As we age, it’s natural to experience a deterioration in body systems, to a certain extent. In particular, vision problems are prevalent, especially in the 60+ crowd. As early as age 40, many people tend to notice a change in their vision or eye health. For our elderly residents in assisted living facilities, many of them will have age or disease-related eye issues. Assisted Living Education has compiled a list of common conditions and expectations experienced in elderly eye health.
Age-related Macular Degeneration (AMD)
Age-related Macular Degeneration is actually the most common form of vision loss among people 50 and older. The macula is a small area located near the center of the retina, and is essential for sharp, central vision. It’s unclear exactly what leads to the breakdown of the macula, but it tends to occur over time.
AMD can be broken down into three stages, Early AMD, Intermediate AMD, and Late AMD, and further classified as dry AMD or wet AMD. Most people experience dry AMD. Early dry AMD is noted by the presence of drusen, which are waste deposits that build up in the macula. Typically, individuals are not yet experiencing vision loss. Those with intermediate dry AMD have larger drusen, and may also have pigment changes in the retina. There may be some vision loss present, but otherwise no symptoms. Late AMD individuals experience vision loss because of damage to the macula. Late AMD can be classified into two types, geographic atrophy and neovascular, or ‘wet AMD’.
Many tend to interchange the terms ‘dry AMD’ and ‘geographic atrophy,’ but they do refer to different stages in AMD. Geographic atrophy is the advanced form of dry AMD, and specifies the deterioration of the deepest retinal cells. This damage affects the photoreceptor cells (rods and cones) of the eye, and thus interferes with how the brain interprets visual information.
Neovascular AMD (also, Wet AMD)
Neovascular AMD occurs when tiny blood vessels develop under the macula. Often times, these blood vessels develop in the wrong place and can leak blood and fluid into the eye, causing scarring and damage to the macula. It is thought that the blood vessels develop in an attempt to clear drusen from the eye. While those with neovascular AMD may only account for 10% of AMD cases, it is the more severe type, and a bigger threat to vision loss.
Because individuals with early and intermediate AMD tend to be asymptomatic, it is important that elderly residents have their eyes examined regularly. While there is no reversing early stage AMD, adopting healthier habits can help slow the process. Exercise, eating plenty of leafy greens, increasing omega-3 fatty acid and antioxidant intake are all suggested.
Intermediate and Late AMD individuals may be able to take certain supplements to slow the advancement of the degeneration. Vitamins C & E, zinc oxide, cupric oxide, beta-carotene or lutein and zeaxanthin are some vitamins & minerals which have been proven effective in delaying the progression of AMD. Of course, the resident’s attending physician should approve any changes to their individual care plan, diet, or medications.
There are more intensive treatments for advanced neovascular AMD, including injections, photodynamic therapy, and laser surgery, all with the intention of slowing the progression and advancement of vision loss.
While exact statistics are not clear, dry eye is a common condition seen in elderly residents, despite its ability to develop at any age. Dry eye is a result of either an inadequate amount of tears, or poor tear quality. Tear production tends to decrease with age, and windy or dry climates can aggravate the condition. Poor tear quality happens when one or more of the three components of a tear (oil, water, and mucus) is not sufficient and does not properly nourish the eye.
Dry eye can be a temporary or a chronic condition, with numerous causes, some as simple as a side effect of a medication, allergies, incorrect vitamin dosages, infrequent blinking, or more severe such as disease of the glands in the eyelids, immune system disorders, chronic inflammation of the conjunctiva, or skin disease.
Treatment for dry eye commonly involves the use of medicated eye drops, although a small surgical procedure can be performed to block the tear duct if the goal is to conserve tears. If dry eye is due to eyelid or ocular irritation, the doctor may recommend the individual receive ointments, a warm compress, or other eyelid cleaners to relieve inflammation around the eyes.
Cataract occurs due to an accumulation of proteins on the lens. This clouds the lens and prevents light from clearly passing through to the retina, where it is transformed into nerve signals and then sent to the brain.
Most cataracts are due to aging, but there are other types of cataracts:
Secondary Cataract – These can form due to other health problems, or even after surgery from other eye issues like glaucoma.
Traumatic Cataract – Cataracts that develop from a traumatic injury.
Congenital Cataract – Some individuals are born with cataracts, but they may not even affect their vision. However, those with affected vision usually have their lenses removed.
Radiation Cataract – Certain types of radiation exposure can cause cataracts.
Individuals with early stage cataracts can rely on environmental changes to help with vision, such as anti-glare sunglasses, treated eye-glass lenses, brighter lighting, and even magnifying lenses. Those whose daily tasks are affected by cataracts find greater benefit in surgery to remove the cataracts. Cataract surgery removes the cloudy lens and replaces it with a new, artificial one.
There are several types of glaucoma, all of which cause damage to the eye’s optic nerve and typically result in vision loss or blindness.
One of the most common types of glaucoma is open angle glaucoma. In a normal-functioning eye, there is fluid continuously flowing in and out of a space in the front of the eye (anterior chamber). This helps bring nourishment to nearby tissues. The movement of this fluid occurs at the open angle where the cornea and iris meet. However, when the fluid does not move or drain properly, it causes a build-up and creates pressure, which, if not treated, can damage the optic nerve.
People are typically asymptomatic initially, but as the damage increases, peripheral vision loss begins to fade. If still left untreated, people can experience ‘tunnel vision’ as their sight deteriorates, and eventually, total vision loss.
Other types of glaucoma include low or normal tension glaucoma; angle closure glaucoma; congenital glaucoma; secondary glaucomas, as a result of a primary medical condition; pigmentary glaucoma; and pseudoexfoliation glaucoma. Angle closure glaucomas are a medical emergency; a sudden increase in pressure builds up within the eye because part of the iris is blocking the fluid drainage. In these cases, people do experience severe pain and nausea, blurry vision, and their eye appears red.
There is no cure for glaucoma, however, there are medicinal and surgical treatments, or a combination thereof, that can delay disease progression if the condition is detected early on.
With these potential eye conditions, or any health concerns in general, it is important for our elderly residents to have regular check-ups and visits with the attending doctors, or their primary care doctor or other specialists. Early detection is key, as well as strict maintenance for any conditions already diagnosed. Establishing good relationships with the residents can also help in detecting any physical or behavioral changes which might indicate an underlying health issue. Each resident’s individualized healthcare plan will outline any current diagnoses or things to keep an eye on.
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