Eye Problems amongst Older People
The commonest eye problems which we see are decrease in vision due to cataract or a retinal condition like retinopathy due to uncontrolled diabetes or hypertension or age related macular degeneration. Some often complain of flashes and floaters.
Risk factors for eye diseases
- Smoking - increases the risk of cataract and macular degeneration by more than 3 times
- Alcohol - More than 1 alcoholic drink per day can increase cataract risk
- Bright UV light / not using sunglasses - increases the risk of cataract and macular degeneration
- High Blood pressure and cholesterol - increases the risk of macular degeneration
- Lack of protective eyewear - risk of eye injury and loss of sight
Flashes and Floaters
Floaters appear as grey or black specks, lines, or "cobwebs", worms, rings or dots in front of the eyes. As the eyes move, the floaters move too. They do not follow your eye movements precisely, as they usually drift when the eyes start or stop moving. Floaters are caused by clumping of pre-existing vitreous fibers in the eye or bits of material suspended in the vitreous jelly that fills the back of the eye.
Flashes are sensations of light, when no light is really there. They may appear as many tiny bright lights (like "sparklers") or like flashes of lightning. Flashes occur when the vitreous jelly pulls on or tears the retina. These flashes usually last for only a second or so, but typically occur repeatedly. They may be more obvious with eye movement or in a dark room.
Some people with migraine headaches may experience a different type of flash. These are usually shimmering, jagged lights that are present constantly for a period of ten-fifteen minutes or so. They typically appear in the center of your field of vision, and progress slowly towards the edges of the visual field. A headache that is commonly throbbing, and on one side of the head, may follow the disappearance of the flashes.
Many people have floaters. This happens in over 70% of the population as part of the normal aging process. Floaters that you have had for years, and that show little change, are usually not serious. It is the sudden onset of one or more new floaters that may be serious. The onset of flashes may also be serious.
Anyone with flashes or the sudden onset of a new floater (or floaters) needs a dilated fundus examination (looking at the vitreous and retina with specialized equipment after putting drops to enlarge the pupils).
Flashes and floaters cause total blindness CATARACT:
The Answer is - No, Floaters cause only a slight blockage of the vision at worst and are usually not detectable by visual testing unless they are very severe.
Importantly, floaters can be related to retinal detachment or a variety of vascular conditions such as diabetic retinopathy, while flashes can be related to retinal tears (breaks) or detachment. These can result in blindness if not treated.
If one eye develops flashes or floaters the other will develop them as well
It is very common for the same condition to occur in the second eye. For this reason, and because flashes and floaters are sometimes caused by retinal breaks, both eyes should have a dilated fundus exam as soon as possible when flashes or floaters develop in either eye.
Cataract is the most prevalent age-related eye disease in the world, and according to the World Health Organization, the leading cause of reversible blindness. There are currently close to 10 million Indians age 40 and older with cataract.
A cataract is a condition wherein the otherwise clear nature of the human lens becomes opaque. Surgery should be considered when the cataract causes enough visual disturbances to interfere with daily activities, such as job requirements, safe driving and household activities. Based on these needs and examination findings, the patient and the ophthalmologist should decide together when surgery is appropriate.
It is not true that cataracts need to be 'ripe' before they can be removed. In fact advances in the field of cataract surgery have made it easier to remove an immature cataract than a mature ['ripe'] cataract.
Common misconceptions cleared:
- Cataract is not a film over the surface of the eye
- It is not caused by overusing the eyes
- Not infectious [will not spread from one eye to the other], nor a cancer
- Not a cause of irreversible blindness
Myths
Cataract can be prevented by taking drugs!
As per todays scientific knowledge the cataract coming with age cannot be prevented by any drugs.
Cataract Surgery is Done with Lasers
The Answer is - Never, Lay men talk of the word 'laser' actually refers to the latest technique called phacoemulsification. No actual laser is used. The surgeries now are stitchless, very quick and with speedy recovery. Due to this short, stitch less procedure, cataract removal is often a misnomer as a laser procedure.
A cataract must be ripe before it can be removed.
With modern cataract surgery, a cataract does not have to ripen before it is removed. When a cataract keeps you from doing the things you like or need to do, consider having it removed.
In fact the phacoemulsification surgery as well as the post- operative period is much easier for the patient and surgeon.
GLAUCOMA
Glaucoma is one of the leading causes of blindness in the world, especially for older people. However visual loss is preventable or stabilized with early diagnosis and treatment.
Glaucoma is a condition of the eye where the optic nerve is damaged. The optic nerve carries images to the brain, which are then perceived as vision. Minute nerve fibres from various parts of the retina join to form the optic nerve. Glaucoma results when the pressure within the eye is high enough to be detrimental to the normal functioning of these nerve fibres, some of which stop functioning. Non-functional nerve fibres result in a loss of retinal function in the area from where they originate, leading to defects in the field of vision.
The disease is called the `sneak thief of sight? because it is painless, symptomless and irreversible. Therefore, the person with glaucoma is usually unaware of it until much loss of vision has occurred. In fact, half of those suffering damage from glaucoma do not know it. Currently, damage from glaucoma cannot be reversed and if the entire nerve is damaged, blindness results. Early detection and regular treatment are the keys to preventing optic nerve damage and blindness from glaucoma.
Myth
Glaucoma can happen to you only if someone in the family has it.
The Answer is - False, Glaucoma though seen as a hereditary trait can also occur in sporadic cases, those on long term steroid use
Anti-Glaucoma Diet?
It cannot be cured by a special diet. This disorder is characterized by increased pressure in the eyeball and can lead to blindness. One important thing to remember is not to drink a lot of fluids in one go if you have Glaucoma
Glaucoma is blinding in all cases!
In modern ophthalmology glaucomas are nearly always prevented from losing vision by using the appropriate drugs or surgery and regular follow ups with eye care professionals. Hence a regular eye examination is a must.
DIABETIC RETINOPATHY
Diabetes mellitus is a condition which affects millions of Indians. It impairs the body's ability to use and store sugar. Elevated blood sugar levels and excessive thirst and urination are the indicators of diabetes. It can affect vision by causing damage to the blood vessels of the retina, or a higher incidence of cataract and glaucoma. Changes are also seen in blood vessels all over the body
It is an advanced stage of the diabetic disease process in which the blood vessels in the retina are damaged and leak fluid or blood. The longer a person has diabetes, the more the risk of developing diabetic retinopathy. People with type I diabetes [diabetes since childhood] are more likely to develop diabetic retinopathy at a younger age.
The symptoms of diabetic retinopathy:
Early diabetic retinopathy usually has no symptoms. Gradual blurring of vision may occur if fluid leaks in the central part of the retina [the macula]. In late diabetic retinopathy [proliferative stage], new abnormal blood vessels begin growing on the surface of the retina or the optic nerve. These vessels have weak walls and leak blood out into the retina and vitreous [jelly that fills most of the eye]. Presence of blood in the path of light entering the eye blocks vision.
Myth
Diabetic patients do not need an eye checkup till they have visual symptoms !
Diabetic patients must have an annual eye checkup. This can help detect early involvement of the eyes. At that stage a rigorous control of diabetes and preventive actions such as laser photocoagulation of the retina might help to prevent severe visual loss later.
AGE-RELATED MACULAR DEGENERATION
The macula is a small area at the center of the retina that allows us to see fine details such as central vision, activities such as reading and writing and appreciating colour vision.
Sometimes the delicate cells of the macula are damaged and stop functioning. The exact cause is not known although it tends to happen as people get older. This is called age-related macular degeneration. The most common types of macular degeneration are the dry [atrophic] and the wet [exudative].
The dry type is caused by aging and thinning of the tissues of the macula. The wet type results from the formation of abnormal blood vessels under the macula which leak fluid or blood and blur the central vision. Children and young people can also suffer from an inherited form of macular degeneration called macular dystrophy, which can sometimes affect several members from the same family
Some Helpful Tips for older people
- Eat a balanced diet, including fresh fruits and vegetables, Greens and fruits provide vitamins, minerals and antioxidants to boost your body's immune system.
- Commit to Exercise regularly (check with a doctor before starting an exercise program). Go for the great outdoors. Nature rambles are good for fresh, oxygenated air. This improves blood circulation.
- Get regular health check-ups and annual eye examination.
SOME COMMONLY ASKED QUESTIONS
"What can I do with nutrition to improve my vision"
- Start with a well balanced diet
- Add Exercise for Circulation
- Ultraviolet protection
- Supplements that help the eyes like Selenium, Vitamin A
Care of eyes during examinations-
- Good lighting
- Taking breaks or periods of rest
- Proper posture
- Good nutrition and hydration
Food for the Eyes?
Some people believe poor eyesight can be corrected by following certain diets or taking vitamin supplements. This is true only if your problem is caused by a vitamin deficiency. Vitamin A, for instance, is needed for night vision. People who lack this vitamin - which is found in dark green leafy and yellow vegetables and fruits - can't see well in dim light because of night blindness. This is a common problem in developing countries like the Philippines.
But gorging on carrots and other sources of vitamin A won't spare you the trouble of wearing eyeglasses if you need them later. Rather than help you, too much vitamin A can cause blurred vision, itchy skin, loss of appetite, hair loss, joint pains and irregular menstruation.
Poor eyesight, which is helped by wearing eyeglasses, has nothing to do with nutrition. Only if you are short of vitamin A, then carrots would enable you to see better in dim light.
Dim Fears
Will reading in dim light harm your eyes? Of course not! This is another myth that refuses to die.
Reading in the dark, in a moving car or in bed won't damage your eyes. The worst you can expect is a headache or nausea. This comes from strained muscles which have to work harder since you're reading in an awkward position.
All Red Eyes are Infections and wearing dark glasses prevent its transmission to others.
It has been our experience in our hospital that most red eyes are due to allergies. However transmitting infection does not take place by looking or staring at the red eyes, but by hand to eye spread.
It is good for the eyes to look directly at the sun.
False. Ultra-violet light is harmful to your eyes, damaging the cornea, lens and retina. Also, never watch welding without wearing the proper protection. Never look directly at an eclipse.
You do not need to have your eyes checked until you are in your 40s or 50s.
There are several asymptomatic, yet treatable, eye diseases (most notably glaucoma) that can begin prior to your 40s.
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