Seeing things differently: Vision and getting older

Changes in our vision are a significant yet common part of getting older. Long-term vision disorders affect 93% of Australians aged 65 and over, according to the Australian Institute for Health and Welfare. All of us will experience at least some degree of vision loss as the years pass, and many of us will develop other eye conditions that may affect our sight.

‘Loss of vision’ means any degree of reduced vision, whether mild or severe. While a blind person is completely or severely unable to see, a person with vision loss may still have sight, although with reduced clarity or field of vision.

Good vision and elder abuse risk

Good eye health is an important factor in living independently for longer. In fact, it can reduce your risk of elder abuse – this is especially because older adults with vision issues may need to rely on other people for help with daily activities.

When your vision is good, you’re better able to recognise faces and read facial expressions. You can identify unsafe situations, and it’s easier for you to read and decipher documents. All of these can help keep you safe and less likely to be taken advantage of.

On a social level, loss of vision could deter you from participating in social activities, making you more vulnerable to isolation and the negative mental health aspects associated with being lonely.

By doing what you can to minimise vision loss, you are more likely to maintain your independence and stay well.

Common age-related vision problems

There are several eye diseases and vision issues that you may encounter as you get older. Although they may seem to be an inevitable part of ageing, it’s important that you seek medical help early so everything possible can be done to minimise any effects on your eyesight.

Presbyopia

From around the age of 40, you may have started noticing that your eyes were losing their ability to focus, making it harder to read or look at close objects. Known as presbyopia, this change usually gets worse until around 65 years of age.

Presbyopia occurs when the lens in the eye becomes stiffer with age, preventing it from focusing light correctly on the retina. It’s a natural part of ageing and is usually managed with prescription glasses or contact lenses.

Cataracts

Cataracts are the clouding of the eye’s lens, which can lead to vision loss. They occur when the protein in the lens breaks downs and clumps together. Even though cataracts have a distinct, cloudy appearance, in their early stages they aren’t always visible when you look in a mirror.

Cataracts are one of the most well-known age-related eye conditions. It becomes more common as we age, affecting around half of everyone over 50 years old. Almost everyone will develop cataracts by the age of 80.

Symptoms of cataracts include:

• blurry or hazy vision

• increased sensitivity to glare or brightness

• distortion or double vision

• haloes appearing around lights

• a sense that you’re looking through a veil or film

• colours fading.

If prescription glasses don’t help clear your vision, surgery to remove the cataracts is often recommended.

Age-related macular degeneration (AMD)

Age-related macular degeneration, or AMD, affects 1 in 7 people aged over 50. The macula, the central part of your retina, deteriorates and your central vision becomes blurred, making it difficult to see things in front of you clearly. Your peripheral vision usually remains unaffected.

Symptoms of AMD include:

• distortion in the centre of what you can see

• reading difficulty that doesn’t improve with new glasses

• decline in seeing objects clearly

• needing more light to be able to see well

• difficulty with adjusting to light levels when driving at night

• decrease in colour vision.

AMD occurs in 2 forms – ‘dry’ and ‘wet’. Dry AMD, the more common form, progresses slowly, but patients with wet AMD experience rapid vision loss. An injection can reduce this rapid loss in vision, but it’s crucial that it’s provided at the right time to be effective.

Glaucoma

Glaucoma is a chronic, progressive eye disease caused by damage to the optic nerve, and it can lead to vision loss and blindless. The most common cause of this condition is increased pressure in the eye due to a build-up of fluid.

One in 8 people over the age of 80 has glaucoma, and 90% of cases are primary open-angle glaucoma. Interestingly, about half of the estimated 300,000 Australians who have glaucoma don’t know they have it.

Symptoms of glaucoma include:

• blurry vision

• clear central vision but reduced peripheral vision

• night blindness and difficulty with low lighting

• increased sensitivity to glare or brightness.

There is no cure for glaucoma, but eye drops, laser treatment and surgery can help manage the condition.

Diabetic retinopathy

This eye condition can cause vision loss and blindness in people who have diabetes. It can affect people of all ages, but particularly older adults.

High blood sugar levels can damage the tiny blood vessels in the retina, which can then leak fluid and blood. New abnormal blood vessels can also grow.

Symptoms of diabetic retinopathy include:

• fluctuating or patchy vision

• blurred or distorted vision

• increased sensitivity to glare or brightness

• ‘floaters’ – the small specks or shapes you sometimes see floating across your vision.

There is no cure for diabetic retinopathy, but you can slow the rate of damage it causes by controlling your blood sugar, blood pressure and cholesterol levels.

Dry eyes

A very common eye condition for older people, dry eyes can be caused by reduced tear production, changes in eyelid function, and hormonal factors (particularly for women).

Symptoms of dry eyes include:

• an uncomfortable itchiness

• a burning sensation.

Eye drops and warm compresses are often recommended to manage dry eyes, and the protective eye care measures listed below can also help.

Possible signs of eye problems

As well as keeping up with regular eye exams, it’s important to be aware of any changes in your eyesight, such as blurred vision, sore or dry eyes and increased sensitivity to light.

These changes might be nothing to worry about, but they could also be signs of problems developing. For example:

• difficulty focusing on close objects can be a sign of presbyopia

• blurred vision can be a symptom of cataracts or AMD

• tiny, yellow deposits in the retina can also signal AMD

• seeing haloes around lights, sudden severe eye pain and vomiting can all be signs of glaucoma

• ‘floaters’ can be harmless, but they can also indicate diabetic retinopathy.

Because your sight is so important, seek medical advice if you do notice any of these changes.

Older people from Indigenous backgrounds

The federal Department of Health and Aged Care reports that Aboriginal and Torres Strait Islander communities are more affected by vision changes than the rest of our population.

They experience 3 times more vision impairment and blindness than other Australians, and in some areas they have high rates of trachoma (an eye infection).

Medical practitioners can help

Your GP can help you find the right support for your vision needs, or you can seek out one of these eye specialists:

• Optician – for fitting eyeglass lenses, frames and contact lenses.

• Optometrist – for eye exams and vision tests, detecting some eye irregularities and diagnosing some conditions, prescribing glasses or contact lenses, prescribing medication for some eye conditions, visual rehabilitation, treating and managing vision changes.

• Ophthalmologist – for diagnosing and treating all eye conditions and performing eye surgeries. Your GP will need to refer you.

What can you do to protect your vision?

While some conditions, such as presbyopia, are an inevitable part of ageing, there are still things you can do to look after your eyes.

• Have an annual eye exam once you’re 65 (and, before then, every 2 years).

• Quit smoking. Being a smoker increases your risk of developing eye diseases such as cataracts, glaucoma and AMD.

• Wear quality sunglasses to protect your eyes, especially on high UV days.

• Actively manage your diabetes and high blood pressure if you have those conditions.

• Look after your general health. Eat a balanced, healthy diet and keep fit with regular exercise.

Tips for families and friends

While presbyopia affects us all as we get older, we shouldn’t assume that vision changes will definitely limit an older person’s ability to look after themselves or live independently.

That’s why it’s important for families and friends to know the signs of reduced eyesight, rather than just assuming that the older person will struggle with their vision because of their age.

Family members and friends are well placed to watch for these signs. You may notice the older person is squinting, bumping into things, missing objects when reaching for them – or even avoiding activities they usually enjoyed, such as reading or driving. An increase in accidents, whether involving only themselves or while driving, is an obvious sign that needs to be taken very seriously.

Age-related changes in health can be a sensitive topic to broach. Here are some tips to help you encourage your older friend or relative to look after their vision without making assumptions about their health.

• Help them schedule regular eye check-ups.

• Where possible, ensure their surroundings are well lit without a strong glare. You could suggest changing light bulbs in their home, choosing direct task lighting (such as a reading lamp), and keeping indoor lights on to equalise changes in light from outdoors.

• Reduce fall risks by installing nightlights in the bedroom or in the hallway. Remove clutter and tripping hazards such as electrical cords and rugs.

Importantly, provide emotional support. Experiencing vision changes can be frightening, and the older person could become anxious that they may no longer be able to live independently.

By helping your family member or friend protect their vision and supporting them in seeking medical help, you will assist them to age well.

Find out more

• Department of Health and Aged Care, ‘Preventing age-related vision loss’ – online article by Assoc Prof Lauren Ayton (2022)

• Deafblind Information Australia, ‘About Deafblindness – terminology’ – a web article explaining ‘blind’, ‘vision impairment’ and ‘low vision’

• Vision Australia, ‘Understanding eye conditions’ – webpage with links to information about common eye conditions

Disclaimer: The information provided on this website is not a substitute for individual health advice from a doctor or dietitian.