By: MICHELE PENDRAK BUSH, O.D.
Our eyes are organs which function to receive and focus light and then transforms that photic energy to signals that are sent to the brain.
The visual process starts as light enters the cornea, through the aqueous humor and on to the lens, then through the central cavity (vitreous humor), then to focus on to the central foveal area of the retina, called the macula.
In the retina, the light is captured by the retinal photoreceptors and transformed into chemical then electrical signals down the optic nerve and finally to specific brain areas.
“Wow! The eyes so cool and they do amazing stuff” …said my 6 years old son, as he watched the “How do eyes see” episode on StoryBots, one of his favorite TV shows. Then, he asked, “mom, why do some people have trouble seeing?”
As I began to say, “Dempsey, when the optical properties of the eyes are healthy and normal…….”, my conversation with my son led me to write about aging eyes and why your sight may not be right.
Time is not on your side, when it comes to age-related eye problems. One of the most common ocular surface conditions is dry eyes, and the major age-related condition in the lens is cataract (opacification or cloudiness of the lens).
Presbyopia, the diminished ability to focus on near objects is another example of natural lens aging, as the lens zonules harden. The lens zonules suspend the lens and allow the natural lens to “zoom in and out”, a process called accommodation.
As you age, the jelly-like vitreous body that fills the central cavity of the eye liquefies. As the vitreous liquefies, it may be able to pull away from its base attachment to the neural retina. This condition can lead to floaters (posterior vitreous detachment-PVD) which increase your risk for a retinal detachment.
Age-associated eye diseases are generally painless in their earlier stages, and sometimes remain unnoticed and untreated until it may be too late for an effective treatment. The National Eye Institute classifies glaucoma, age related macular degeneration (AMD) and diabetic retinopathy in this category of asymptomatic, sight threatening diseases.
5 million people in the U.S. over the age of 50 and roughly twice as many women, as compared to men, are affected by dry eyes. It is estimated that 70% of Americans over the age of 60 have MGD (meibomian gland dysfunction). The meibomian glands are located at the eyelids which produce the oily components of the tear film.
There are significant new opportunities for dry eyes prevention and better modes of treatment. New FDA approved pharmaceutical agents validate the long-standing approach to manage dry eye disease, especially flare ups. Low Level Light Therapy (LLLT) is a non-invasive, pain and stress-free treatment for dry eyes and MGD.
Proteins from the lens begin to accumulate resulting in a change from a naturally transparent lens to opaque, leading to cloudy or blurred vision. As a cataract progresses, the lens begins to turn yellow leading to difficulty distinguishing shades of color and distance vision may be affected.
It is estimated that cataracts affect almost 22 million Americans over the age of 40 and nearly half of U.S. citizens over the age of 80. There are over 4 million cataract surgeries performed in the U.S. each year and this number is estimated to increase at a rate of 3.1% each year.
Ptosis/Dermatochalasis (droopy eyelids)
There is a now a drop for that! Other than surgical options, there was little to be done to improve the appearance of “tired eyes”. A recently FDA-approved eye drop is an effective non-surgical treatment for upper eyelid ptosis.
Glaucoma is a complex disease with vision loss due to pathologic changes of the neural retina, optic nerve, brain, and associated changes in the anterior segment (the portion of the eye between cornea and lens). More than three million Americans over age 40 are living with glaucoma, and this number is projected to grow to 6.3 million by 2050.
Early detection and the right management can help slow the progression of the sight-threatening disease. Today’s therapies include options including topical drugs, selective laser trabeculoplasty (SLT), minimally invasive glaucoma surgery (MIGS), and conventional incisional surgery offer the potential for effective decrease in IOP (intraocular pressure).
Studies have shown that 20% of patients undergoing cataract surgery have concurrent diagnosis of glaucoma. Glaucoma patients now have a once-in-a-lifetime opportunity to have an innovative MIGS device at the same time.
Age related Macular Degeneration (AMD)
Macular degeneration is an ocular disease caused by deterioration of the macula, the part of the retina that controls central vision.
Macular degeneration accounts for 8.7% of all blindness worldwide, and is one of the leading causes of blindness in adults over the age of 60.
Dry macular degeneration is the most common and less aggressive form accounting for 80-90% of AMD cases. Dry AMD results from aging and thinning of the macula, pigment in the macula, or a combination of the two causes. Supplements as advised by the National Eye Institute may slow down the progression of AMD. Eye vitamins with AREDS2 supplementation (this refers to the age-related eye disease study conducted by NEI in 2006) have a significant positive impact on the progression of AMD. Include in your diet fruits and leafy vegetables with lutein-zeaxanthin content such as kale, collard greens, spinach, broccoli and if you smoke, try your best to quit.
Wet macular degeneration is the more severe form. Abnormal blood vessels grow beneath the macula, leaking blood and fluid. Leaky vessels in the macula cause the development of blind spots and sudden loss of central vision. Treatment of wet AMD involves stopping the development of leaky blood vessels. This is typically accomplished through anti-VEGF (anti vascular endothelial growth factors, which reduce new blood vessel growth) injections, laser surgery and photodynamic therapy.
One of the many tissues that diabetes can affect is your eyes. In diabetic patients, retinal blood vessels walls weaken, leading to retinal hemorrhages and fluid accumulating in the macula, with subsequent vision loss and even blindness. Diabetic patients may develop cataracts at earlier ages than nondiabetic patients. People with diabetes have twice the risk of developing glaucoma.
Diabetic retinopathy affects almost 4.5 million Americans over the age of 40. The prevalence of diabetes is expected to rise in part because of the obesity epidemic.
Most serious eye diseases can be diagnosed even before symptoms are noticed. Your eye doctor will examine, diagnose and manage your eye conditions to ensure that your eyes remain healthy. Schedule your exam with Siepser Eyecare today.
- Vision problems in the U.S. Prevent Blindness America Web site.
- Eye Health Statistics at a Glance. American Academy of Ophthalmology.