As you age, so do your eyes, leading to changes in your vision over time. Some of those changes may be a normal part of getting older and won’t cause any serious problems. But others, such as retina damage and glaucoma, could threaten your vision if not treated.
Low vision and vision loss can make life challenging, limiting your independence and mobility and placing you at risk for falls and injuries. So it’s important to stay on top of any changes and to recognize signs of a serious eye condition or emergency.
1. Presbyopia: Farsightedness
Most people ages 40 and older develop presbyopia, a type of farsightedness associated with aging. Presbyopia can make it harder to do daily activities such as reading and working at the computer.
If you have to hold reading material farther away to focus on it, have trouble reading fine print, require more light to read, or have eyestrain or tired eyes, you may want to check with your doctor for presbyopia.
For most people, eyeglasses or contact lenses can help correct or improve vision. A doctor can increase the strength of your prescription as needed.
2. Cataracts: Cloudy Eye Lenses
Cataracts affect the lens of the eye, which is mostly made up of water and protein. As you age, proteins on the your lens of your eye start to collect and may cloud your vision.
In their early stages, cataracts may cause no symptoms, but eventually you may notice blurriness, haziness, or brownish-tinted vision.
The risk of cataracts increases with age: 1 in 5 people ages 65 to 74 have cataracts that affect their vision. More than half of people age 80 or older either have cataracts or have had surgery to remove them.
Smoking, diabetes, and spending a lot of time in the sun without sunglasses also may increase your risk of cataracts. They can be genetic, too.
Cataracts are highly treatable with surgery. The surgery is quick, should be relatively painless, and is typically performed on an outpatient basis. It involves replacing the clouded lens with an artificial intraocular lens.
Cataracts can also worsen or cause myopia (nearsightedness) or astigmatism (distortion in vision), neither of which are related to aging.
“As the eyes develop cataracts with aging, myopia and astigmatism can be caused by the worsening cataract,” says Jill Bixler, MD, an assistant professor of ophthalmology and visual sciences at the University of Michigan in Ann Arbor. “Some people will have a stable glasses prescription for decades, and then it will start to change in later life as cataracts develop. Cataract surgery can address some or all of the myopia and astigmatism in a person’s refractive error.”
3. Age-Related Macular Degeneration
Age-related macular degeneration (AMD) involves changes in the macula, a part of the eye necessary for seeing objects clearly. There are two forms of the disease: dry, or atrophic, AMD and wet, or neovascular AMD. Dry AMD accounts for 80 percent of AMD cases and has early, intermediate, and late stages, while wet AMD is always considered a late stage of AMD.
Age-related macular degeneration affects an estimated 18 million people in the United States ages 40 and older. Most of those people have early-stage AMD, which typically doesn’t have symptoms. But about 1.5 million have an advanced stage of AMD, which can cause reduced or distorted central vision in one or both eyes, blind or blurry spots in your vision, and a reduced ability to see colors.
Treatment for dry AMD is limited, though nutritional supplements can slow the progression from intermediate to advanced stages of the disease. A newly approved injectable drug called pegcetacoplan (Syfovre) can treat advanced stages. For wet AMD, anti-vascular endothelial growth factor (VEGF) drugs are injected into the eyes and can stop the growth of abnormal blood vessels and preserve vision.
4. Diabetic Retinopathy
Diabetic retinopathy refers to retina damage caused by high or variable blood sugar levels. Among people with diabetes, 26.4 percent develop it, with it threatening the vision of 5 percent.
In its early stages, diabetic retinopathy may cause no symptoms, but over time, it can lead to blurred or fluctuating vision, blind spots, vision loss, and floaters.
At any stage of diabetic retinopathy, one of the most important steps you can take is to keep your blood sugar and blood pressure levels in a healthy range, which will decrease your risk of disease progression and vision loss.
Treatments for more advanced stages of diabetic retinopathy include:
Laser treatment to stop the growth of new blood vessels
Injections of anti-VEGF drugs to stop new blood vessel growth
Steroid injections into the eyes to reduce inflammation and stop new vessel growth.
These may slow vision loss but can’t cure diabetic retinopathy or fully restore vision once it’s diminished.
5. Dry Eye Syndrome
Your eyes must be sufficiently lubricated for your vision to remain clear. Many older adults experience dry eyes from low tear production.
Dry eye can cause symptoms that include:
Eye discomfort, including stinging and burning
Redness
Blurred vision
Light sensitivity
Itchy sensation in eyes
There isn’t a cure for dry eyes, but over-the-counter saline lubricating drops or artificial tears will relieve some discomfort and keep vision clearer. You can also try to blink frequently and limit screen time.
If eye drops aren’t enough to relieve your symptoms, prescription drugs may help manage the condition. In rare cases, surgery may be necessary to repair eyelids and ensure lubrication.
6. Watery Eyes
Epiphora, or chronic watery eyes, is more common in adults age 50 and older.
In older adults, eyes can become watery if the eyelids start to sag away from the eyeballs. Tears may build up and not drain properly into the nose. Inflammation and swelling from allergies or infection may cause blocked tear ducts.
Tear glands also may produce excess tears as a result of dry eye syndrome.
7. Glaucoma
Glaucoma refers to a collection of eye conditions that can damage the optic nerve. About 3 million Americans have it, according to the Centers for Disease Control and Prevention.
Glaucoma often is a result of increased pressure in the eye, known as intraocular pressure. If left untreated, it can lead to a loss of peripheral vision and total blindness.
Glaucoma often causes no symptoms in its early stages, but it can be detected during an eye exam. One type of glaucoma, called angle-closure glaucoma, does cause acute symptoms that include:
Severe headaches
Severe eye pain
Nausea or vomiting
Blurred vision
Halos or colored rings around lights
Red eyes
Angle-closure glaucoma is considered a medical emergency, and you should contact your healthcare provider if you experience its symptoms suddenly.
Glaucoma damage cannot be reversed. Treatment options include:
Eye drops
Medication
Surgery
Laser treatment
8. Eye Floaters
Eye floaters occur when the vitreous humor, a gel-like substance in the middle of your eye, lifts up from the surface and moves around. Floaters are a normal part of aging.
Floaters are most noticeable when you are looking at a blank background, like a piece of white paper or a clear blue sky. Floaters can look like:
Squiggly lines
Spots
Threadlike strands
Small shadowy shapes
Dark spots
Flashes of light
Eye floaters are not dangerous, and treatment often isn’t necessary. If you have a sudden onset of lots of floaters, flashes of light, or both, contact a medical professional. In some cases, these can be signs of retinal detachment.
9. Retinal Detachment
Aging can cause the detachment of your retina, the light-sensitive layer of tissue that sits in the back of your eye. When it moves out of place, it can become damaged and permanently impact your vision without treatment.
J. Michael Jumper, MD, president of the American Society of Retinal Specialists in San Francisco, says symptoms retinal detachment are often noticeable and can include:
Black spots or floaters in vision
Flashes of light
Sudden or gradual shadow in vision, as if a curtain is closing in from the top, bottom, or side
Retinal detachment requires immediate treatment. When caught early, your retina can be reattached via laser surgery or other types of surgery.
How Age-Related Eye Conditions Are Diagnosed
An eye care specialist or other healthcare provider can diagnose eye diseases using a combination of methods, usually starting with an eye exam. While most people think of these as just checking how well you see, they also can reveal age-related vision issues.
“Even for people with no ocular symptoms, we typically recommend a screening eye exam every three to five years in young healthy people and every two years in people over age 65,” Dr. Bixler says.
Regular eye exams usually include pupil dilation and a slit lamp exam, in which a specialist examines all parts of your eye using a microscope and bright light.
Your eye specialist may also recommend more specific eye tests, especially if you are noticing vision changes. These tests include:
Fluorescein angiography: This looks at the blood vessels in your eye.
Tonometry: This test measures pressure inside your eye.
Retinal imaging: In this test, a specialist reviews your retina.
Corneal topography: This reviews the surface of your cornea.
Optical coherence tomography: Cross-section pictures create a full view of your retina.
How Age-Related Eye Conditions Are Treated
Because of the wide variety of age-related eye conditions, treatment depends on the specific condition.
Treatments that may be used to treat age-related eye problems include:
Prescription glasses or contact lenses
Over-the-counter or prescription eye drops
Medications
Surgery, including LASIK and cataract surgery
How to Prevent Age-Related Eye Conditions
While not all eye diseases are preventable, you can reduce your risk. Steps to prevent issues include:
Avoid smoking.
Get regular eye exams.
Monitor your blood sugar levels if you have diabetes.
Wear sunglasses to protect your eyes from UV light.
Eat fruits and vegetables.
The Takeaway
Vision changes are a normal part of aging.
In some cases, symptoms of eye problems can point to something more severe or a medical emergency, such as a detached retina.
Medical issues such as diabetes can lead to eye and vision problems.
Regular eye exams are essential to maintain good eye and vision health.
