How to Protect Your Eyes as You Age

Nothing announces middle age quite like whipping out a pair of reading glasses in a restaurant so you can read a menu. Our eyes-like the rest of our bodies-change as a natural consequence of aging.  The lenses become cloudy and less flexible which make focusing a challenge, and dryness is often an issue.

Other common complaints include driving difficulties at night, the inability to distinguish between colors, and trouble reading the small print on labels, cell phones, and computers. To compensate, many people in their 40s (and older) find themselves wearing glasses, using eye drops, and thinking about their vision for the first time in their lives.  Quality Health consulted two experts-Allison Ashbeck, OD and Christian Klein, MD-for advice on how to care for the eyes through the ages.

The Eyes Have It
"The American Optometric Association recommends a comprehensive, dilated eye exam at least every two years," says Ashbeck, adding that a driver's license vision test is not sufficient. (Note: Those living with diabetes, hypertension, or other illnesses should have their eyes examined more frequently.)

A comprehensive eye exam can be performed by an OD (doctor of optometry) or an MD (ophthalmologist) and includes tests that evaluate depth perception, color vision, eye muscle movements, peripheral or side vision, and the pupil's responsiveness to light. Eye drops are used to dilate the pupil, giving doctors a better view of the internal structures of the eye. This helps them detect diseases in their early stages before vision loss occurs.

To measure the pressure in the eye-and assess the risk of glaucoma-your doctor will use one of several diagnostic tools. The gold standard is called the Goldmann Applanation Tip. Glaucoma can be difficult to diagnose. It's a complicated disease that damages the optic nerve and leads to progressive, irreversible vision loss. After age-related macular degeneration (AMD)-a disease that impacts the macula, which is responsible for central vision-glaucoma is the leading cause of blindness.

Experts say you can expect more frequent changes in your eyeglass or contact lens prescriptions as you age through your 50s, but the changes should cease in your 60s.  Reading glasses, or readers, purchased at the drug store are fine for many people especially when worn over contact lenses but Klein and Ashbeck recommend prescription readers for others. "For the sharpest vision, people with a lot of astigmatism, or who are very near or far sighted should have readers ground by an optician," says Ashbeck. "Many people have astigmatism and over-the-counter readers don't correct for this."

The other problem with drug store readers is they are the same strength in each eye. "But most people don't have identical vision in each eye so you end up with one eye getting either over- or under-corrected," Ashbeck explains. It's true that made-to-order readers cost more but there are many reasonably priced options available at the optometrist's office.

Klein says if you live long enough you will develop cataracts, but today's surgical treatment options have significantly improved. Intraocular lenses are used to correct the vision during cataract surgery but the ophthalmologist says that 80 to 90 percent of the lenses used today still only correct for either near or far sightedness- not both- so most patients will require glasses following surgery. "There is a newer class of implantable lenses generically referred to as deluxe lenses that can correct for both distance and near, but they are not covered by insurance," says Klein adding that most people opt for surgery when their lifestyle is impacted. "I tend to operate when driving gets really difficult or a patient complains she can't see clearly enough to enjoy a favorite television show."

On average, cataract surgery takes 15 to 30 minutes and most people go home on the same day. "Recovery time is fairly minimal and involves using eye drops for several weeks," the doctor says. "Within a few days, the vision returns but it takes about a week to really sharpen up."

Eye Health Warning Signs
As you reach your 60s, it's wise to be attentive to warning signs of age-related eye health since many eye diseases have no early symptoms and develop painlessly.  Seek the care of a vision specialist if you experience any of the following conditions:

Vision that fluctuates.  Vision that is clear one day and fuzzy the next could be a sign of diabetes or hypertension (high blood pressure). Both of these chronic conditions can damage blood vessels in the retina and cause vision loss.

Floaters and flashes of light. Klein says seeing particles float in the fluid that fills the inside of the eye is fairly common and can be a normal part of aging but if you notice more floaters than normal or they are accompanied by bright flashes of light, contact your eye doctor immediately. "This could indicate a tear in the retina and waiting too long can result in permanent vision loss," Klein warns. "However, retinal detachment is more common in people who are very near sighted."

Loss of side (or peripheral) vision can be a sign of glaucoma. Seek treatment as soon as you can. According to the National Eye Institute, glaucoma affects an estimated 2.2 million Americans. African Americans over age 40, everyone over 60 (especially Mexican Americans), and people with a family history of the disease are at higher risk.

Distorted images, wavy lines, or blind spots near the center of your vision could be signs of age-related macular degeneration (AMD).

The eyes aren't just a window to the soul; they enable doctors to see significant changes in the rest of the body, too, says Ashbeck.  "I can look at the back of the eye and see changes in blood vessels that can be indicative of diabetes or heart disease."

Medication is also a common part of aging but many people are unaware of the visual side effects they cause. Antihistamines for allergies and other ailments, for example, can dilate your pupils and make the eyes more susceptible to certain vision problems. And a growing body of research links the aging eye to everything from insomnia and memory loss to less responsiveness and depression.

Aside from exercising regularly, eating a healthy diet with antioxidant-rich foods, and keeping your weight in a healthy range, having regular eye exams is the best way to care for your vision.



Christian Klein, MD
Ophthalmologist at the Flaum Eye Institute at the University of Rochester Medical Center in Rochester, NY

Allison Ashbeck, OD
An optometrist with South River Eye Care in Edgewater, MD

American Optometric Association

The Glaucoma Research Foundation

The New York Times
"Aging of Eyes is Blamed for Health Woes" by Laurie Tarkan
Feb. 2012