Seeing Well as You Grow Older
By Michael J. Dodd, MD
Our eyesight is our most precious sense. It is said that more than 80 percent of the information we use and learn comes from our vision. We all want to maintain excellent vision through our lifetimes. Fortunately, our eyes require little maintenance and most of us will have good vision as we grow older. But this does not mean you should avoid getting your eyes checked. Regular eye exams every two years are recommended for all over the age of 40.
What sort of problems can threaten our vision as we grow older? Is there anything we can do to protect our precious sight?
Assuming we had good vision as youngsters the first aging problem we encounter is known as presbyopia. This means that the natural lens in the eye loses its elasticity and the ability to focus on near objects. The usual time for this to occur is around age 42 to 45. Gradually, patients notice difficulty reading; they find themselves moving print farther away to keep it in focus. This happens to nearly everyone and is easily resolved with simple magnifying glasses to bring things back into focus. Many patients can purchase these at the drug store. Some patients may require a prescription for reading glasses and should consult with an eye specialist for a complete eye examination to be sure the eyes are healthy.
Another problem seen as we age is glaucoma. This is a actually a group of eye disorders that is characterized by high pressure in the eye, which, if left untreated can damage the optic nerve and cause vision loss. This can only be diagnosed by an eye specialist. There is treatment, which consists of eye drops, laser surgery or traditional surgery in an operating room. Everyone over age 40 should get a bi-yearly eye examination to be certain glaucoma is not present.
Cataracts are another aging problem. A cataract is a clouding of the natural clear lens which does the focusing in the eye. If presbyopia is the first aging change in the lens, cataract is the second. As we approach 60, the lens changes color and gradually becomes cloudy and the natural transmission of light is inhibited. When the vision drops below 20/40, most eye surgeons believe that cataract surgery is justified if the patient is having difficulty. Cataract surgery is elective; there is no emergency. This is not like cancer where the cataract must come out quickly or the eye will be injured. Modern cataract surgery is quick and safe. Typically only eye drops are used for anesthesia and the procedure time is less than 15 minutes. At the time the cataract is removed a tiny plastic lens implant is placed in the eye to allow the eye to accurately focus.
Can we avoid cataracts? Contrary to certain product advertisements, there are no drops or medicines that will stop or reverse cataracts. A good healthy lifestyle is probably the best thing one can do to avoid or delay cataract formation. For example, smoking is a negative risk factor for cataract formation. If you still smoke, this is another good reason to quit.
Macular degeneration is an unfortunate aging disorder of the retina — the inner layer of the eyeball which transmits the light image to the brain. This disorder is typically first seen by eye doctors when they inspect the retina during an examination. Small white spots called drusen are an early indicator that macular degeneration may be starting. During this early phase, patients do not notice any vision loss. Over time the drusen may lead to small areas of scarring which can cause loss of central vision. This makes it difficult to see details such as print, faces or road signs. Scarring with no blood or leakage in the retina is called “dry” macular degeneration. “Wet” macular degeneration occurs in those patients where bleeding in the retina develops. A hemorrhage in the retina may cause a sudden dramatic loss of central vision. The major risk factor for macular degeneration is being over the age of 70. Studies have shown that smoking is also a risk factor.
Treatment consists of oral vitamins with high ratios of zinc and vitamin A. For those patients with “wet” macular degeneration, there is an injection available that can be given to reverse the hemorrhage.
The most important message for maintaining healthy eyes as we age is to eat properly, exercise on a regular basis, stop smoking and take vitamins daily. And don’t forget to get regular eye examinations.
Dr. Dodd is an instructor at the University of Maryland Department of Ophthalmology and gives volunteer lectures at the Anne Arundel Community College Nursing Department. He can be reached at his Annapolis office at 410 224-4550 or firstname.lastname@example.org