Age Related Expectancies

Eye Care for the Aging Eye

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Ptosis is usually not much of a problem initially. Often times though, the droppiness of the lid progresses until you find yourself getting headaches along your forehead from trying to keep your eyebrows help up to pull the lids higher. Or, you may begin to notice neck pain from leaning your head backwards, trying to see through then narrowing area between your lids. If, during relaxation, the lid margin is beginning to cover the pupil margin, your superior peripheral vision is being blocked by the lid.

Ptosis can be a part of normal gaining; can occur after injury, or as an aftereffect of cataract or other eye surgery It can be a muscle problem, a tumor, a nerve problem or even a symptom of a systemic disease like diabetes. If you believe droopy lids are becoming a problem for you, tell your eye doctor. Specific testing can be performed to assess the severity of the problem and determine treatment or surgical options.

Dry eyes can be a real problem with ocular comfort and in the overall health of the eye. It is defined as a chronic lack of sufficient lubrication and moisture in the eyes. It usually presents with symptoms of scratching, sandy foreign body sensation, burning and obviously dryness. Now it may seem strange, but sometimes tearing eyes can result from dry ye syndrome as the body tries to overcompensate for the dryness. There are ways that your eye doctor can access the eye to determine how dry your eyes are and specifically which layer of your tear film is affected.

Watery Eyes, also known as epiphera, can be a very annoying and sometimes painful problem. The constant wiping away of tears can cause irritation to the skin surrounding the eye. Usually there is a mechanical reason for the tearing. As briefly mentioned before, one possible cause is actually dry eyes. There are three different layers to the tear film: A thin layer of mucin (which helps hold the tears onto the eye), followed by a thicker layer of aqueous (the salt water we think of with tears, produced by the lacrimal gland), and a thin layer of oil (that helps prevent evaporation of the tears). If the tears are evaporating off the eyes too quickly from a reduction in the amount of oil, the lacrimal gland may produce more tears. These new tears still do not contain the correct distribution of oil, mucin and aqueous. They can spill right over the lid instead of resolving the true problem.

A second cause may be the lid position. The lower lid may fall forward in a position called ectropia. This can cause the puncta to sit away from the eye and the tears are unable to go down the natural tear drain. A simple lid surgery can pull the lower lid back towards the eye and solve this problem.

A third cause of tearing would be a blockage in the lacrimal drainage sytem. Your eye doctor can perform a simple test to see if tears are passing from your eyes down through the puncta and into the lacrimal drainage passageway. If a blockage is suspected, a thin probe is inserted and the blockage is assessed. Sometimes a simple probe under a local anesthetic is all you need to open the drain again. In more stubborn cases, saline solution can be flushed through, trying to break up the blockage and clear it out.

Pink eye is a general term for a condition that can be caused from allergies, bacteria, or viruses. Pink eye is very contagious in close communities such as schools or retirement homes. The single best method of preventing the spread of pink eye is hand washing. If a member of the family has pink eye, make sure to clean door knobs and light switches as well.
In the back of the eye, behind the lens and in front of the retina is the supportive gel like fluid called the vitreous. The vitreous is attached at various spots including the optic nerve head. The vitrious becomes more watery as we age. As it gets more watery it can cause tugging at it’s attachment sites. This can result in a vitrious detachment. With a vitrious detachment comes a large floater due to the previous attachment site being opaque and not allowing light to pass through. An explosion of floaters can also occur duing a retinal detachment. Due to the fact that the retina does not have pain receptors like our skin does, any pressure or pulling is perceived as light. This can cause flashing. If new floaters appear or if flashing lights are visible, you should call your eye doctor immediately. It is not something you want to wait on.

There are several different types and causes of cataracts. If we all live long enough we will likely have some lens changes in our eyes. UV light is associated with cataracts, so wearing sunglasses with UV protection or having a UV coat applied to your regular glasses may slow down cataract progression. Uncontrolled diabetes, radiation treatment, lead exposure, steroid use, diuretics and major tranquilizers may contribute to cataract formation. Some researchers believe that a diet high in antioxidants such as beta carotene (vitamin A), selenium and vitamins C and E, may put off cataract formation, while eating a lot of salt may increase your risk. Other factors that can increase the likelihood of developing cataracts include smoking, air pollution, and heavy alcohol consumption.

Cataracts are monitored by your eye doctor until they begin to interfere with your day to day activities. When that happens, cataract surgery is usually indicated. Surgery today is much simpler than it was in the past. It’s an outpatient procedure, and in the vast majority of cases, it is performed under local anesthesia only.

Diabetes and high blood pressure can lead to ocular changes. One of the most devastating to vision is diabetic and hypertensive retinopathy. Diabetes and high blood pressure, especially when they’re unstable can cause blood vessel changes throughout the body. When this occurs in the eye your eye doctor may notice little pinpoint hemorrhages in the back of the eye. If there are only a couple of scattered hemes in the midperipherery, generally the focus is on controlling the variability in the blood sugar or blood pressure. If the hemorrhages are significant, laser treatment may be necessary to seal up the blood vessels. If hemorrhages begin to occur near the macula, where our best vision is located, acuity may be threatened. Diabetic patients should have a dilated retinal examination every year to monitor for retinal changes, and to catch them early enough to prevent devastating vision loss.
There are several different types of glaucoma and different risk factors. All of the types affect the optic nerve head and nerve fiber layer and will cause peripheral vision loss when left alone. Glaucoma is treated with eye drops that work to lower the intraocular pressure (IOP). Risk factors for glaucoma include age, family history, diabetes extreme nearsightedness, previous eye surgery, oral or inhaled steroid use (especially higher doses for prolonged periods), and ethnic background. There are several different eye drops for your eye doctor to choose from to treat glaucoma. Your medical history, allergies, and current medication list are all factors in your doctor’s decision of which drug to choose for you. The important thing is to be compliant with using the drops to maintain a consistently lower IOP. This can help stabilize the eye and prevent further vision loss. Some forms of glaucoma are very aggressive and even with medications doesn’t stabilize. Surgical options exist for progressive glaucoma when medications are not enough.

Macular degeneration is the leading cause of vision loss and blindness in Americans 65 years of age and older. This disease breaks down our sharpest most sensitive vision, our central vision. There are two forms of macular degeneration: dry (atrophic) and wet (exudative). The dry form is more common, and less devastating to vision. Macular degeneration is more common over age 65. Caucasions and women are more likely to be affected. It can also occur as a side effect to some medications and tends to run in families.

Ways you can monitor for macular changes would be to cover one eye and look at something straight, like a door frame or a window sill. Watch to see if the door frame’s appearance changes when viewed with one eye alone. Macular degeneration can make straight lines look wavy. It can also cause a shadowy area to appear in your central vision. To monitor for early macular changes, have a complete eye exam every year. Sometimes more frequent monitoring is necessary.

Many Americans are seeing impaired. Even a diagnosis of legal blindness does not mean they are unable to see at all. Legal blindness is defined in the United States as a visual acuity of 20/200 or worse in the better eye with corrective lenses (20/200 means that a person must be 20 feet from an eye chart to see what a person with “normal” vision can see at 200 feet), or have a visual field restricted to 20 degrees diameter or less in the better eye. Numerous devices exist to help people with impaired vision see more clearly. The sad fact is that many individuals with impaired vision are unaware that anything other than magnifiers exists to help them. Telescopes and magnifiers are only the tip of the iceberg. There are high tech gadgets that can allow people to read again who never thought they could. Many retirement communities are investing in CCTV’s in their common rooms for their residents to use. CCTV’s magnify books, magazines, newspapers, photos, even fingers (if you want to trim nails or apply nail polish onto a TV screen, where the magnification is only limited by the size of the television.

If you, or someone you know, is unable to see comfortable even with an updated glasses prescription, a very good local low-vision resource is this non-profit organization:

Edith Bishel Center for the Blind and Visually Impaired
628 N. Arthur
Kennewick, WA 99336
(509) 735-0699