The Five Most Common Eye Problems in the Elderly
As we age, our bodies begin to break down, and the eyes are no exception. No one knows this better than the elderly. There are five eye conditions that most commonly plague this age group:
- Diabetic Retinopathy
- Macular Degeneration
- Dry Eye Syndrome
Each of these problems can have a profound effect on a person’s vision. If not treated, all of these diseases can cause permanent blindness.
Cataracts are a direct result of the aging process. Behind our iris is a part of the eye called the lens, which allows the eye to focus at different distances. It also gives the eye 30 percent of its focusing power.
As the lens grows, it constantly produces new fibers. The old fibers are pushed toward the center of the lens, and form the nucleus. As we get older, the nucleus of the lens hardens through a process called sclerosis. Sclerosis not only causes hardening, it also causes the lens to become yellowed, which affects the patient’s color perception. Many patients note that colors are much more vibrant after cataract surgery.
Glasses can correct vision in a patient with cataracts until the cataract becomes “mature.” This means the lens has hardened to the point that it has become cloudy and the patient no longer has any useful vision. At this point it becomes necessary to remove the cataract and replace it with an artificial lens implant.
Diabetes is a metabolic disorder in which the body is either intolerant of or cannot properly use insulin. Because of this, blood sugar levels are not regulated properly. Chronic exposure to high blood sugar levels damages the blood vessels all over the body including the eye.
Because of the highly specialized nature of the retina, the retinal blood vessels are very delicate. When exposed to chronically high blood sugar levels, these blood vessels begin to break down and eventually hemorrhage leaking blood onto the retina, which permanently destroys the tissue. This is called diabetic retinopathy.
What Diabetic Retinopathy Looks Like
The loss of these blood vessels also prevents oxygen from getting to its destination. To compensate for this, the eye grows new blood vessels, which is called neovascularization. These new blood vessels are even weaker than the original blood vessels and lead to further bleeding and retinal damage. They can also cause glaucoma.
Treatment involves laser therapy to cauterize any bleeding, and prevent new blood vessels from hemorrhaging. Anti-VEGF treatments inhibit the vascular endothelial growth factor and have been found to be effective in preventing further neovascularization and in some cases can even improve vision.
How Glaucoma Affects the Optic Nerve
Glaucoma is the name given to a disease of the eye in which the pressure of the globe (eyeball) rises and causes damage to the optic nerve.
The optic nerve is the gathering of retinal fibers into a bundle that exits the eye and travels to the occipital lobe of the brain. Each area of the retina corresponds to a specific section of the optic nerve. The retina is, essentially, one big neuron with a very long axon or tail.
Many patients ask me, “There’s pressure in the eye?” Yes, in order to keep its shape, the eye maintains a constant pressure using a fluid called aqueous.
In glaucoma, the aqueous fluid doesn’t drain properly and because the eye is constantly producing aqueous, the fluid builds up. This pressure damages the delicate optic nerve fibers, which leads to peripheral vision loss and eventually permanent blindness.
The first line of treatment is eye drops to lower the production of aqueous which allows the fluid time to drain. There are times when drops are not effective, however. In these cases, laser therapy or surgery is often required.
Image of AMD
Age-Related Macular Degeneration
Age-related macular degeneration, often called ARMD or AMD, is exactly what it sounds like: a degeneration of the macula.
The macula is the part of the retina that allows us to see fine details. It is densely packed with cones, the retinal cells that allow us to see in color and detail.
As we get older, the immune system begins to mistake healthy retinal cells for cellular garbage and attacks these cells. The result is the breakdown or “degeneration” of the cells that make up the macula.
The effect on the central vision is devastating. Patients who suffer from AMD slowly lose the ability to drive, read, write, watch TV, and do just about anything that requires the ability to see directly in front of them. The peripheral vision is unaffected, so the patient never goes completely blind, however.
There are two types of macular degeneration: wet and dry. The dry form is the initial stage of the disease. As the disease progresses, the retina begins to grow new blood vessels (neovascularization). These blood vessels can hemorrhage and leak blood onto the retinal tissue. When this happens, it is called wet AMD.
Unfortunately, there is no treatment for the dry form of the disease, although vitamins have been proven to slow the progression of the disease. The wet form of AMD can be treated with anti-VEGF medications that prevent further neovascularization and in some cases can reverse the process to some degree.
Treatment for Chronic Dry Eyes
Dry Eye Syndrome
The tear film is one of the first things affected by the aging process, especially in women. The lipid layer of the tear film prevents evaporation, but as we age, this layer thins and evaporation occurs more rapidly.
In women, this happens very quickly during and after menopause because of the drop in estrogen levels. The quick evaporation of the tear film causes the cornea to dry out which causes the sensation of sand in the eye, excessive tearing, light sensitivity, and cloudy vision.
Dry eyes can also be caused by an under-production of tears. This is typically associated with diseases such as Sjogren’s syndrome and the use of narcotic pain medications. It can also be caused by long-term contact lens wear.
Treatment involves alleviating the symptoms. Most of the time the cause can’t be easily remedied or is a chronic illness, in which case the goal is to make the patient as comfortable as possible. Artificial tears are the most common and effective treatment. However, for more severe cases, punctal plugs or prescription eye drops may be necessary.
It’s important to remember to see your eye doctor right away if you suspect you have an eye problem. A sudden loss of vision, or sensation of something in the eye could be an ocular emergency and you should contact your ophthalmologist.
Questions & Answers
If there is something that appears to be like a big ink blot when I look out of one eye, what could it be?
That depends on several factors, but you need to see your eye doctor right away. If it happened suddenly, you could have had one of four conditions that are most commonly known as a stroke in the eye:
Central retinal artery occlusion or CRAO
Central retinal vein occlusion or CRVO
Branch retinal artery occlusion or BRAO
Branch retinal vein occlusion or BRVO
Typically, CRAO and BRAO cause total loss of vision, but it can be just central depending on where the occlusion is located.
You could also have a vitreous hemorrhage. If you are diabetic or on blood thinners, this is a common cause of the "ink blot" shaped loss of vision. They typically happen suddenly as well, but tend to float when you move your eye.
It could also be a severe case of wet macular degeneration that has hemorrhaged, although this typically develops gradually over time.
However, if you have noticed a sudden and severe change in your vision, you need to see your ophthalmologist right away. In the case of a CRAO, treatment needs to be administered within 90 minutes, or vision loss becomes permanent.
If you haven't already, I advise you to call your ophthalmologist right now, or walk in to their office and explain your symptoms. Never wait to see your eye doctor, it's better to be safe than sorry.
© 2012 Melissa Flagg COA OSC