Like every other body part, our eyes change as we get older.
Some of the changes are mostly inconveniences: You need to grab your glasses to read or sidle up to a light source for close-up tasks. More worrisome is the older you get, the higher your risk for eye disease.
Age-related eye diseases — macular degeneration, cataracts, diabetic retinopathy and glaucoma — are the leading causes of blindness and low vision in the United States.
As baby boomers age, those numbers are on the rise. Cases of early age-related macular degeneration, for example, are expected to almost double to 17.8 million by 2050 from 2010 among those 50 and older, the Centers for Disease Control and Prevention says. Cases of diabetic retinopathy are expected to quadruple by 2050.
Good vision is critical to mental and physical health. People who can’t see often feel socially isolated and stressed by simple daily tasks. Reduced vision can mean losing the ability to read, drive or live independently.
But here’s the good news: Thanks to new technologies and treatments, most eye diseases can be caught early and treated without debilitating vision loss.
“We’ve seen a number of advances in eye care over the last 20 years,” says Dr. Nikisha Kothari, an ophthalmologist with Texas Health Arlington Memorial Hospital. “With the newest imaging technology, we’re picking up on these diseases a lot earlier. New treatment options are leading to better results and preventing vision loss.”
Stay on top of your eye care, and you’ll boost your chances to keep your sight. Here’s what you need to know.
Understand that most of these diseases can progress to the point where your vision is permanently damaged — before you notice any symptoms.
“I can’t stress enough the importance of getting a regular eye exam,” says Dr. Karen Saland, an ophthalmologist with Texas Health Presbyterian Hospital Dallas. “Not just an exam to get glasses or contacts, but an exam where the physician looks at the different parts of the eye to make sure they are healthy.”
Age-related macular degeneration, or AMD, comes in two types: wet and dry. Blurred vision is a key symptom. With both types, early detection and treatment are critical. With wet AMD, leaky blood vessels grow under the retina. Injections can stop the leaking from those abnormal blood vessels. In dry AMD, the center of the retina, called the macula, deteriorates. Treatment options are limited for dry AMD, but the AREDS-2 formula of vitamins and minerals may keep the disease from progressing.
“We now have very effective medications for wet AMD that we inject in the eye,” says Dr. Angeline Wang, assistant professor in the Department of Ophthalmology at UT Southwestern Medical Center. “Those injections will restore or maintain your vision, but you will need to have them every one or two months.”
AMD is hereditary. If you had a parent with wet AMD who was told that nothing could be done, know that your experience will likely be different.
“Over 20 years ago, patients may have been told their only option was to wait and see,” Kothari says. “That has definitely changed. I have patients whose wet AMD was caught early and who are still seeing very well, even to the level of being able to continue to read, drive and maintain their independence.”
Glaucoma is a group of diseases that damage the optic nerve. The American Academy of Ophthalmology reports that Christie Brinkley, 68, and U2 lead singer Bono, 61, were diagnosed with glaucoma in recent years. In both cases, there were no symptoms; the disease was detected in routine eye exams. The most common type of glaucoma, open angle glaucoma, has no warning signs.
“In most cases, patients don’t feel it coming on or notice changes in their vision until the damage is done,” Saland says. “Unless you go to the doctor and get checked for glaucoma, it’s very easy to be missed.”
If caught early, glaucoma can be treated with medicated eye drops and laser treatments, in most cases preventing or at least slowing its effects on your vision.
Cataracts cloud the lens of the eye.
“Almost everyone 55 and older will develop a cataract, but not everybody will develop one that is visually significant and requires surgery,” Wang says.
Treatment is surgery, which involves replacing the clouded lens with an artificial lens. Because cataracts develop gradually, treatment isn’t as urgent as the other conditions listed, but if your doctor advises it, don’t put it off.
“The larger the cataracts become, the more challenging it is to remove them surgically,” says Kothari. “You want to have them removed in a timely manner.”
A bonus of cataract surgery: People who are nearsighted may no longer need eyeglasses, except for reading glasses depending on their lens choice, after the surgery. And one recent study showed that people who have cataract surgery have a significantly reduced risk of developing dementia.
Diabetic retinopathy is caused by damage to the blood vessels in the tissue of the retina, at the back of the eye. Poorly controlled blood sugar increases your risk for this disease. Symptoms may include floaters, blurriness, dark areas of vision and difficulty perceiving colors. But don’t wait for symptoms to see a physician because diabetic retinopathy can cause blindness. Careful diabetes management may suffice for mild cases; advanced cases may require injections, laser treatment or surgery.
If you’re older and have had diabetes for years, there’s a good chance your physician has already told you to get regular eye exams with an ophthalmologist. Don’t ignore that advice.
The American Academy of Ophthalmology recommends that individuals 65 and older without risk factors should have an examination by an ophthalmologist every one to two years. If you have a higher than average risk or already have eye conditions, you may need them more often. Unfortunately, the CDC reports that about 40% of adults at high risk for vision loss didn’t undergo an eye exam in the last year.
Note that an exam to prescribe eyeglasses or contacts isn’t sufficient. However, some optometrists do perform eye pressure and imaging tests that will detect glaucoma, signs of bleeding and other eye diseases as part of a comprehensive exam. If you’re not sure, ask. If abnormalities are detected, the optometrist will refer you to an ophthalmologist.
“You want to be sure that someone is checking your vision, the pressure in your eyes and taking a look at the back of your eyes,” Wang says.
Like most types of health insurance, Medicare doesn’t cover eyeglasses or routine vision care. However, Medicare does cover routine exams for people at high risk of diabetes or a family history of glaucoma or AMD as well as medical care for those with eye diseases. And since almost everyone has some eye issue by age 65, Medicare will usually cover a visit to the ophthalmologist.
“Many people assume they are not covered because they don’t have vision insurance,” Saland says. “But a visit to the ophthalmologist falls under health insurance and, depending on your plan, may be covered.”
If you do experience symptoms, act quickly. That goes for serious symptoms (double or blurry vision, eye pain, blind spots, sudden vision loss) as well as seemingly minor ones (floaters, reduced peripheral vision, light sensitivity.) An ophthalmologist will usually see you on the same day if your symptoms warrant; most have appointment slots every day for urgent appointments. Don’t delay. Waiting just a few days can lead to much bigger problems and possibly permanent vision loss.
“Unfortunately, I see patients who waited too long to come in to be seen for a retina issue because they thought they just needed new glasses or their cataracts were getting a little worse,” Kothari says.
The American Academy of Ophthalmology offers EyeCare America, a network of ophthalmologists willing to conduct routine eye exams at no out-of-pocket cost for those 65 and older. For more information, visit aao.org/eyecare-america.
For more information on symptoms and prevention, visit eyesmart.com, a consumer-oriented website from the American Academy of Ophthalmology.