Vision Care
 Changes occur in our eyes as we age. Most of the changes are part of the natural process of aging and include:
- Lens changes that include yellowing and/or increased opacity
- Presbyopia or farsightedness
- Decreased peripheral vision
- Floaters – tiny strands or clumps of cells that float into the field of vision
- Decreased night vision
- Pupils become smaller and less flexible
- Less tolerance for bright lights and glare
Many of the changes are a minor inconvenience at worst, but the effects cannot be ignored, especially by those experiencing them. An understanding of age related vision changes, how to care for our eyes with the resources available, the types of vision disorders and their treatments will go a long way to increase your confidence in caring for your vision needs.
Poor Vision may be a barrier to your autonomy.
- Visual impairment affects nine percent of our seniors, or one senior in 11
- Poor vision causes 25 percent of falls causing injury among seniors – vision problem
- Seniors may avoid evening events due to vision difficulties with poor lighting and glare, resulting in isolation, misunderstanding
- Driving may become more difficult for seniors.
- Harder to process light in darkness
- More difficult to see into oncoming traffic headlights and a longer time to adjust to changes in light levels.
- Reduced peripheral vision makes parallel parking more challenging
- Less able to distinguish colors and more difficult to read signs
- Vehicle crash injuries and fatalities to seniors increased by a startling 47 percent between 1980 and 1989
- Drivers with cognitive impairment are over seven times more likely to be in an at-fault crash
If you are concerned your driving skill is being affected by loss of visual acuity, a new way to assess driving, based on award winning research can be found at www.DriveABLE.com.
Eye Exam
It is important for people of all ages to have regular eye exams every two years. Once you turn 45, make sure that you also ask to have a tonometry test every time. Tonometry measures your intraocular pressure or the pressure inside your eyes. It helps your eye doctor detect glaucoma, a disease that causes pressure to build up inside your eyes and can cause blindness. Glaucoma can be treated if it's caught early.
Three kinds of eye specialists may perform an eye exam:
OPTHALMOLOGISTS are medical doctors who provide full eye care, such as giving you a complete eye exam, prescribing corrective lenses, diagnosing and treating complex eye diseases, and performing surgery.
OPTOMETRISTS provide many of the same services as ophthalmologists, such as evaluating your vision, prescribing corrective lenses, diagnosing common eye disorders and treating selected eye diseases with drugs. Your optometrist will refer you to an ophthalmologist for more complex eye problems and for conditions requiring surgery.
OPTICIANS - DISPENSERS fill prescriptions for eyeglasses, including assembling, fitting and selling them. Most also sell and fit contact lenses.
What’s involved in an eye exam?
A complete eye exam involves a series of tests designed to evaluate your vision and check for eye diseases. None of these tests will hurt. Your doctor may use odd-looking instruments, aim bright lights directly at your eyes and request that you look through a seemingly endless array of lenses. Each test evaluates a different aspect of your vision.
The eye exam usually begins with your doctor asking about your medical history and any vision problems you might be experiencing. Next, your eye doctor makes a quick check of your eyes using a light to ensure the exterior parts of your eyes are functioning correctly. Finally, your doctor measures your visual acuity, assesses your need for glasses and examines your eyes for signs of disease. If any signs of disease are found, your eye doctor will refer you on to a specialist or assess and prescribe as needed.
Four common types of visual disorders or diseases are as follows:
Macular Degeneration
- Accounts for 33-34 percent of the total incidence of blindness
- Loss of central vision, but not peripheral vision
- Causes difficulty writing cheques, reading labels, seeing face in mirror, recognizing loved ones.
- Sufferers will appear to not look directly at those they are speaking to.
- Risk factors include age, smoking, high cholesterol, high blood pressure and diabetes
- Can occur in one or both eyes
Glaucoma
- Affects seven percent of Seniors
- Often treatable if discovered early
- Results from elevated pressure in the eye
- Can cause blurred vision and circles of light
- Often painful leading to watery eyes
- If untreated this disorder may lead to total blindness
Diabetic Retinopathy
- Present in 90 percent of those who have had diabetes more than 20 years
- A common complication from diabetes
- Affects half of diabetics
- Treatments include laser surgery and vitrectomy (salt solution injected into eye to reinforce structure)
- Treatable, but not curable
Laser Treatments
Laser eye surgery is most commonly used to correct three vision problems - myopia (near-sighted), hyperopia (far-sighted) and astigmatism (distorted vision when looking at objects at any distance). While laser surgery can be wonderful as it may remove the need for glasses, it is important to remember that most people’s eyes continue to change after 40. Even with laser surgery, there may again be a need for glasses.
Common Laser Proceedures
The two types of laser eye surgery commonly performed in Canada are PRK (Photo-Refractive Keratectomy) and LASIK (Laser Assisted in situ Keratomileusis)
PRK - the surgeon uses a computer guided laser beam to vaporize small amounts of tissue on the surface of the cornea. The procedure removes just enough tissue to reshape the cornea in a way that corrects vision. The healing process is complete in about a week.
LASIK surgery is more complicated. The surgeon first cuts and lifts a flap in the cornea, then, uses a computer guided laser to remove calculated amounts of tissue from the inside layers of the cornea. After the flap is closed the eye heals quickly by itself.
Considerations before Laser Treatement
- Complications are rare fortunately. But the risks go up significantly for people with certain conditions. You may not be a suitable candidate for laser eye surgery if:
- You have a chronic condition (such as lupus or diabetes) or take medications (steroids or certain acne prescriptions) that could affect your ability to heal
- You have a history of eye disease (herpes simplex, glaucoma, dry eyes, eyelid infections)
- You play sports where you are likely to be hit in the face
- People with large pupils under low light conditions often experience glare, halos or ghost images after laser surgery. This could interfere with your ability to drive at night.
- Health Canada advises that you are more likely to have a successful outcome with laser eye surgery if you:
- Choose your eye surgeon carefully - a referral from your own eye care professional to an eye surgeon is the traditional approach
- Discuss the risks, benefits, and your expectations with your surgeon to make sure you are a suitable candidate for laser eye surgery
- Make a commitment to participate fully in the follow-up care recommended by your eye doctor.
Cataracts
- Causes blurring or dimming of vision
- Lens become opaque or cloudy
- Affects six percent of seniors
- Lens removal and replacement is most effective treatment – 95 percent success rate
Cataracts are classified as one of three types:
A NUCLEAR Cataract forms in the nucleus, the center of the lens, and is due to natural aging changes.
A CORTICAL Cataract which forms in the lens cortex and gradually extends its spokes from the outside of the lens to the center. Many diabetics develop cortical cataracts.
A SUBCAPSULAR cataract begins at the back of the lens. People with diabetes, high farsightedness, retinitis pigmentosa or those taking high doses of steroids may develop a subcapsular cataract.
Cataract Symptoms and Signs
A cataract starts out small, and at first has little effect on your vision. You may notice that your vision is blurred a little, like looking through a cloudy piece of glass or viewing an impressionist painting. Light from the sun or a lamp may seem bright or glaring. Or you may notice when you drive at night that the oncoming headlights cause more glare than before. Colors may not appear as bright as they once did.
If you think you have a cataract, consult an eye doctor for an exam to find out for sure.
Prevention
Some eye care practitioners believe that a diet high in antioxidants, such as beta-carotene (vitamin A), selenium and vitamins C and E, may forestall cataract development. Factors that increase risk of cataracts include a diet high in salt, cigarette smoke, air pollution and heavy alcohol consumption.
Treatment
When symptoms begin to appear, you may be able to improve your vision for a while using new glasses, strong bifocals, magnification, appropriate lighting or other visual aids.
Consult your doctor about surgery when your cataracts have progressed enough to seriously impair your vision and affect your daily life. Many people consider poor vision an inevitable fact of aging, but in fact, cataract surgery is very successful in restoring vision. Nine out of ten people who have cataract surgery regain very good vision, somewhere between 20/20 and 20/40. It is a simple, relatively painless procedure and a patient is usually free to leave shortly after. During surgery, the surgeon will remove your clouded lens, and in most cases replace it with a clear, plastic intraocular lens (IOL). New IOLs are being developed all the time to make the surgery less complicated for surgeons and the lenses more helpful to patients. One example is a new IOL that lets patients see at all distances, not just one. Another new IOL blocks both ultraviolet and blue light rays, which research indicates may damage the retina. Always consult your physician and eye doctor while making your choices.
REFERENCES
- Health Canada. “It’s Your Health.” www.hc-sc.gc.ca/iyh-vsv/med/surgery-chirurgie_e.html
- Society of Certified Senior Advisors, 2005. “Physiological Changes of Aging.” Certified Senior Advisor (CSA) Canadian Study Book, pg. 13-21.
- All About Vision. “Cataracts & Cataract Surgery.” www.allaboutvision.com/conditions/cataracts.htm
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