Oh, the Aging Eyes

Droopy eyelids, dry eyes, floaters, cataracts, ocular migraines are just some of the eye problems we may have to deal with as we age

By Deborah Jeanne Sergeant

As you begin to “play trombone” with your reading materials to get them in focus, it becomes apparent you may need reading glasses. Most people require correction for presbyopia — short distance vision — around their mid-40s to early 50s. While an unwelcomed sign of aging, it’s easily corrected with drugstore “cheater” glasses.

Less common are other changes in vision related to aging. Some are more serious than others.

To tell the difference between what’s normal and what’s not, physician Raul Vazquez, founder of Greater Buffalo United Accountable Healthcare Network (GBUAHN), recommends annual eye exams.

“You may have a change in pressure and glaucoma becomes an issue,” he said. “If it’s not treated, you can go blind.”

Family history plays a role in glaucoma, which is damage to the optic nerve. Usually, loss of the peripheral vision indicates onset. The lost vision cannot be restored. The risk of vision loss is higher for people with certain health issues. Vazquez noted diabetics and those with hypertension should be especially vigilant about their vision.

Slowly, over time, cataracts can develop in older age, although for diabetics and those with hypertension, they can develop the condition at younger age. The vision becomes dim and more yellow in tone and night driving becomes very difficult. The lens, which sits behind the iris, becomes cloudy. Exposure to UV light, diabetes and certain medication can hasten the otherwise age-related condition. With a 10-minute, outpatient surgery, doctors can replace the lens with an artificial lens.

“If you’re looking at graph paper and you see distortions in those lines, that’s telling you have problems in the back of your eye,” Vazquez said. “You may have macular degeneration and if you have a bleed in your eye, you can go blind.”

People with family history of macular degeneration or smoking are more likely to develop the condition.

Droopy eyelids may affect vision as one ages.

“The eyelids may feel heavier and crepey,” said Rajeev Ramchandran, associate professor of ophthalmology, public health sciences, at the Center for Community Health and Prevention at Flaum Eye Institute in Rochester. “In the front of the eye as you get older, you get more wrinkles. You start getting brow aches from having to lift your brow up.”

As the lid droops, it can block vision. An evaluation can help determine if a surgical approach could remedy the problem.

Dry eyes can also cause vision issues for older adults. It may feel like a foreign body is in the eye or that the eye tears a lot. Ramchandran said that the lipid layers may not be as present.

“You may not be taking in as much water as you used to,” he said. “The intake of liquid may also be affecting your tears.”

The eyelid also may not close as well as it used to, which can cause tears to leak and the eye to water more. Or a duct in the lower lid may be locked. Ramchandran recommends using non-tearing baby shampoo on a warm washcloth to clean away any build-up.

Behind the lens, there’s the vitreous jelly.

“It’s mostly made of collagen and water,” Ramchandran said. “Just as you have breakdown in the skin, you have breakdown in the collagen of the eye. That can result in some more mobility of the jelly and also the condensation you see as ‘floaters’ which are common. For someone who’s nearsighted, they get floaters sooner.”

He said that having a few floaters shouldn’t concern anyone, but a sudden increase or very large numbers of floaters or seeing “flashing lights” can indicate that the jelly is pulling hard enough to cause retinal tear. Retinal detachment can cause permanent blindness, so anyone experiencing these symptoms should seek immediate medical care.

Some people who have ocular migraines suffer temporary vision loss that returns right away; however, losing vision without history of migraines should definitely seek prompt care.

Stroke can also affect the retina and optic nerve.

“If you have any pieces of your vision that you’re losing, those are signs you really need to get checked out,” Ramchandran said.

Kerstin Abreau, doctor of ophthalmology at The Eye Care Center in the Finger Lakes area, also said to seek immediate medical attention for symptoms such as “flashes of light, an increase in floaters, a black curtain coming across your vision, loss of vision in one or both eyes, or double vision.”

If your regular provider cannot see you, you may need to go to the emergency room.

“Please, do not wait to see if your symptoms go away on their own as this may result in permanent damage,” Abreau said.

She recommends that people 60 and older visit their vision care provider annually to ensure that changes in vision are normal. Diseases like glaucoma and macular degeneration are more common with older age. People with eye conditions may need more frequent eye exams.