Vision

Getting regular eye examinations is an important part of life at any age. Especially when you are older, bad eyesight can make living independently difficult, and can increase your chances of falls, fractures, and depression. Some vision problems are more common in older age but may be managed or progression slowed with regular eye examinations.

Age Related Macular Degeneration (ARMD)

ARMD is the leading cause of severe vision loss in older people. An estimated 25-30% of people over the age of 75 show signs of ARMD. It is a disease that results in the retina deteriorating and making clear vision difficult. The macula, which is part of the retina, can affect central vision which will make it difficult to read, recognise facial features, interpret colour, and drive. It is caused by a build up of retina waste products that collect between the retina and underlying tissue which slowly causes the degeneration of the macula.
 
There are two types of ARMD, dry and wet ARMD. Dry ARMD is the most common form, and 90% of people with this disease have the dry form. This results in the slow degeneration of the macula. The wet form may deteriorate more quickly. As the retina is starved of oxygen, it tries to grow new blood vessels, but these can be fragile and leak which causes severe and sudden vision loss.

Symptoms

ARMD is not associated with any pain, but there are vision-related symptoms you may notice, including:

  • Gradual blurring of your central vision, which can be more severe in one eye
  • Great fluctuation of the clarity of your vision depending on lighting
  • If you have wet ARMD, you may notice straight lines may appear wavy, broken, or distorted

Who is at risk?

You are more at risk of developing ARMD if you are:

  • Of an older age
  • Smoke
  • Have high cholesterol or vascular disease
  • Have an immediate family member who has ARMD
  • Women may be slightly more at risk

Prevention

ARMD may be prevented with a healthy lifestyle. You can protect your macula health by eating a diet rich in fruit, dark leafy greens, and fish, maintaining a normal blood pressure and cholesterol, quitting smoking, and getting regular eye examinations.

Treatment

There is no effective treatment yet for dry ARMD. Some treatments may slow the progression of the disease, and you should talk to your optometrist about what the right approach is for you.

Glaucoma

This eye condition comes in many forms, but all forms result in damage to the optic nerve, which results in permanent vision loss. The most common form of glaucoma will progress without you being aware of it and cause damage by creating elevated pressure in your eye, damaging the optic nerve. By the time you notice visual signs of damage, it may be too late. You should get regular eye exams with your optometrist to catch glaucoma in its early stages and slow progression.

Who is at risk?

You are more likely to have glaucoma in older age. Glaucoma affects 2% of the population in New Zealand, but around 10% of people over the age of 70 have glaucoma. You are also more at risk of developing glaucoma if you:

  • Have a family history of glaucoma, which increases your risk by 10 times
  • Have high blood pressure, diabetes, or thyroid disease
  • Have been taking steroids for an extended period

Prevention

Glaucoma cannot be prevented, but you can slow the progress of it with regular eye exams. Early diagnosis and prompt treatment are key to slowing the progress of glaucoma, and if you begin treatment early you may prevent further glaucoma damage.

Treatment

Treatment may vary depending on what is right for you. Some medications and eye drops cause the eye to make less fluid or to improve the drainage of fluid, which can slow the progression of glaucoma damage. Laser treatment can also help to drain fluid. In some cases, surgery to make a new channel for fluid to drain may be an option. Speak to your optometrist about what is right for you.

Cataract

Mostly related to older age, cataracts are formed by chemical changes in the lens of your eye. You may notice some clouding over your normally clear lens, which develops slowly over many months. Cataracts are caused when the lens can no longer maintain its chemical process that keeps the lens clear from UV damage and oxidative stress, which makes it cloud over. Depending on the severity, cataracts may not impact your daily life, and if they do you may need surgery to improve your vision.

Symptoms

The symptoms of cataracts can include:

  • Blurred vision, including seeing a film or haze
  • Veiling glare, which is when light is scattered by the cataract causing difficulty or sensitivity with bright lights
  • A change in your optical prescription
  • Double vision when viewing with just one eye

Cataracts do not always have a visible film on the outside of the eye. They generally do not cause irritation or pain, and they are not caused by the over-use of the eye.

Who is at risk?

You are more at risk of developing cataracts as you age. Some other risk factors include diseases such as diabetes, if you are a smoker, and frequent sun exposure.

Prevention

You can lessen your chances of developing cataracts by protecting your eyes from UV light with sunglasses and hats. You should also aim to stop smoking. Having frequent eye exams to monitor the health of your eyes will help to catch cataracts early.

Treatment

Generally, cataracts will not need treatment until they become inconvenient in daily life. If they begin to affect your ability to function daily, you may have surgery to remove them. Surgery for cataracts is generally safe and effective.

Diabetic retinopathy

People with diabetes are at a higher risk of blindness or vision loss caused by their diabetes. The retina, which is in the back of the eye, is made up of blood vessels and light-sensitive cells. Diabetes can cause the walls of these blood vessels to weaken and bulge, which can make them bleed, leak fats, or leak fluids into the surrounding tissue. This can cause vision loss, scarring, or retinal detachment.
 
If you have diabetes, you should get frequent eye exams to monitor the health of your retinas. If you have serious diabetic retinopathy, you may be referred to an ophthalmologist. Early detection and treatment for diabetic retinopathy will help to delay any further damage.

Treatment

Maintaining a healthy lifestyle will improve your chances of developing diabetic retinopathy. If you do develop it, you may need laser treatment to seal the leaking retinal blood vessels or stop the growth of fragile abnormal blood vessels in your eye. You may also need surgery if the bleeding causes persistent cloudy vision, scarring, or retinal detachment.

Preventing vision loss

While you cannot completely prevent some forms of eye disease, there are some things you can do to lower your risk of eye disease and keep your eyes healthy. These include: 

  • Getting regular eye examinations
  • Eating a healthy diet. Research has shown that omega-3 fatty acids and dark leafy greens may protect your sight
  • Maintain a healthy weight to lower your risk of diabetes, diabetic eye disease, and glaucoma
  • Quit smoking, as this has an increased risk of ARMD, cataract, optic nerve damage, and blindness
  • Wear protective eyewear in sports or activities such as DIY or gardening
  • Wear sunglasses to protect from UV rays from the sun
  • Rest your eyes. If you are on the computer a lot, take a 20 second break to look at other things every 20 minutes to reduce eyestrain
  • Know your family eye health history

Living with vision loss

If you are living with vision loss, you may need assistance with adapting and maintaining independent living. Blind Low Vision New Zealand offers tuition on adapting to daily living, teaching you techniques, tips, and showing you useful products that can help you in your home. You can find out more on the Blind Low Vision website. You can find information on getting around if you are blind or have low vision here. Information on counselling, finding a community of other people with vision loss, and financial support can be found here.
 
Some tools, such as low vision magnifiers, screen readers, and computer aids, can help you to read or see things close to you if you have low vision. Blind Low Vision NZ recommend Humanware or Pacific Vision for products. 

Websites of interest

Find your nearest Age Concern