Ageing Eyes: Spot the 10 Warning Signs

Our eye structure and functions begin to deteriorate at the age of 40—a natural process called ageing eyes that affects our ability to see (vision). According to a census conducted by the Department of Statistic Malaysia, around 413,000 Malaysians with the age of 50 and above had visual impairment. 

Most age-related eye conditions are fairly normal and can be treated with artificial tear drops,  specialty glasses, or laser surgery to correct impaired vision.

However, some chronic eye diseases have no cure and cannot restore vision loss. Treatments for these cases are limited to ways of slowing down progression only. 

What are Common Age-Related Eye Conditions?

Age-related eye conditions develop gradually and barely noticeable, until your vision starts to experience abnormal changes like blurriness or narrowing. There are a long list of eye conditions caused by ageing, but these are the four major ones:

Cataracts

Cataracts are one of the most common age-related eye diseases, whereby your lens is covered by cloudy areas. This happens due to the build-up of protein in the lens as you age, which reduces the amount of light from entering your eye. As a result, your eyesight becomes hazy or foggy. Cataracts can affect either one or both eyes.

A study in 2018 reported untreated cataracts as the leading cause of blindness. Fortunately, it is reversible through cataract surgery to prevent total loss of vision. 

Glaucoma

Being the second major cause of blindness, glaucoma is a result of the optic nerve (that connects the retina in your eye to the brain) becomes damaged. When the fluid in your eyes is not properly drained or clogged, the excess amount of fluid pushes the wall of your inner eye—this increased pressure damages the nerves. 

Early stages of glaucoma affect the peripheral or the sides of your vision first, before slowly reducing your central vision to complete loss. Unlike cataracts, glaucoma is permanent and has no cure, but treatments can prevent it from getting worse. 

Age-Related Macular Degeneration (AMD)

AMD is an eye condition that distorts only your central vision, without affecting the peripheral vision. Imagine there are three people, you can see the ones on the right and left clearly, but the middle person may appear blurry or darkened. AMD consists of two types: dry AMD and wet AMD. 

It is caused by the deterioration of the macula, which is the central spot of the retina responsible for sharp and detailed vision such as reading, driving, sewing, and recognising faces. AMD is also irreversible; however, there are ways to slow down the progression rate through supplements, drug injections, and laser therapy. 

Diabetic Retinopathy

Diabetic retinopathy develops when the high blood sugar levels in diabetes damages the blood vessels of your retina. Too much sugar can clog these blood vessels, and this high pressure causes them to leak fluid or bleed out. New blood vessels may grow to replace the damaged ones, but their fragile form is also prone to leakage and bleeding. 

If untreated, this eye disorder can lead to blindness. Maintaining your level of blood sugar as well as blood pressure is a great step to minimise the risks. For severe cases, laser treatment and drug injections can be considered. 

Warning Signs of Ageing Eyes

Determining the sight-threatening signs before it is too late can make a huge difference in saving your vision as much as possible.   

• Vision loss 

Ageing adults experience different degrees of vision loss, usually affected by various eye diseases :

• Loss of central vision (a symptom of AMD)
• Loss of side or peripheral vision (a symptom of glaucoma)
• Cloudy and hazy vision (a symptom of cataracts)
• Blurry vision of near objects, or presbyopia
• Low vision

Low vision is when your impaired vision can no longer be reversed or fixed with usual treatments like prescription glasses, contact lenses, surgery, and medications. It can be caused by either AMD, glaucoma, or diabetic retinopathy. 

• Eye pain

Any pain within or around the eye area should call for immediate treatment to the eye clinic. It may indicate high pressure in the eye due to serious conditions like glaucoma. If the pain is experienced together with the following symptoms, that signals an emergency:

• Headache
• Nausea
• Vomiting
• Sudden blurry vision
• Sudden sensitive to light

Avoid covering or pressing your affected eye prior to treatment, as this can worsen the pressure. 

• Difficulty adapting to light changes

Do you know how our eyes are able to transition from well-lit rooms to dark spaces and vice versa, without causing us headaches? That is the work of our irises. 

The iris refers to the coloured part of our eye, which some are born with in brown, blue, or green. It contains muscles that control the amount of light entering the pupil (the dark circle in the middle of your eye lens). These muscles contract in bright surroundings to allow less light in, and expand in darker surroundings to let more light in. 

Just like the rest of our body muscles, iris muscles also get weaker with age. As a result, the pupil has a slower response to brightness and darkness, which causes ageing eyes to take longer time when adapting with light changes. 

This complication can trigger dizziness or headaches and make driving in tunnels more dangerous—increasing the risks of falls and accidents.  

• Poor night vision

While the iris and pupil are important in light adjustment into the eye, the components that provide us with the ability to see in different levels of light are rod cells and cone cells. 

Each of these photoreceptor cells have distinct functions:

• Rods – Very sensitive to light, which is useful for lower light levels (e.g night time)
• Cones – Allows us to perceive colours, which is more useful in higher light levels (e.g daytime)

Research concluded that we lose rod cells faster than cone cells as we grow older, which contributes to unclear vision in dark or dim-lit environments. Cloudy lens due to cataracts is another reason why older adults have difficulty driving and reading at night.

• Eye floaters and flashes

If you see shadows of tiny lines, spots, or irregular shapes floating in your vision and moving around as your eyes move—these are eye floaters. 

The eyeball is filled with jelly-like fluid called vitreous humour. As we age, the jelly shrinks and becomes more watery. This allows fibres inside the vitreous to float around easily, pushing them to stick together.  

Eye floaters are actually a part of the normal process of ageing, and you eventually get used to it after a while. They can appear even at a young age especially those with nearsightedness. 

However, it can also be abnormal if you start seeing more floaters than usual, or it appears with flashes of light (after rubbing your eyes too hard). These may be a sign of torn retina or diabetic retinopathy, which can lead to permanent vision loss if untreated. 

• Double vision (Diplopia)

Seeing two images of the same object may be normal if you just started wearing spectacles for the first time or getting a new lens. Usually, this lasts temporarily. However, consistent double vision among elderly can mean entirely something else, either cataracts or underlying serious health conditions such as stroke.

Various factors can be attributed to double vision such as problems with the cornea, lens, eye muscle, or impairment in the  nerve or brain. You may experience double vision on one eye only (monocular diplopia), or on both eyes (binocular diplopia). 

• Difficulty to see sharply

Contrast sensitivity allows us to recognise the outlines of an object sharply, without any blurriness fading into the background. This ability makes driving at night and in a fog much safer as we can make out the shape of cars on the road. It also prevents us from having to squint our eyes in front of the screen to get a clearer view. 

Having reduced contrast sensitivity means you struggle to differentiate objects from similar-coloured backgrounds or in low light. For example, elderly from the age of 71 may not be able to notice a white vase in front of white wall as the colours seem to blend in together, making the vase seemingly disappear. 

• Dry eyes

Dry eye syndrome (DES) is a common condition especially for older adults above 50 years old. 

Ageing causes the lacrimal glands in our eyes to produce less tears. Certain medications like drugs for hypertension and Parkinson’s disease are known to cause dry eyes as a side effect. Hormonal changes in menopause may affect the tear production as well. 

The lack of moisture not only leaves the surface of our eyes dry, it also makes it harder to flush out dust and dirt caught from the environment. Your eyes can get really uncomfortable due to itchiness, redness, and burning sensation. This leads to constant rubbing or touching the eye area, which can  increase the risk of infection.   

• Distorted vision

The fluid leak or bleeding in the retina caused by AMD can create distorted images. For example, you may see straight lines appear as wavy or bent, and objects seem out of shape. Because of this, seniors with AMD are prone to dizziness and headaches. 

A common way to diagnose AMD or other alterations in vision is by using a testing tool called Amsler Grid, which displays horizontal and vertical lines on a grid. 

• Eyelids problems 

The ageing process on your eyelids is more than just a decline in appearance like fine lines and wrinkles. Apart from eye problems, your eyelids can experience a condition called blepharitis due to meibomian gland dysfunction (MGD). 

Meibomian glands are located at the edges of your upper and lower eyelids. They produce oil to seal and lock the tears, so that your eyes would not dry out quickly. As you get older, the glands are not working properly which may trap oils along your eyelids and become clogged, causing inflammation. Adding to this, your eyelashes can collect these excess oils together with bacteria and develop crusts.

As blepharitis usually happens repeatedly, the key is to apply warm compress and gently wipe the crusts off your eyelids regularly. 

Other age-related eyelids issues may involve drooping or sagging of eyelids (ptosis) and lower eyelids turning outward (ectropion) or inward (entropion). 

When to Consult a Doctor or Optometrist

Reach out to your eye doctor immediately, if you start to notice unusual and sudden changes to your vision that interfere with your daily activities, mainly the following:

• Blurry vision
• Cloudy vision
• Itchy and red eyes
• Intense eye pain with nausea and headache
• Difficulty seeing at night and in low lights
• Seeing increased amount of floaters, or floaters appeared with flashes
• Eyelid problems that interferes with your vision

When it comes to our eyesight, it is always risky to wait until your signs and symptoms get worse. This is because certain eye conditions can no longer restore your vision to normal and you can also potentially lose your ability to see permanently.

Our eye health plays a vital role in living a quality life. Make regular check-ups a practice since young, even when your eyesight has no issues. Dilated eye exams may be suggested for high-risk individuals including ageing adults and diabetic patients.

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