss with eye drops alone," he says.
Laser treatment and surgery may also help. The usual eye tests for glaucoma include IOP measurement, optic nerve check, aqueous drainage examinations, and a visual field assessment.
"Due to the gradual and silent progressive nature of glaucoma, lifelong monitoring with treatment is necessary for effective control of this condition and to preserve sight as much as possible," Dr. Cheng advises.
Some changes in the aging eye may not cause direct impact on vision, but sometimes they signal an underlying medical problem – for instance, dry eyes. Our eyes produce tears during our lifetime to protect the cornea, the transparent outer layer of the eyeball.
“It is a very common condition which may be the underlying cause of many ocular symptoms, including that of excessive tearing,” he says.
"It occurs when tear production decreases with age and is also more common in postmenopausal females due to hormonal changes affecting the glands in the eyelids," Dr. Cheng explains. "Certain medications such as those used for relieving cough and colds, also reduce tear secretion. In addition, medical conditions such as rheumatoid arthritis, thyrotoxicosis, and Sjogren's Syndrome are commonly associated with dry eyes."
Those affected typically begin experiencing redness, itchiness, or even pain in the eye, excessive tearing due to reflex secretion of tears to flush off irritants, sensitivity to bright light, or the sensation of having something sandy, gritty or like a 'foreign body' in the eye.
"Artificial tear preparation is the main treatment and this is administered with applying eye drops, ointments, or gels as often as necessary. Avoid contact lenses and being in an air-conditioned or other aggravating environments where possible. For more severe cases, special plugs are applied to block tear drainage and retain the tears in the eyes as well as the use of immunosuppressive agents," he adds.
It is true that with age comes failing eyesight, but it does not always result in diminished vision. On the contrary, we often come across people in their 90s who have excellent vision.
Expect changes, but with timely screening and proper eye care, our vision can be maintained and kept healthy. Dr. Cheng offers the following age-proofing tips: