{Health} Oh say can you see? Should your aging eyes be a cause for alarm?

The bad news: loss of eyesight can’t be reversed. But, don’t panic: the changes you may notice in your vision may be related to hormonal shifts as you experience peri-menopause and menopause. According to Dr. Gullapalli Rao, a world-renowned ophthalmologist and founder of the L V Prasad Eye Institute, these types of changes are typical ails of aging and not necessarily cause for alarm. Here, Dr. Rao shares the different types of eye troubles FOFs commonly experience, which might be a sign for disease and which you can safely turn a blind eye to, so to speak.

As we get older, what are common issues we may experience with our eyes or vision?

  • Glaucoma, which is when the optic nerve is damaged. One of the causes is increased pressure within the eye. Normal, healthy eyes create a clear fluid called aqueous humor. When drainage of this fluid is hindered, this causes an increase in pressure. While the risk for glaucoma increases with age, this is a correlation, not a direct cause.1
  • Increasing need for vision correction (reading glasses) which can be caused by presbyopia, an age-related condition characterized by a gradual loss of ability of the eyes to focus for near work (activities like reading, where your eyes have to focus on near objects).
  • Increase in dry eye which manifests in the form of irritation and the occasional blurring of vision when you stare at an object like the television for a long time. This is caused by a loss of tear production in the eye, often as a result of changes in hormonal balance as people age.
  • Cataracts, or clouding in the lens of the eye, is usually common after age 65 but can occur earlier. Cataracts are most commonly associated with aging. Other risk factors are diabetes, smoking, exposure to ultraviolet light, nutrition and genetic factors.

What is the correlation between diabetes and the eyes?
Diabetes produces changes within the blood vessels that can in turn produce changes specifically in retinal blood vessels that may lead to bleeding in the eye. It can be detected early and treated with a laser. If neglected, it can turn into a serious condition which might require a complex surgery. It can all be avoided with proper control of diabetes, blood pressure and liquids. If these three are controlled, then the changes of serious eye problems developing are minimized. In addition, diabetes can accelerate a cataract.

How quickly does it turn into a serious condition?
It depends on how long the individual had diabetes, and how well it is controlled.

What is “normal” and to be expected for aging eyes? What may be a red flag for disease or blindness?
Changes that are normal include presbyopia, irritation and redness from decreased tear production and eye floaters. Symptoms that may be more serious include a sudden increase in the number of eye floaters,2 seeing flashing spots, or any sudden loss of vision at all.3

The Society for Women’s Health Research reported that 62 percent of women in menopause or peri-menopause experienced symptoms of dry eyes. Why is this and what is the best fix or prevention methods?
That’s because of the hormonal changes in the body. It’s nothing to worry about, but there’s nothing we can do to prevent it. It may help to start using over-the-counter artificial tears for the eyes.

Eye floaters are another symptom of menopause. Why is this and what is the best fix or prevention methods?
Aging can cause eye floaters. Eye floaters can appear as spots, threads, or fragments of cobwebs, which float slowly before the observer’s eyes. They are caused by changes in the consistency of a clear, gel-like substance inside the eye called the vitreous. As one gets older, the vitreous can become thinner and clumps may form in the fibers. These clumps are what cause the appearance of floaters.4,5 There’s nothing much you can do to prevent them, but, it’s a normal physiological change. Unless they cause significant visual problems or are associated with some other changes, no treatment is required.

How often should a woman over 50 go for an eye exam? Should they go more frequently as they age?
If there are no other medical problems or history of eye disease, once in two years should be adequate. If someone is a diabetic, then an annual checkup would be good.

Any way to reverse eye damage/poor eyesight that comes with aging? If not, what are the best tools, medication or aids you recommend for coping?
There is nothing that can reverse these changes. With a cataract we have a very routine procedure of cataract surgery that all ophthalmologists perform which has a success rate of 95-96 percent.

What is your take on laser eye surgery?
It’s good for people between the ages of 20 and 40 with a diopter between -2 and -8. Once you go above -8 it’s a complicated refraction. It’s used primarily for farsightedness or myopia. After age 40, presbyopia becomes more prevalent and worsens gradually over time. The surgery would correct your vision for objects at a distance, but could actually make near vision even worse.6 Laser surgery has a complication rate of 15 to 30 percent.

There has been a dramatic drop in vision impairment among FOFs over the last generation, new research shows. Self-reported eyesight issues that limit activity, declined by over 50% in just two and a half decades, according to data from two nationally representative surveys. Does your research support this? If so, what do you think accounts for the upturn in vision health?
There has been a drop because people have become more aware of healthy lifestyle strategies to maintain healthy vision including decline in smoking which has been linked to vision problems.7 But, it’s important to note that this drop is based on percentages; in terms of gross numbers there might be more people with vision impairment because of the increase of population and aging of the population.

About Dr. Gullapalli Rao

Dr. Rao is a world-renowned ophthalmologist and founder of the L V Prasad Eye Institute.

He received his postgraduate training in ophthalmology at the All India Institute for
Medical Sciences. Dr. Rao came to the United States in 1974, where he trained first at
Tufts University School of Medicine in Boston and then at the University of Rochester.
He worked on the faculty at the University of Rochester until his return to India in 1986.

His specialities include diseases of the cornea, eye banking and corneal transplantation and community eye health, eye care policy and planning. From 2004-2008, he served as President and CEO of the International Agency for the Prevention of Blindness. In this role, he led a global initiative to eliminate avoidable blindness by the year 2020.

Additional Sources
1. http://www.ophthalmologyweb.com/Featured-Articles/20031-Glaucoma-and-Aging/
2. http://www.mayoclinic.com/health/eye-floaters/DS01036
3. http://www.webmd.com/eye-health/benign-eye-floaters
4. http://www.mayoclinic.com/health/eye-floaters/DS01036
5. http://www.webmd.com/eye-health/benign-eye-floaters
6. http://www.mayoclinic.com/health/lasik-surgery/MY00375
7. http://www.cdc.gov/pcd/issues/2011/jul/10_0156.htm

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