Are you noticing changes to your vision with each passing year—nearsightedness or cloudy or blurry vision? Some of this is normal—but some changes are more serious than others. Bottom Line Personal asked Jeffrey Anshel, OD, what changes to look for…and what you can do to preserve your vision.
Presbyopia, a loss of focusing ability, commonly starts around age 40 and is most noticeable among people who hadn’t needed vision correction earlier. Presbyopia makes it harder to read at a distance of 16 inches—where we tend to hold reading material—and difficult to make out small print. (If you’re nearsighted, you probably know that taking off your glasses and holding the print closer to your eyes makes it more legible.) Presbyopia occurs because the lens of the eye becomes less flexible over time, hampering focusing ability. What to do…
Wear reading glasses—but not drugstore “readers.” These cause eyestrain—both lenses are the same power, while your eyes might require different powers…they don’t correct for astigmatism…and the “optical center” of each lens likely will not align properly with the distance between your eyes.
If you already wear glasses, talk to your eye doctor about a prescription for multifocal or progressive lenses, so you won’t have to switch glasses for reading and distance.
If you wear contacts, you can wear reading glasses over your lenses. Or try multifocal contact lenses or monovision correction with one contact lens for near vision, the other for distance.
For computer work, try occupational progressive lenses that correct intermediate- and near-vision. Typical “reading lenses” are single-vision only and so may not be the correct prescription for computer work.
To avoid eyestrain from your screens: Relieve your eyes with my 20-20-20 rule—every 20 minutes, take 20 seconds to look 20 feet away.
To make reading easier in general: Improve your lighting…choose a large-print format…use an e-reader that lets you adjust the lighting and font size…and listen to audiobooks on occasion.
Night driving can be challenging for people with presbyopia. Possible solution: If you wear monovision contact lenses, ask your doctor to place a prescription lens for distance in an eyeglass frame on only the side that matches up to your near-vision contact lens (the lens in the other side of the frame remains clear). This way, you will have both eyes corrected for distance vision. Wear these glasses over your contacts when driving.
Dry eye occurs when your tear glands don’t work well. It’s most common in women over 40 because tear production is linked to estrogen production, so women may experience it throughout and after menopause. Symptoms vary with the type of dry eye—your eyes might produce fewer tears…or your tears may evaporate quickly, leaving you with a gritty, stinging or burning feeling and then you may make too many tears in response. What to do…
Over-the-counter eyedrops such as Systane may soothe your eyes temporarily, but ask your eye doctor about specific lubricating eyedrops or ointments. Three prescription medications for dry eyes: Restasis, Xiidra and Cequa.
Caution: Do not use eye “whiteners,” which, surprisingly, can make your eye red and uncomfortable in the long term.
Take supplements such as MaxiTears Pro, HydroEye and EZ Tears. There are over-the-counter versions of these, but ask your doctor which nutritional supplements he/she recommends for dry eyes—he may write a prescription.
Switch to daily disposable lenses if you wear contacts—they will be more comfortable than monthlies.
Use a humidifier in your bedroom and, if possible, at work to add moisture to the air…or try an air purifier to remove irritants that bother your eyes—some devices do both. If your house is very dry, a whole-house humidifier will have a big impact, though it must be installed by an HVAC professional.
Age-related macular degeneration (AMD). This disorder stems from changes to the macula, the small centralportion of the retina, and causes vision to become blurred or distorted. There are two types of AMD—dry and wet.
Dry AMD is more common and occurs as the macula thins with advancing age. It progresses over years through three stages—early, intermediate and late. There’s no treatment for late stage, so catching it early is imperative.
Wet AMD, caused by damage to the macula from abnormal blood vessel growth in the back of the eye, is always considered late stage and causes faster vision loss, but there are treatments.
What to do…
Take OTC supplements known as the AREDS2 formula—named for the “Age-Related Eye Disease Study 2.” The formula contains specific amounts of vitamin C, vitamin E, zinc, copper, lutein and zeaxanthin. These supplements can slow the advance of both types of AMD (they do not prevent the condition).
Injections into the eye of biologic drugs, such as bevacizumab and aflibercept, may help some cases of wet AMD. While the injections are not painful, advances may soon reduce the frequency of the injections from every six to eight weeks to just twice a year.
Cataracts are cloudy areas in the lens that prevent light from passing through to the back of the eye. The result is blurry or hazy vision that worsens over time—you may not even realize it is happening at first. Why it happens: The lens gets nutrients, including vitamin C, from a fluid in the eye called aqueous humor. As the lens thickens with age, it’s difficult for it to get those nutrients and it starts to lose transparency. Some cataracts stay small and don’t impact vison, but if yours interfere with your lifestyle, cataract surgery can replace the clouded lens with a clear plastic one.
Reminder: Even though cataract surgery is the most common surgery performed by ophthalmic surgeons in the US, it does have risk. Some conditions, including dry eye, may get worse after the procedure. But it usually is worth the risk because your vision will continue to decline as the cataract gets denser.
Glaucoma. This threat to vision is more commonly linked to the aqueous humor—when this fluid can’t drain properly, it builds up, increasing pressure in the eye and causing optic nerve damage. Types of glaucoma include “open angle” with no early symptoms and “closed angle” with symptoms that come on quickly, including eye pain, redness and blurred vision as well as a severe headache, nausea and vomiting. If either type of glaucoma progresses unchecked, it can lead to vision loss and, ultimately, irreversible blindness. What to do…
Prescription eyedrops sometimes can control glaucoma, though laser treatment or surgery may be needed.
The combination supplement Mitrogenol, which contains French maritime pine bark (Pycnogenol) and bilberry extract, has been found by some studies to enhance traditional treatments. Talk to your doctor.
Control your blood sugar if you have diabetes. Some studies have pointed to a greater risk for open-angle glaucoma among people with diabetes.
Floaters and flashes. Nearly everyone has floaters, pieces of cells stuck inside the eye, but they’re not always noticeable or can be ignored. Why they occur: Before you’re born, blood vessels grow through the center of the eye and then dissolve to leave the area clear. Some cells remain suspended in the vitreous humor, a gel that sits between the lens and the retina. You may see floaters when you’re facing a bright wall or ceiling or staring at a display screen. Because the gel softens as you get older, you’re likely to see them more often.
Beware: Suddenly seeing floaters along with flashes of light in the front of an eye can signal a detached retina. See an eye-care specialist immediately. If the retina loses its connection to the brain, you may lose all vision permanently.
Diabetic retinopathy. Diabetes risk tends to increase with age—about 25% of Americans over age 60 have this chronic disease. When diabetes is uncontrolled, one of the many complications is diabetic retinopathy, when blood vessels can’t nourish the retina properly. There are no warning signs in the early stages, but as it progresses, you may experience cloudiness or blind spots in your field of vision. Ultimately, blood vessels can bleed into the eye, leading to significant vision loss or even blindness. What to do: Controlling blood sugar is essential. If you develop swelling of the retina, caused by poor integrity of the blood vessels, treatment may involve injections and/or laser therapy.