Thana Mohana Priya M, B. Optom

Optometrist, Aravind Eye Hospital, Tirunelveli, India

Introduction

While everyone wishes to age gracefully and without hindrance, most of our organs wear out as a process of ageing There are many age-related ocular changes which include degenerative changes from the anterior to the posterior ocular surface. ⁽¹⁾ Global estimates place the number of elderly persons with poor vision and visual impairments at 256 million. “Over 45 percent of people with visual impairment are over the age of 65, according to the World Health Organization”. ^(2-3)

The Lid Changes

With age, the loss of orbital fat leads the eyes to “sink in”, leading to lid laxity. Progressive laxity can cause punctal eversion, followed by eversion of the eyelid from the globe (ectropion). ⁽⁴⁾ On the other hand, because the pre-tarsal orbicularis muscle is rather powerful, the eyelid may invert (entropion), rubbing the eyelashes. Blepharitis is an inflammation that can cause red or swollen eyes, crust around the eyelashes, or soreness. ⁽⁵⁾

Figure 1: Picture of an unaffected eye alongside one with entropion and ectropion
(Picture Courtesy: https://www.readocs.com/eyelid-surgery/entropion-and-ectropion/)

The Lacrimal system changes

Watery eyes in the elderly are usually caused by eyelid malposition. Dacryocystorhinostomy is a surgical procedure that is usually used to address a nasolacrimal duct obstruction. ⁽⁶⁾ A reduction in the quantity of tears that the lacrimal gland produces results in dry eyes. To maintain tears in the conjunctival sac, use artificial tears or punctal plugs. ⁽⁷⁾

Figure 2: Illustrates the tear production as it is in the normal state on the left and the obstructed tear duct on the right.
(Picture Courtesy: https://www.aboutkidshealth.ca/Article?contentid=962&language=English&hub=healthwellness)

Difficulty with fine prints

After age 40, presbyopia is a regular occurrence. This makes close-quarters tasks more difficult, including reading or stitching. Reading glasses, various types of contact lenses, and refractive procedures can all be helpful. ^(8-10)

Cataract

When the lens within our eye becomes clouded, it develops a cataract, which impairs vision. Around the age of 40 to 50, age-related cataracts might appear. Surgery can be used to cure them, and they can also lead to improved eyesight. ^{(11, 12)}

Figure 3: Comparison of a cataract’s effects on normal and cataract’s effects on normal eyes, and the corresponding changes in the pathway of light
(Picture courtesy https://www.nvisioncenters.com/cataracts/)

Night-time vision challenges

Older adults find it harder to focus and adapt their eyes in the dark. The rod cells in the eye that are required for low-light vision deteriorate with age. Older drivers must limit their driving to the daytime, according to the National Traffic Safety Administration.

The Vitreous humour alterations

As we become older, the vitreous – a jelly-like material that fills the centre of the eye can thicken or decrease. Small gel clumps may cause floaters to appear in your vision. Although normally harmless, consult your ophthalmologist if you suddenly start to see more. ⁽¹⁴⁾

Age-related macular degeneration (AMD)

The most prevalent age group for persons with AMD is those over 50. In the early stages of the condition, patients might not detect any symptoms. Nevertheless, central vision will gradually deteriorate. Various forms of AMD require different treatments. ^(15,16)

Figure 4: Typical versus macular-degeneration eyes in a fundus image
(Picture Courtesy https://www.hopkinsmedicine.org/health/conditions-and-diseases/agerelated-macular-degeneration-amd)

Glaucoma

Glaucoma can be seen in people of any age; however, it is most common among elderly people. If the condition is not treated quickly, it might cause blindness by damaging the optic nerve. Symptoms may go undetected. The greatest approach to protect against vision loss is to get routine eye check-ups. ^(17,18)

Figure 5: Compares eyes with normal vision to eyes with glaucoma-related abnormalities.
(Picture Courtesy https://www.synergyeye.com/glaucoma.html)

Conclusion

It is essential to have regular eye examinations after the age of 40 in order to lead a healthy lifestyle.

References

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