Elderly eye problems

HOLISTIC VIEW

As with the rest of the body, the eye also undergoes significant changes as a part of the ageing process. In fact, vision and hearing abilities are the two most important special sensory functions of the body that tend to fail simultaneously as we age. Visual difficulties may impair mobility, and hence, other day-to-day activities. Here’s looking at some common age-related eye ailments:

Presbyopia: It literally means trying to see as an old man sees, and is usually the first sign of ageing in the eye. It usually starts around the age of 40 and is characterised by progressive difficulty in focusing close distances. It can be improved by the use of glasses and contact lenses, which can be for reading alone, bifocal (for distance and near) or progressive (that enable focusing at different distances).

Cataracts: These are the second most common eye problem in adults over 45-50 years. It results from the clouding of the eye’s lens that helps focus the light rays in the eye. Patients usually complain of blurred vision, glare, reduced perception of contrast and colour. Although in early stages, patients may benefit with change of glasses, cataract surgery with removal of the lens and implantation of an artificial lens (intraocular lens)
provides permanent cure.

 Glaucoma: Characterised by increased fluid pressure in the eye (either due to decreased escape from the eye or increased production), it leads to nerve damage, progressive narrowing of the visual field and ultimately, irreversible blindness. This condition has two subtypes - open angle glaucoma, which is slowly progressive and associated with a painless decrease in vision. On the other hand, acute angle closure glaucoma may be associated with sudden and painful decrease in vision and redness of the eye. Incidence of glaucoma tends to increase after 40 years of age and in the presence of a positive family history. Hence, it is advisable that geriatric patients undergo a comprehensive ocular examination.

Age-related macular degeneration: This condition is characterised by slow age-related damage to the central part of the retina called macula. It is one of the leading causes of decrease in vision in the elderly. It occurs in two forms – Dry AMD, which presents with a slow decrease in vision, most marked in the central part of the vision and wet AMD, which usually presents with a more rapid decrease in vision due to bleeding or swelling in the retina.

Diabetic retinopathy: In patients with an unusually long duration of diabetes, progressive changes may take place in the retina with collection of fluid and blood in the retina, that may impair vision. Since the incidence of diabetes increases with age, this condition usually reflects in the elderly. Even though good breakthrough has been achieved in control of the condition, the best option remains early detection and strict
control of diabetes.

Vascular occlusions: This group of diseases (retinal vein occlusion, retinal artery occlusion and ischemic optic neuropathy) usually presents itself with a decrease in vision, following a cessation of blood flow in the important blood vessels in the eye. Prolonged and poorly controlled hypertension, blood sugar and cholesterol patients are predisposed to such conditions.

 Floaters: Floaters are characterised by the experience of seeing small dots/black spots in front of the eye. These are more often seen in a well-lit room. Floaters often are normal, but can sometimes indicate a more serious eye problem, such as retinal detachment, especially if they are accompanied by light flashes. 

The elderly not only need a regular eye checkup, but also a more comfortable and compassionate environment for them. Hence, there is a need for the development of a dedicated geriatric eyecare system focusing on preventive, curative and social aspects for elderly people.


(The author is consultant, paediatric ophthalmology, strabismus and neuro-ophthalmology, L V Prasad Eye Institute, Visakhapatnam)