Elderly eye problems

There are several eye problems that become more common among people as they age, although they can potentially affect anyone at any age. They include:

Presbyopia/ long-sightedness is the loss of the ability to clearly see close objects or small print without glasses. It is a normal process that happens slowly over a lifetime

Presbyopia is often corrected with reading glasses and contacts

Your parent can try ready-made reading glasses, which can be bought from a pharmacist or supermarket

Start with a low dioptre power and increase it gradually if needed, or visit an optometrist for an eye test and bespoke glasses

N.B. everyone over the age of 40 should have a two yearly eye examination, even if your parent does not need glasses

Most people find they cannot read without reading glasses once they have read with them. The glasses do not change the natural ageing process, but it is more comfortable to use them than not and creates less strain

Floaters are tiny spots or specks that float across the field of vision

Most people notice them in well-lit rooms, or outdoors on a bright day. Floaters are often normal, but they can sometimes indicate a more serious eye problem, such as retinal detachment, especially if they are accompanied by light flashes

If your elderly relative notices a sudden change in the type, or number of spots or flashes they see, they should visit their GP as soon as possible, who will refer them to an Opthamologist

Dry eyes. This happens when tear glands cannot make enough tears, or produce poor quality tears

Tear quantity and quality reduces with age and many people, particularly women, get dry eyes

Symptoms are gritty, itchy, red and burning eyes and the eyes may even water as the body tries to flsuh away the irritation with ‘reflex’ floods of tears, as there is not enough continuous ‘background tear’ production

Your parent can try lubricant drops from the pharmacist, or get them prescribed by the GP

Hypromellose drops are good to start with and if this does not help, try carbomer gels.

If this does not help, your parent’s GP or optician may suggest that your parent uses a humidifier at home, or humidifying aerosols

The GP might also suggest preseravtive free drops, or drops with Hyalauronic acid

Tear duct plugs or surgery may be needed in more serious cases of dry eyes

Watering eyes and blepharitis

Having too many tears can come from being sensitive to light, wind, or temperature changes. Protecting your parent’s eyes by shielding them, or wearing sunglasses can sometimes solve the problem. Tearing may also mean that your elderly relative may have a more serious problem, such as an eye infection or a blocked tear duct. Your parent should see their GP or optician in the first instance, who can refer them for treatment for  both of these condition

The cause maybe excess tear production, poor quality tears (see under Dry Eye), or blepharitis which is inflammation of the eyelid margins

If eye lid margins are crusty, sticky or red, blepharitis is usually the culprit. It can be improved by keeping the lashes clean by scrubbing them with dilute baby shampoo or blepharitis solution and cotton wool balls daily

It’s also worth trying Carboner gel four times a day for a month to see if reflex tearing is the problem

If this doesn’t work then see your parent’s optometrist or GP

If the eyelid is lax, or the tear duct blocked, referral to an ophthalmic surgeon for further expert advice and treatment may be appropriate

Conjunctivitis is a condition in which the tissue that lines the eye lids and covers the eyeball becomes inflamed

It is sometimes called “pinkeye.”

It can cause redness, itching, burning, tearing, or a feeling of something in the eye

Conjunctivitis occurs in people of all ages and can be caused by infection, exposure to chemicals and irritants, or allergies

This can be treated by buying chloramphenicol drops over the counter at the chemist

Cataracts are cloudy areas that cover part of or the entire lens inside the eye

From middle age onwards, the lens gradually becomes cloudy and this is cataract formation, but the speed of this formation and how much it affects vision varies

Cataracts often form slowly, without pain, redness, or tearing in the eye. Some stay small and do not alter eyesight.

In a healthy eye, the lens is clear like a camera lens and light has no problem passing through it to the back of the eye to the retina where images are processed. When a cataract is present, the light cannot get through the lens as easily and, as a result, vision can be impaired

Symptoms include glare in bright sunlight and headlights, blurred vision, particularly in the distance whne reading road signs and recognising people from a distance

If they become large or thick, cataracts can usually be removed by surgery. If your parent develops symptoms, they should see their GP

If you are affected by the cataracts then it is probably reasonable to go for surgery

Cataract surgery and replacement of the lens with an implant is high tech, but very safe these days

It is usually done under local anaesthetic, so age is not a barrier. Patients of 100 years old are commonly treated and more than 95% of patients will have an improvement in their vision and no complications

However if your parent feels they can see well even if they are told they have some cataract, there is usually no need to consider an operation until they find there is a problem with their sight

The operation is the same whether the cataract is mild or more severe, so your parent can wait until they feel they need it

Glaucoma develops when there is too much fluid pressure inside the eye

Glaucoma affects 1 in 50 people over 40 and this increases with age, so it is relatively common

It is a disease of the optic nerve that causes insidious painless damage to sight

The eye pressure is usually, but not always elevated

Holes in the vision at the side occur but these are only noticed when the disease is very advanced

There is no treatment that will cure loss of vision it needs to be prevented. So as most people are unaware that they suffer from glaucoma everyone over 40 years should see an optomerist every 2 years for an eye examination, even if they do not need glasses

The optometrist will check the eye pressure with a puff of air, do a visual field test and look at you optic nerve

If any of these tests are abnormal, your parent may be recalled for a repeat test, or referred to an eye clinic

Treatment is usually prescription eye drops but occasionally  laser or surgery

Glaucoma is like high blood pressure treatment is usually needed for life.

Age related macular degeneration (AMD) damages the middle of the retina and causing difficulty reading right up to total loss of central vision and being unable to recognize friends and family

It is the commonest cause of visual loss in this country and your parent’s risk is increased if they smoke

It comes in two forms:

  1. dry AMD, where the central retina becomes worn out with age and reading and then distance vision are gradually lost. There is no specific treatment for dry AMD but a good bright light and magnifying aids may help. A minority of people progress to the more severe form
  2. wet AMD, in which abnormal blood vessels grow and leak under the retina. This causes distortion of vision so that straight lines appear to have a bend in the middle and central vision is blurred. If you notice this you should see your optometrist with a few days and you will be referred to your local eye department for further tests and treatment. Note there are many vitamin  supplements sold, these have only been medically proven to be effective for people who have intermediate or wet AMD not mild dry AMD and the tablets need to contain the AREDS formula. For further information see www.nei.nih.gov/health/maculardegen/armd_facts.asp

Sudden loss of vision. Anyone noticing sudden loss of vision in one eye should never ignore it

Phone your parent’s optometrist immediately and ask to be seen that day

If your parent can’t see an optometrist, get an emergency appointment with their GP, or go to the local emergency department if they can’t be seen by anyone else

Your parent needs to be examined and then it can be decided how urgently you need to be seen by their local eye department who will be able to advise them if treatment is available

If loss of vision is gradual, make an appointment to see an optometrist, not their GP. as they have the best training and equipment to assess you

Corneal diseases. The cornea is the clear, dome-shaped “window” at the front of the eye. It helps to focus light that enters the eye

Disease, infection, injury, and exposure to toxic agents can damage the cornea causing pain, redness, watery eyes, reduced vision, or a halo effect

Treatments include making adjustments to the glasses prescriptions, using medicated eye drops, or having surgery

Eyelid problems. The eyelids protect the eye, distribute tears, and limit the amount of light entering the eye

Pain, itching, and tearing are common symptoms of eyelid problems. Other problems may include drooping eyelids, blinking spasms, or inflamed outer edges of the eyelids near the eyelashes

Eyelid problems often can be treated with medication or surgery

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Sightsavers
Fight for sight

Mrs Sally Webber is a Consultant in Ophthalmology at The Royal United Hospital, Bath and Circle Bath. She was appointed as a Consultant in 1999 and has since been lead clinician of the department for 4 years. She graduated in 1983 from the Royal London Hospital and following two years of general medical training, obtained her membership of the Royal College of Physicians. Mrs Webber then trained in general Ophthalmology in Oxford and the Oxford region and became a fellow of the Royal College of Ophthalmologists. She went on to carry out sub-specialty training in Ophthalmic Plastic Surgery at Moorfields Eye Hospital, London with the world renowned surgeon Mr Richard Collin. Mrs Webber is passionate about medical education and training. She is a volunteer surgeon and teacher, in Bihar, India for the charity Second Sight. She specialises in small incision cataract surgery with phacoemulsification and folding lens implant and medical and cosmetic eyelid and watering eye surgery. For further information contact Circle Bath 01761 422 222 or www.circlepartnership.co.uk/locations/bath/our-consultants/sally-webber or email enquiries@circlebath.co.uk

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