Like crow’s feet and graying hair, changes to our eyes are inevitable as we age. But while some age-related eye issues — such as needing reading glasses — are harmless, others, like cataracts, can impact your vision (or worse) and need to be diagnosed and treated.
Here, a look at the most common age-related conditions, and three symptoms that may be signs of more serious eye-health issues.
Presbyopia
While you’re still in your 40s, the lens in your eye begins to lose flexibility, making it hard to read up close or small print. “It’s very disconcerting for a lot of people, because it’s the first sign that they’re getting older,” says Sumayya Ahmad, assistant professor of ophthalmology at Mount Sinai Hospital’s Icahn School of Medicine in New York City. You may notice that you’re holding reading material at arm’s length, or that you have trouble reading the menu in a dimly lit restaurant.
If presbyopia’s your only vision problem (meaning you don’t otherwise use contact lenses or glasses) then all you need to do is don a pair of reading glasses, says Michelle Andreoli, an ophthalmologist at the Wheaton Eye Clinic outside Chicago and a clinical spokeswoman for the American Academy of Ophthalmology. But if you already wear specs, you’ll need to switch your lenses to bifocals, in which the top of the lens is corrected to treat distance vision, while the bottom helps you see things close up; or opt for progressive lenses, which have gradual focal changes. If you wear contacts, you have two options: monovision lenses, which correct one eye for seeing at a distance and the other for close-up vision, and multifocal lenses, in which different parts of the lens are set at different powers.
Loss of contrast sensitivity
At around age 60, you may start noticing that it’s harder to drive at night or in fog, or, conversely, to adjust from going from a dark backyard into a bright kitchen. These are all due to decreased contrast sensitivity, says Andreoli, which makes it hard to distinguish between an object and its background. This is because your eye’s rod cells, which help you see in dim light, degrade with age. The best way to combat this, at least during the day, is to wear a pair of over-the-counter sunglasses tinted orange, yellow or amber to enhance contrast, Andreoli says. But be wary of using these at night, since they can reduce the amount of light entering the eye and thus make it harder to see in the dark. If you’re experiencing a lot of trouble driving at night, see your doctor; you may also have cataracts or dry eyes, which can make the contrast problem worse.
Dry eye: Up to 75 percent of adults over age 40 experience dry eye, a condition in which your eyes don’t produce enough tears. “As you get older, tear production slows, as do other glands around the eye that produce oil that also helps keep eyes moist,” explains Howard Krauss, a Los Angeles ophthalmologist. As a result, your eyes may sting, feel gritty or sometimes even tear excessively (it’s your eye’s natural response to irritation, Krauss notes). Women are more susceptible, especially as plunging hormone levels during menopause affect the eye’s tear production (although it’s unclear exactly how or why).
Cataracts
By age 80, more than half of all Americans have had a cataract — a clouding of the lens in the eye — according to the National Eye Institute. You’re more at risk if you smoke or drink a lot of alcohol, have had a lot of UV exposure, or have diabetes (a 2018 study published in the medical journal Eye found that it nearly doubles the risk of getting a cataract). “People usually complain of blurry vision, first at a distance, then up close — they can’t see the TV, they have trouble reading books, and they may find it hard to drive,” Andreoli says. If cataract symptoms are mild, you may not need to do more than get a new eyeglass prescription to help you see better. But if you’re having trouble with day-to-day activities, then you’ll need surgery, where your ophthalmologist replaces your cloudy lens with a new, artificial one.
Three red flags for potential eye disease or damage
People between the ages of 55 and 64 should have a comprehensive eye exam every one to three years, and then every one to two years after age 65, even if they have no symptoms, according to the American Academy of Ophthalmology. This allows your doctor to screen you for potentially sight-stealing conditions such as age-related macular degeneration, diabetic retinopathy, glaucoma and cataracts. But if you notice any of these three signs, see your eye doctor right away.
A small blurred area near the center of your vision. This can be a sign of age-related macular degeneration, an eye disease that causes damage to the retina.
Decreased peripheral vision. It could indicate glaucoma, a disease that damages your optic nerve. While glaucoma can’t be reversed, it can be slowed down significantly with prescription eye drops.
Floaters. These small spots in your field of vision are actually specks or threads of protein that can form, as you age, in the vitreous, the gel-like fluid in the space between the eye’s lens and retina. If you see them occasionally, and they disappear after a few minutes, you don’t need to worry. But if a large number suddenly appear and/or they’re accompanied by flashes of light or vision loss, see your doctor immediately or head to the ER as it could be a sight-threatening retinal detachment.