Mrs Priya, an 80-year-old lady is fondly known in her neighbourhood for her sunny and warm predisposition, as well as a passion for baking and making snacks. Murukku, pastries, and a variety of assorted local desserts like kek lapis, kuih talam, onde-onde; you name it.
Without fail, she would arrive at her neighbours’ homes on their birthdays, bearing their favourite pastries.
Mrs Priya was always cheerful and relished her independence. She went for morning walks religiously and joined her friends for tai chi three times a week. She enjoyed reading books to pass the time as well.
However, she had been noticing that it was increasingly hard to read the fine print, and she had to squint more. She also noticed that her vision was getting blurrier, but she brushed it off, attributing it to old age.
One beautiful morning, Mrs. Priya decided to bake an apple crumble for Mrs. Tan’s 55th birthday. Despite her blurry vision, she carefully measured the ingredients, determined to make the best treat for her neighbour. However, as she stirred the pot of applesauce, a sudden searing pain shot through her hand as it accidentally came into contact with the hot surface, leaving a painful burn.
Eyes: The Window To The Soul
Vision is arguably the most crucial sense among the five, which includes taste, smell, touch, and hearing.
It allows us to appreciate a stunning sunset, witness the joy in our loved ones’ smiles, savour delicious meals, and enjoy various activities. Good vision adds immense value to our lives, enhancing their quality more than we realise.
As we grow older, our vision often declines too. A study found that approximately 4.5% of Malaysians aged 60 and above experience vision impairment.
9 Vision Issues in the Elderly
Some various causes and factors affect our vision as we age. Let us dive into the more common types:
- Presbyopia (long-sightedness)
This is the most common eye disorder in the elderly.
It’s a condition where individuals can see distant objects easily but have trouble focusing on nearby objects. They might find it difficult to read fine print and require brighter light for reading.
Presbyopia develops when the lens in the eye loses flexibility, making it challenging to bend and focus light accurately onto the retina.
Treatment
Your doctor may prescribe special reading glasses or contact lenses for you, or in certain cases, surgery.
- Age-related macular degeneration (ARMD)
It’s a chronic eye condition that impacts the macula, primarily due to aging (as indicated by its name). This disorder specifically affects central vision, potentially hindering daily activities such as driving, reading, or writing.
Who Is At Risk?
Individuals diagnosed with ARMD often have a history of chronic smoking, underlying high blood pressure, obesity, a family member or relative with ARMD, or a diet high in saturated fat. Most cases of ARMD occur after the age of 60.
Signs and symptoms
- Gradual blurry vision
- Distorted shapes and objects
- Trouble differentiating colours (ie finding it hard to tell apart between green and blue)
- A dark or blurry spot at the centre of the visual field
Treatment
There are two types of ARMD: dry and wet ARMD. Wet ARMD, accounting for 10% of cases, can be managed with regular eye injections or surgery. However, dry ARMD, making up 90% of cases, currently has no treatment.
Strategies that can help support individuals living with dry ARMD include
- Magnifying lenses while reading
- Installing brighter lights at home
- Supplements such as lutein, vitamin C, vitamin E, and zinc have been discovered to slow the progression of vision loss.
- Cataracts
This is a visual disorder that impacts the lens capsule, it typically affects individuals between the ages of 60 to 70 years old. Progressing gradually over the years, it may go unnoticed until it begins to interfere with central vision. The condition causes the lens to become cloudy and opaque.
Surprisingly, this disorder accounts for 48% of global blindness cases. Fortunately, blindness caused by this condition can be reversed through surgery.
Signs and Symptoms:
- Blurry vision
- Increased sensitivity to glare
- Poor vision in dim places and at night
- The colours do not look as vibrant as before
Treatment
Surgery is the most effective option for treating this condition. Two common surgical techniques are:
1. Phacoemulsification: This involves breaking off and removing the cloudy lens, followed by inserting an artificial lens.
2. Extracapsular surgery: In this procedure, the entire cataract is removed and replaced with an artificial lens.
- Glaucoma
There are two types of glaucoma: Closed-angle glaucoma and open-angle glaucoma.
Closed-angle glaucoma develops rapidly due to a sudden increase in eye pressure, which damages the optic nerve. This rise in pressure occurs because of a blockage in the drainage system of the aqueous humour, often caused by a shallow anterior chamber. It’s crucial to seek urgent medical attention as this is a medical emergency.
On the other hand, open-angle glaucoma involves a gradual increase in eye pressure due to a slower flow of aqueous humour through the trabecular meshwork. This pressure buildup eventually leads to optic nerve damage.
Unlike cataracts and ARMD, glaucoma primarily causes peripheral (side) vision loss. If left untreated, glaucoma can progress to blindness.
| Closed-angle glaucoma | Open-angle glaucoma | |
| Signs and Symptoms | Intense eye pain Nausea, vomiting Blurry vision Headache Halos or rings around lights Red eye | No symptoms during the early stages Blurry vision occurs gradually |
Treatment:
Both require prescription eye drops, laser or surgery.
- Diabetic retinopathy
This condition stems from diabetes mellitus and often develops subtly, without noticeable warning signs.
1 in 5 Malaysians suffers from diabetes mellitus, and 1 in 4 elderly people with diabetes is at risk of developing diabetic retinopathy within five years of diagnosis. If left untreated, it can progress to blindness. The longer someone has diabetes mellitus, especially if it’s poorly controlled, the higher the risk of developing this vision disorder.
Signs and symptoms:
- Gradual blurring of vision
- Patchy vision
- Shapes floating in your vision field (floaters)
- Sudden vision loss
Treatment:
Your doctor might suggest anti-VEGF injections to slow down or even reverse the condition. Other treatment options include laser therapy or eye surgery.
Preventing this is straightforward, managing diabetes mellitus effectively is the key.
- Dry Eyes
As one age, there is reduced tear production.
Signs and symptoms
- Sandy feeling in eyes
- Eye dryness
- Easily tired
- Burning sensation
Treatment
Artificial tears can be purchased over the counter at pharmacies.
- Watery Eyes
Do you find that your eyes tear up easily?
This can occur due to droopy lower eyelids, a blocked drainage system, or factors in your environment such as temperature, wind, and fluctuations in light.
Treatment
Plastic surgery for droopy eyelids is typically performed by an ophthalmologist. To prevent exposure to bright light, consider wearing sunglasses with UV protection.
- Retinal Detachment
This condition is a medical emergency!
It occurs when the retina, a thin layer of tissue at the back of the eye, detaches from its original position, leading to retinal detachment.
Risk factors:
If you
- Have had eye surgery
- Have a family history of retinal detachment
- Have a recent eye surgery (cataracts operation)
- Are short-sighted
Signs and symptoms
- Floaters (tiny specks drifting through your vision field)
- Blurry vision
- Sudden flashes of light in one or both eyes (photopsia)
- Gradual peripheral vision loss
- A dark curtain-like shadow falls over your vision field
Urgent medical treatment is needed to give oxygen to the eye. If not, it can result in irreversible vision loss.
Treatment:
Eye surgery is required on the day of admission.
- Eyelid Issues
Besides the eye, eyelid problems can also play a role in vision impairment.
Some common conditions include:
- Blepharospasm: involuntary twitching of the eyelid
- Trichiasis: a condition where your eyelashes grow toward your eye rather than away.
- Entropion: inversion of the eyelid
- Dermatochalasis: excess loose eyelid skin
Treatment:
Entropion and dermatochalasis are conditions that can be treated with cosmetic eye surgery, which is also known as oculoplasty.
Investigations
An ophthalmologist conducts a range of tests and eye examinations to reach a diagnosis. They are medical doctors specialising in eye medicine and can perform eye surgeries.
These tests may include a visual acuity chart, visual field assessment, eye pressure testing (if glaucoma is suspected), and the use of tools like a slit lamp microscope to assess the structure of your eye.
Can Vision Loss be Prevented in the Elderly?
Yes, you definitely can have healthy eyes as you age!
Here are some eye care tips:
- Get your eyes checked regularly! It’s recommended to have an eye check-up annually or once every two years. If you have diabetes or high blood pressure, your doctor may advise getting your eyes checked at least once a year.
- Stop smoking.
- Eat a balanced diet.
- Lead an active lifestyle.
- Maintain a healthy weight.
- Manage diabetes and high blood pressure effectively.
- Reduce screen time! Spend time outdoors in nature, enjoy the scenery and greenery, as it helps reduce eye strain and keeps your eyes healthy.
- If your job involves long periods of computer use, set a timer to take breaks every 20 minutes. This reduces eye strain.
Conclusion
If you or your loved one have problems with your vision, seek professional medical attention today!
