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The Five Most Common Eye Problems in the Elderly

Updated on May 22, 2017
Daughter Of Maat profile image

Melissa Flagg is an ophthalmic technician with over 21 years of medical experience working with patients in the eye care field.

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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:

  • Cataracts
  • Diabetic Retinopathy
  • Glaucoma
  • 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.

A cortical cataract.
A cortical cataract. | Source

Cataracts

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.

Diabetic Retinopathy

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

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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

Increased pressure in the eye causes cupping of the optic nerve. Think of the optic nerve as a doughnut with the center hole being the cupping. Increased pressure in the eye causes that doughnut hole to grow, permanently damaging nerve fibers.
Increased pressure in the eye causes cupping of the optic nerve. Think of the optic nerve as a doughnut with the center hole being the cupping. Increased pressure in the eye causes that doughnut hole to grow, permanently damaging nerve fibers. | Source

Glaucoma

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

This is what dry AMD looks like.
This is what dry AMD looks like. | Source

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.

© 2012 Melissa Flagg

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    • KenWu profile image

      KenWu 4 years ago from Malaysia

      No one can hideaway from cataracts. Glaucoma is the (most) scariest eye problem of all. It won't be detected until it reaches the serious stage.

    • Daughter Of Maat profile image
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      Melissa Flagg 4 years ago from Rural Central Florida

      Indeed, glaucoma is usually found when there is only 24 degrees left of the peripheral vision!

    • Janine Huldie profile image

      Janine Huldie 4 years ago from New York, New York

      I had to read this article, because my maternal grandmother did indeed suffer from Dry Macular Degeneration for the last 15 or so years of her life. She never did go completely blind as you explained here, but eventually was unable to read, write and do basic things that we take for granted in our every day lives. Thanks for writing this and educating others on all of these eye problems. I do appreciate reading and learning a bit more here. I have voted and shared too!!

    • Daughter Of Maat profile image
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      Melissa Flagg 4 years ago from Rural Central Florida

      Thanks Janine! Macular Degeneration was probably the most devastating disease I saw during my career. Even more so than glaucoma. Mainly because patients lost the ability to write and read and that really obliterated their quality of life. Most of my patients were avid readers and only being able to see with their peripheral vision was torture. I heard so many say "I'd rather just go blind." Very sad, I felt horrible for these patients because there's only so much we can do and I hated that helpless feeling.

    • Janine Huldie profile image

      Janine Huldie 4 years ago from New York, New York

      Daughter of Meat, you just described my grandmother to a tee and her story. It was horrible to watch it unfold and in the beginning when she first found out, she just cried all the time. Once she did begin to accept it, at least she seemed more at peace with what was happening, but still it broke my heart to see my grandmother lose most of her vision and only have her peripheral vision left barely intact. Seriously thank you for writing about this and for sounding as though you not only understand, but totally sympathize with this eye problem.

    • Daughter Of Maat profile image
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      Melissa Flagg 4 years ago from Rural Central Florida

      @Janine, It was my pleasure to write this, and the hub on AMD. I do indeed understand and I like to think I can empathize with my patients because if I was in their shoes, I don't know what I would do. I, myself, am an avid reader, and I do quite a bit of detailed work (and writing of course). The thought of losing only my central vision and never being able to see my husband's face again, or even be able to sign a check is just unbearable.

      Those patients who choose to undergo the treatments and have injections into their eye monthly are some of the bravest people I have ever met and I was always surprised at the number of patients who kept their spirits up despite only being able to see the big "E" which is 20/400. For these patients, and all those who suffer with AMD, I will continue to write about the disease and research available treatments. As a tech, patients would inevitably open up to me, and I made a point to listen and find the answers they needed and I will continue to do that with my writing.

      Thank you for your touching comment. It means a lot to me and tells me I haven't lost touch with my patients.

    • dwachira profile image

      [ Danson Wachira ] 4 years ago from Nairobi, Kenya

      I hear people, especially students complaining much about Cataracts but it is such a relief that minor eye surgery can correct this problem. Eye problems are common to many people and this article has very useful information. Voted up and i will have to share this.

    • Janine Huldie profile image

      Janine Huldie 4 years ago from New York, New York

      Daughter of Maat, I just want to say a simple thank you and you definitely haven't lost your touch with your patients. I still think about what my grandmother went through each and everyday (and she is now gone almost 3 years). Just know from the bottom of my heart I appreciate you being such a caring person on this sensitive topic. Thanks you!!

    • lrc7815 profile image

      Linda Crist 4 years ago from Central Virginia

      Great information! As someone who has lost her central vision in one from AMD, I am always glad to see others educating on the problem. Good job!

    • Daughter Of Maat profile image
      Author

      Melissa Flagg 4 years ago from Rural Central Florida

      @dwachira cataracts surgery is indeed one of the simplest surgical procedures anyone could undergo. Mainly because it has become so routine. Although, I'm a bit shocked that students are complaining about cataracts. Their a bit young for that... :D

    • Daughter Of Maat profile image
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      Melissa Flagg 4 years ago from Rural Central Florida

      @Janine thank you!! Thank you so much! :D

    • Daughter Of Maat profile image
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      Melissa Flagg 4 years ago from Rural Central Florida

      @Irc7815 thank you for your comment, and I'm so sorry you have to suffer with this horrible disease. I wish you all the best, and if there's anything I can do, please let me know.

    • lrc7815 profile image

      Linda Crist 4 years ago from Central Virginia

      Thanks so much Gaughter of Maat. As you know, with dry AMD there is nothing to do but hope that science finds a treatment or a cure. I will be following you though. :-)

    • Daughter Of Maat profile image
      Author

      Melissa Flagg 4 years ago from Rural Central Florida

      @Irc7815 Unfortunately that is so true. Although the new treatments are promising, they aren't a cure. I think nutrition is really the only way to go until medical science finds the key to curing and preventing AMD. Since we know it's an autoimmune disease, a diet high in antioxidants should be very beneficial.

    • lrc7815 profile image

      Linda Crist 4 years ago from Central Virginia

      Hi Daughter of Maat. I am fairly disciplined and eat a lot broccoli, spinach, carrots, and blueberries. I also take asupplement made by Science Based Health called Macular Protect Complete (physician recommended) and 500 mg. Vitamin C. For a while I was using a product called Thai-go, a mangosteen juice but it was very expensive. Do you have any other suggestions?

    • Daughter Of Maat profile image
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      Melissa Flagg 4 years ago from Rural Central Florida

      I would increase the vitamin C. Personally, I take 8,000mg of Vit C per day. But you may need more. You can visit my hub on vit C, and just scroll down to the end, there's a link to Dr. Andrew Saul's website that explains why and how vitamin C works and why we should all be taking a lot more than the RDA. Vitamin C can cure cancer, and halt autoimmune diseases in their tracks, it's an amazing vitamin. It's also very cheap.

      Make sure you're getting the essential fatty acids as well. A handful of cashews or other nuts daily should be enough. Lots of leafy green vegetables and try to limit dairy products. The casein in animal products can be very detrimental to the whole body, not just the eyes. That's about all you can do. I'm constantly reading about what vitamins do what in the body, so if I find anything that might help, I'll be sure to let you know!

    • frogyfish profile image

      frogyfish 4 years ago from Central United States of America

      An excellent informative hub that answered some questions I had. Glad for your comment above about the C, fatty acids to help. I recently met a lady who said that IV glutathione had greatly helped her macular degeneration. It did have to be given by a physician. Video was also quite interesting and helpful. Thanks for sharing your expertise here!

    • Daughter Of Maat profile image
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      Melissa Flagg 4 years ago from Rural Central Florida

      @frogyfish Thank you! I'm glad you found this hub informative. Vitamin C also increases glutathione levels since its required in its production. :D

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