Aging and the Eyes
As birthdays accumulate and wisdom grows, our bodies change as well. Starting from our 40s and going forward our eyes mature and exhibit some decline in function. Some changes are normal while other changes can be signs of age-related diseases.
As you pass your mid-40s, you may notice that its more difficult to focus on objects up close. This is a perfectly natural aging change as the lens in the eye hardens and the ciliary muscle loses some of its function. A teenager is able to focus as close as three inches, whereas most 45-year-old people can see clearly at about 10-12 inches. As people approach 70, their ability to focus at near is about three to four feet. Typical reading distance is 12-16 inches, hence the need for reading glasses. People who are far-sighted may notice these changes sooner; conversely, near-sighted people may not notice until later.
Presbyopia, as this condition is called, is most commonly treated with glasses, either reading glasses or bifocal lenses. Some people prefer to use contact lenses, either multifocal lenses or monovision (one eye is corrected for near vision and the other eye is corrected for distance vision). Surgical alternatives are available as well, such as monovision LASIK or refractive lens exchange. Monovision LASIK is laser vision correction to achieve similar outcomes to monovision contact lens. Refractive lens exchange is similar to cataract surgery which we’ll discuss next.
Cataracts are aging-related changes to the natural human lens which, as it progresses, becomes an eye disease. According to the Mayo Clinic, about half of all adults over 65 have some level of a cataract, increasing to 90% of people over 75. Cataracts develop as the lens in the eye becomes progressively harder and more yellow. Over time, your vision is more sensitive to bright lights, colors appear washed out, objects are not clear, and you may have increasing difficulty with your overall vision. Risk factors for early cataracts or progression of cataracts include sun exposure, smoking, diabetes, certain medications, and family history.
Fortunately, modern cataract surgery is extremely safe and effective, with over 95% success rates. Typically, the cataract is removed through a 1/8-inch incision with the use of an ultrasound and a plastic lens replaces the natural cataractous lens. Patients rarely need an eye patch, usually notice improved vision in a few hours and typically can resume regular activities within day or two. Frequently after surgery, patients can see well at distance with minimal or no glasses. Since 2006, patients have had the option to choose specialized implant lenses that can allow vision at near and distance with a minimal need for glasses.
With aging, our bodies produce fewer tears. This is particularly true after menopause. The composition of the tears changes as well, becoming thinner and more watery. The result of such changes can be persistent dryness, scratching and burning in your eyes and chronic redness, often referred to as dry eyes. Certain medications, such as those frequently used in the treatment of high blood pressure or depression, can exacerbate the condition, resulting in sharp stabbing eye pain or momentary haziness in vision. With the approaching summer, dehydration and sleeping under ceiling fans can worsen the underlying lack of tears, resulting in more symptoms.
Initial treatment may be as simple as increasing daily water intake and using over-the-counter mosturing drops. Allergy eyedrops, marketed “to get the red out” worsen the condition and should not be relied upon. In more serious cases, treatment may consist of prescription eye drops, nutritional supplements, or blockage of the tear duct to increase the time the tears stay on the eye surface.