The Aging Eye

       Suddenly you can’t see the small print. For the first time in your life, you need reading glasses. You may joke that your arms are getting shorter, but we both know that your changing vision has nothing to do with appendages.

        The human eye has multiple parts and layers that change with increasing years. The lens of our eye is located behind the iris, the colored part of our eye. The lens functions like the lens in a camera, controlling focus. In most cases, we are born with clear lenses able to flex to make focusing possible.

         Through aging, the lens grows in layers, rather the way an onion grows. But with time those layers become denser and more pigmented. Denser lenses are not able to flex as well; focusing at becomes harder.

        We begin to lose our focusing power starting from age 10, but not until the 38 to 42-year-old range do most people require reading glasses or bifocals. And, unfortunately, the process continues. That may mean frequent prescription changes in your 40s and 50s. 

       As the lens becomes less functional in focusing, it also begins to develop pigmentation and clouding. This process is referred to as cataract development. On average, most people begin to show signs of early cataract changes in their mid-50s. You may not be aware of cataracts until your vision becomes affected by glare, blur or nighttime difficulty.

        In the beginning, the cataracts may be managed by observation, UV protection and eyeglass prescription changes. Certain medications, disease processes and environmental exposure can hasten the cataract development as well. We will all develop cataracts if we live long enough. It is a normal process. However, not all of us will require surgical intervention.

        When best-corrected vision declines to a 20/30 level or worse, it is time to discuss surgical removal of the natural lens. The actual timing for surgery is made after a consensus is met between patient, surgeon, primary physician and insurance carrier.

       While the lens changes are progressing, other changes are occurring in the front of our eyes. Our eyelids may begin to droop and lose elasticity, the meibomian glands can atrophy and our conjunctiva (the mucous membrane lining our eyes) may stretch and develop extra tissue (pingueculae). The tear film changes, and dry eye will develop. All of these changes can reduce the quality of vision.

       Inside the orbit itself, the vitreous (the gel behind the lens) begin to degenerate by the time we are in our 20s. Symptoms include seeing black spots or gnats that we call floaters. They are completely benign.

       With more time, the vitreous typically separates from the loose attachment sites with the retina. Some may develop a vitreous detachment, a mostly benign condition that is very different from sight-threatening retinal detachment. 

Glaucoma is another condition whose risk increases with age. In most cases, there are no signs or symptoms of glaucoma until a significant amount of vision is lost. Glaucoma can lead to blindness, but with early intervention, it can be managed extremely well through the newer medications (drops) and surgical procedures. A thorough eye examination can diagnose and manage this condition.

         The retina and retinal vessels also change with age. Many systemic conditions such as diabetes, hypertension, high cholesterol and blood perfusion disorders can affect these intricate blood vessels, potentially leading to hemorrhaging and atrophy. Sometimes these conditions can be managed with intra-ocular injections.

          Macular degeneration is yet another sight-threatening, age-related condition. Certain populations are more prone, and there can be a genetic component. Advances in treatment have vastly improved the quality of life for many.

        The quality of our vision can affect our lives. Good vision is part of staying independent. The common thread in these age-related changes is early detection and intervention with annual eye examinations. After all, life is about vision.

–Rose Susel Lucente, Dunkirk Vision