Although eye problems increase after age 60, the same problems can be present as early as age 40. Some such as cataracts are a result of aging and others are related to general diseases like diabetes and high blood pressure. Eye problems can be a result of medications such as steroids. Your family doctor knows how these problems link with eye disease and can discuss them with you.
A thorough eye assessment is helpful at about age 40. Early eye problems in people who seem to have perfect vision can be detected then. Everyone knows that it is common to need reading glasses or bifocals in the early 40s. Other symptoms which are less well-known but may indicate problems are blurred vision, haloes around light and irritable red eyes. Your family doctor can refer you to an ophthalmologist (eye specialist) if necessary.
One frequent change of aging is a dry eye that results from decreasing tear production. This is improved by the use of artificial tears but there are other aspects of a dry eye that your doctor can discuss with you. Also the tissues around the eye can become loose, floppy or droopy.
In North America the most common eye problems in people over age 60 are presbyopia, cataracts, glaucoma, macular degeneration and diabetes.
The difficulty reading fine print or seeing to thread a needle that often begins in the 40s is described as presbyopia - poor focusing at close range. It can not be prevented and is easily corrected by glasses. This is a normal coming of age.
Light coming into the eye is made into clear vision when it is focused by the lens of the eye. An opacity (clouding) of the lens of the eye is called a cataract. Changes of the lens may occur in people as young as 20 or 30 and almost everyone over age 65 has some cataract.
It does not become important until vision becomes hazy or blurred making it difficult for the person to see. Some disease, like diabetes, or medications, like cortisone, can make the cataract worse. Currently there is no prevention of cataract, although protection from intense sunlight (ultraviolet radiation) by sunglasses may have some value. Vitamins, particularly anti-oxidant vitamins C, E and beta carotene may offer protection. Scientific proof remains lacking.
Currently, surgery is the only treatment for cataract but is only needed when vision is seriously affected. Modern surgical techniques, where the cloudy lens is replaced with a new clear implant, make this surgery less daunting than years ago.
Glaucoma remains the leading cause of blindness in North America. It is called the thief of the night because it can silently destroy vision without warning. Glaucoma is generally a result of increased pressure in the eye which over years progressively destroys the optic nerve. A person is seldom aware of vision loss until 'the light goes out.' Once the vision is gone there is no recovery. Fortunately, regular eye exams can detect glaucoma before it causes widespread damage and in time to treat it with eyedrops or occasionally laser and surgery.
Another less common type of glaucoma, acute glaucoma, develops suddenly over several hours with severe headache, pain, nausea and vomiting. Vision loss and haloes around lights occur. This requires immediate care by an eye specialist but can usually be cured with laser treatment or eye surgery.
If you have a family history of glaucoma, are black, or are very near-sighted, you should discuss your risk of glaucoma with your family doctor. You may be advised to see an eye specialist. Some medications can also cause glaucoma and your doctor is aware of these.
The macula is the critical center part of the retina, the photographic plate of the eye. It is needed for straight ahead and reading vision. With aging, the macula may not function as well. If the loss of vision is severe it is called macular degeneration.
Generally this is a slow, progressive change but if abnormal blood vessels form, it can develop rapidly. The cause is unknown and the risk factors include family history, poor nutrition, smoking, arteriosclerosis (hardening of the arteries), diabetes and high blood pressure.
With macular degeneration, reading and central vision (such as watching television or driving a car) become increasingly difficult. Because the peripheral vision (side vision used for activities like walking and dressing) remains intact, people with macular degeneration do not go completely blind. Sometimes the condition can be treated with laser. The value of medications like vitamins is still up for discussion.
Those with diabetes are at higher risk of eye disease than others but if the diabetes is well controlled, the risk of eye problems is reduced. If you have diabetes, you should be seen by an eye specialist when first diagnosed and then yearly. Since the treatment of diabetic eye disease is best done in its early stages, regular eye exams will mean that problems can be detected when they have a better chance of being treated successfully. Treatment is usually with laser, although sometimes surgery is needed.
Talk to your family doctor about the ongoing care of your eyes. Remember that some eye problems do not give symptoms in the early stages. Your doctor and, if necessary, an eye specialist can give you advice and care for the health of your eyes.