By JUDD MATSUNAGA, Esq.
Did you know that over nine million adults ages 65 and over in the United States can’t see clearly? The vast majority of them started with good vision. However, as they aged, they lost their sight to diseases like macular degeneration, glaucoma, and diabetes. What’s more, the number of visually impaired Americans is expected to double by the year 2050 as the Baby Boomer generation ages.
Many people will never have to deal with serious eye disease (e.g., they die young). For everyone else, your eyes will age, just like the rest of your body. Chances are, if you haven’t already, you will eventually experience some age-related changes in vision. For most people, the first sign of the aging eye is the deterioration of close-up vision, or presbyopia (age-related far-sightedness).
I never knew I had presbyopia until recently, when I read a Special Health Report from Harvard Medical School called “The Aging Eye.” From this Special Health Report, this article will cover some normal age-related conditions, such as presbyopia, as well as the four eye diseases that pose the greatest threats to vision after age 40: cataracts, glaucoma, age-related macular degeneration, and diabetic retinopathy.
Let’s start with how the eye works. The eye is often compared to a camera, but the organ of sight is far more complex than even the most expensive camera. It also works harder than you may realize. Not only does it continuously focus and refocus as you shift your gaze, but it also executes a constant series of rapid movements that you’re not even aware of in order to capture the maximum amount of visual information, while at the same time adjusting for changes in light.
And in contrast to a typical camera, which gives you a flat image, the stereoscopic view presented by two eyes enables the brain to assemble a three-dimensional picture of the world that helps you drive a car, play pickleball, and much more. That said, your eyesight will likely diminish over your lifetime. Just as hair turns gray and skin sags with age, the eyes, too, undergo changes as you grow older.
As your eyes age, your eyelid muscles weaken, and the skin becomes thinner and more flaccid. This can cause the upper lid to droop, obscuring your vision if the lid falls over the pupil. The lower lid can also sag. When that happens, whether from normal aging or a condition like Bell’s palsy (sudden weakness of the facial muscles), it leaves that portion of the cornea exposed and can cause it to dry out.
Tear production also drops with age. In addition, the lubricating glands in the eye and lids produce less of the oily film that keeps tears from evaporating. These changes, which can also result from eyelid inflammation (blepharitis), can lead to a buildup of sticky mucus or dry out the cornea, causing irritation or an uncomfortable, gritty sensation in the eye and fluctuations in vision.
The thin mucous membrane (conjunctiva) that lines the inside of the eyelids and covers the sclera (the white of the eye) turns thinner and more fragile with age. The white of your eye may acquire a yellow hue (from fat deposits) or grayish translucent patches (from calcium deposits). The exposed conjunctiva between the lids begins to degenerate, and the cornea can develop an opaque white ring around its edge.
With time, the lens hardens and loses its elasticity. This makes it more difficult to focus on near objects, a common condition called presbyopia. You might find it more difficult to see at night. A decrease in pupil size and photoreceptor function with age also makes it harder for your eyes to adapt to the dark. These changes usually occur simultaneously in both eyes.
These changes occur gradually and often become apparent in later years, as the structures in and around your eyes become less efficient. Presbyopia, which means “aging eye” in Greek, is a very common age-related eye condition meaning the gradual loss of your eyes’ ability to focus on nearby object. You might have already noticed that you have to hold your menu at arm’s length to read it, especially in a dimly lit restaurant.
Presbyopia occurs when the aging lens becomes more rigid and less efficient at bending to accommodate changes in focus. An accompanying lag in the function of the ciliary muscles — the ring of muscles that helps the lens focus near or far — contributes to the difficulty in seeing small print. If you find yourself reading things at arm’s length, you probably have presbyopia. It may start as early as your late 30s, but it typically develops in the 40s and 50s and eventually affects everyone.
Blurred close vision that leaves eyes tired and strained is an early hint that you’ve developed presbyopia. After reading or doing other detailed work, you may find it hard to see distant objects clearly. The problem may be more pronounced when you try to read in poor light, or in the evening when you’re tired. Eventually, as your presbyopia worsens and the lens of your eye becomes stiffer, you may need new corrective lenses or another remedy.
Your eyes are coated with a tear film — consisting of the tears themselves (produced in the lacrimal gland in each of your upper lids), a thin layer of oil that prevents the tears from evaporating too quickly (produced in the tiny meibomian glands that line the upper and lower lids), and a layer of protein called mucin that acts as a lubricant. This tear film helps to cleanse and nourish the outer structures of the eye.
But as you age, the production of both oil and tears declines, producing irritation, burning, or a slightly painful, scratchy feeling in the eye. Sometimes mucus (made largely from mucin) builds up, causing a sticky sensation. You may become sensitive to light, have trouble wearing contact lenses, or even find it difficult to cry. When the problem is severe, it may feel like you have sand in your eyes. This combination of symptoms is called dry eye syndrome.
Although some people develop dry eyes as they grow older, others have the opposite problem — watery eyes. Counterintuitively, the problem often develops because of dry eye syndrome. Dry eyes are uncomfortable, which causes the eyes to reflexively produce more tears — sometimes, too many.
Watery eyes also can result from tear drainage problems. Normally tears drain from the surface of your eye through small holes (puncta) at the corners of your upper and lower lids near your nose, passing via the channels of the tear drainage system into the nose. But if this drainage system gets blocked at any point, tears can build up in the eyes until they spill over the lids. An eyelid problem or infection can also lead to watery eyes.
Although many of these changes are part of the normal aging process, some set the stage for more serious eye problems that need to be monitored. The four eye diseases that pose the greatest threats to vision after age 40:
Cataract. This clouding of the lens usually develops slowly over many years. You may not notice the cloudiness until it blocks your central line of sight and impairs your vision.
Glaucoma. Over time, the anterior chamber in each eye may become shallower in certain people — those who have small eyes and are farsighted, for example. The narrowing can lead to a blockage in the aqueous humor drainage system near the iris. The resulting fluid backup may lead to a sudden rise in pressure inside the eye that damages the optic nerve, a condition known as closed-angle glaucoma. Left untreated, it can cause blindness.
Another form of glaucoma, called open-angle glaucoma, occurs when pressure builds up gradually in the eye because of a different problem: a slower outflow of aqueous humor through the trabecular meshwork. As in closed-angle glaucoma, the resulting buildup of pressure inside the eye c0an damage the optic nerve, if left untreated, and cause blindness.
Age-related macular degeneration. As the retina ages, it may grow less sensitive to light because of cell loss, a reduced blood supply, or degeneration. The macula is especially prone to deterioration. Age-related macular degeneration is a serious disease that can steal a person’s central vision, making it difficult to read, write, or drive a car.
Diabetic retinopathy. Diabetes is a disease in which the body either doesn’t produce enough insulin or doesn’t use it effectively. Insulin normally moves sugar from the blood to the cells for energy. Without it, sugar builds up in the bloodstream and can damage blood vessels and organs throughout the body — including the eyes. Diabetic retinopathy occurs when blood vessels that feed the retina leak, leading to retinal swelling, or when new blood vessels form, causing bleeding into the retina or retinal detachment. When left untreated over time, this condition can lead to blindness.
By age 60, your retina requires three times as much light as it did when you were 20. One very easy way to see more clearly is to improve the lighting in your home. Use brighter bulbs. Position lamps so that the light shines directly onto the materials in front of you. A lamp with an adjustable neck can help you focus the beam right where you need it.
In conclusion, whatever your vision problem, there are now more ways to cope with it than ever before. But remember, regardless of your age, the single most important thing you can do is to have your eyes checked regularly and follow your doctor’s treatment recommendations. Ophthalmologists, optometrists, and occupational therapists can help you protect your eyes and help preserve your vision as you age.
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Judd Matsunaga, Esq., is the founding partner of the Law Offices of Matsunaga & Associates, specializing in estate/Medi-Cal planning, probate, personal injury and real estate law. With offices in Torrance, Hollywood, Sherman Oaks, Pasadena and Fountain Valley, he can be reached at (800) 411-0546. Opinions expressed in this column are not necessarily those of The Rafu Shimpo.