Change is the only constant thing in life. Just like the rest of our body, our eyes change as they age. While it is not as obvious as our height, our hair or skin, it still undergoes dramatic changes as we advance in age.

From the age of 40 years, you will probably notice that your vision is changing. One of the first symptoms of our eyesight starting to fail is the loss of our ability to focus on near objects, or you have a problem adjusting to glares or differentiating between some colours. If you have to increase the distance between your eyes and your reading material, the lenses of your eyes become less flexible, and the condition is known as presbyopia, caused by hardening of the eye’s lens which becomes less flexible and less able to thicken.

Unfortunately, this is not the only change in the health of your eyes as you age.

Nearly all the structures of the eye that bend, guide and transform light entering the eye change with age, reducing the amount of light that reaches the retina.

• Eyelids thin as we age, causing them to droop and cut down on available light.
• The ageing cornea flattens, and the increased scattering of light gives the corena a yellowish tinge.
• The opening of the pupil decreases with age (senile miosis), which also limits the light falling on the retina – which is mostly felt in dim light.
• And then there are fewer nerve cells in the ageing retina, and visual processing in the brain is slower.

No older patient is typical.

Changes to the appearance of the ageing eye may include the following:

• Yellowing or browning caused by many years of exposure to ultraviolet light, wind, and dust
• Random splotches of pigment (more common among people with a dark complexion)
• Thinning of the conjunctiva
• A bluish hue caused by increased transparency of the sclera
• Arcus senilis (a deposit of calcium and cholesterol salts) could appear as a gray-white ring at the edge of the cornea.

If you suffer any of these symptoms, it is advisable to ask your GP for a referral to an eye specialist:

• Permanent dark spot in the central field of vision
• Loss of peripheral vision
• Spots in the field of vision
• Veil obstructing vision
• Wavy or crooked appearance to straight lines
• Eye pain
• Sudden appearance of floaters or flashers
• Sudden loss of full or partial vision
• Trouble adjusting to dark rooms
• Unusual sensitivity to light or glare
• Crossed eyes

Other symptoms of ageing eyes include:

• Change in iris colour
• Double vision
• Difficulty focusing on near or distant objects
• Dry eyes with itching or burning – or excessively watery
• Episodes of cloudy vision
• Excess discharge or tearing
• Growing bump on eyelid
• Halos (circles around lights) or glare
• Inability to close eyelid
• Redness around the eye

Age is a major risk factor for developing age-related eye diseases, including age-related macular degeneration, cataract, diabetic eye disease, glaucoma, dry eyes and retinopathy. Fortunately, all of these are conditions that benefit from the intervention of an eye specialist.

• Cataract
• Glaucoma
• Macular Diseases including Macular Degeneration
• Diabetic Eye Disease (diabetic retinopathy)
• Dry Eye
• Pterygium (sutureless pterygium surgery)
• Retinal Vein Occlusions
• Retinal Artery Occlusions
• Retinal Tears

A cataract is a clouding of the eye’s lens – the lens becomes less transparent to light and so things look blurred, with faded colours and lots of glare and halos. The lens is located just behind the iris (the coloured part of the eye). It is approximately the size of a Smartie® and is responsible for focusing the incoming light onto the retina. It is made of protein and water. Through ageing, the proteins tend to clump together, stopping light transmission. As the lens becomes cloudy, it obscures the incoming light from reaching the retina. Cataract therefore reduces our quality of vision.

Cataract formation is accelerated by UV light, diabetes, short-sightedness, eye trauma, iritis, trauma, radiation, genetics, smoking, certain eye surgeries, certain medications and certain medical conditions.

The macula is the centre of the central and high-resolution area of the retina. It is where light is focussed and it allows us to see objects in fine detail. Many diseases can affect the macular but age-related macular degeneration (AMD) is one of the most common. It tends to occur in people over the age of 60 but there are similar conditions that can occur in younger people.

One of the first symptoms is loss of the central part of the visual field. There may be distortions which grow worse until central vision is lost. Sadly, it is this central part of vision that is most required – for driving, reading and recognising faces.
While ageing is clearly the predominant risk for this disease, it can be aggravated by genetics and smoking.

Treatment for age-related macular degeneration (AMD) depends on the type. 

There are two types of AMD – wet and dry – and they are treated differently.

Wet AMD

This is treated with anti-VEGF injections which stop abnormal blood vessel growth. Laser therapy is also sometimes used to destroy leaking blood vessels, if they are not in the centre of the macula. Another treatment, for specific variants of wet AMD, is Photodynamic therapy (PDT), where a light-sensitive drug is injected into the arm and activated by laser to close off blood vessels.

Dry AMD

Currently, there is no cure for dry AMD. However, lifestyle changes such as not smoking, eating healthily, maintaining a healthy weight and exercising regularly, as well as consuming certain vitamin and mineral supplements, following the AREDS2 formula, may help slow the progression of the disease in some people.

Glaucoma occurs with the fluid in your eye, the aqueous humour, is produced faster than it can drain away. This causes increased intraocular pressure (IOP), which damages the optic nerve.

It is first sometimes detected when there is peripheral vision loss, sometimes called ‘tunnel vision. It will result in blindness if it is not treated.  You may not know you have glaucoma, so you need to have your eyes examined regularly if you are over 40.

Treatments include drugs that lower intraocular pressure, as well as procedures such as trabeculoplasty, canaloplasty and trabeculectomy, which help the fluid drain away.

The simplest way to understand diabetes is to think of your blood vessels as metal pipes. Sugar causes your pipes to ‘rust’ and leak fluid. In the eye, it commonly affects the microvasculature of the retina that swells and leak because of the changes that high levels of glucose induce. The condition can be blinding if not treated.

Some of the first signs are irregular spots of visual loss, or dark flecks, as well as blurred vision. Tight glycaemic control and regular eye checkups are recommended to help slow the progression of the disease, while management involves laser and eye injections. Dr Andrew works with your GP to optimize your risk factors for vision loss including blood sugar, blood pressure, and cholesterol.

Another common ageing eye disease is that of hypertensive retinopathy. It is largely asymptomatic and therefore can go undetected, until headaches or blurred vision occur. Management is primarily preventative, keeping blood pressure below 140/90mmhg is recommended, as there is no surgical treatment.

A pterygium is a fleshy, abnormal growth of the conjunctiva (the mucous membrane layer of the eye). It is common in people with a lot of UV light exposure, such as surfers and people who work outdoors. It is not a cancer but it can grow quite large and cause significant irritation, redness, and blurred vision. Treatment involves complete removal of all the abnormal tissue and covering the surgical area with normal conjunctiva from another part of the eye. The procedure can give outstanding cosmetic results.

Structural changes in the vitreous body, a large gel-like region that lies between the lens and the retina, have several implications for the elderly. In the aging eye, the vitreum liquefies and the gel portions clump together, causing spots, or floaters, to appear in the field of vision.

The number of mucous cells in the conjunctiva may decrease with age. Tear production may also decrease with age, so that fewer tears are available to keep the surface of the eye moist and the consistency changes, so that tears evaporate more rapidly. The eyes are also likely to be very teary too, strangely enough.

Treatments for dry eye include over-the-counter artificial tears, gels, or ointments, lifestyle adjustments like using a humidifier and taking breaks from screens, and medical interventions such as prescription eye drops or procedures for severe cases. Other options include warm compresses and eyelid hygiene to manage oil gland blockages, increasing dietary intake of omega-3 fatty acids, and wearing protective eyewear like sunglasses.

At-home and lifestyle treatments

• Artificial tears: Use over-the-counter eye drops, gels, or ointments to lubricate the eyes. Gels provide longer relief, while ointments are best for nighttime use as they can blur vision.
• Warm compresses: Apply a warm washcloth to your closed eyelids for several minutes to help loosen blockages in the meibomian glands.
• Eyelid hygiene: Gently clean your eyelids using a mild soap, such as tear-free baby shampoo, to remove debris and bacteria.
• Environmental modifications:
  • Humidify your home and work environment.
  • Minimize direct exposure to air conditioners and heaters.
  • Wear wraparound sunglasses to protect your eyes from wind.
• Screen time management: Follow the 20-20-20 rule: every 20 minutes, look at something 20 feet away for 20 seconds to encourage blinking.

Dietary and supplements

• Increase omega-3s: Consume foods rich in omega-3 fatty acids (like fish, flaxseeds, chia seeds, and walnuts) or take supplements to help with tear quality.
• Stay hydrated: Drink plenty of water, as dehydration can worsen dry eyes.

Medical treatments

• Prescription eye drops: A doctor may prescribe anti-inflammatory eye drops (such as cyclosporine) to reduce inflammation and increase tear production.
• In-office procedures: For severe cases, a doctor may recommend procedures like Intense Pulsed Light (IPL) therapy to unblock meibomian glands or treatments that stimulate tear production by stimulating nerves.
• Tear duct plugs: In some cases, a doctor can insert tiny plugs into the tear ducts to help tears stay in the eye longer.

Other prescription medications: A doctor may prescribe oral medications for severe cases or certain nasal sprays that can stimulate tear production.

We can’t stop the ageing process, but we can protect our eyes from several risk factors. Your lifestyle and independence can be severely compromised if you have poor eyesight or lose it altogether. It is therefore really important to look after your eyes. Maintaining a healthy lifestyle like eating healthily and exercising regularly, not smoking, protecting your eyes from the sun, watching your blood sugar levels and your blood pressure, will all help maintain physical health and well-being. A healthy, nourishing diet will include

• Green leafy vegetables (for example, spinach, broccoli and kale)
• Oily fish (for example, sardines, salmon, mackerel, tuna, anchovies)
• Citrus fruits and green peppers (for Vitamin C)
• Nuts (in particular, walnuts, lentils, cashews, peanuts and Brazil nuts)
• Seeds (like chia, flax and hemp)
• Yellow vegetables, like sweet potatoes, pumpkins and carrots
• Beef, pork, and oysters
• Eggs
• Milk
• Oats
• Olive oil
• Lots of water.

Vitamins to maintain eye health

• Vitamin A helps keep your cornea clear.  Reduces risk of age-related macular degeneration
• Vitamin B1 (Thiamine). This vitamin helps convert food to energy and ensures that cells function correctly, and so may reduce the risk of cataracts.
• Vitamin B, especially B6, B9 and B12.  These vitamins lower levels of homocysteine, a protein that is inflammatory and can increase your risk of developing age-related macular degeneration.
• Vitamin B2 (Riboflavin).  This is an antioxidant that supports general eye health.
• Vitamin B3 (Niacin).  This is an antioxidant, and it also helps convert food to energy.  It may help prevent glaucoma (when your optic nerve becomes damaged).
• Vitamin C is a powerful antioxidant.  It also helps make collagen, which is a protein that provides structure to you eye, in particular the cornea and sclera.  So, it may help lower the risk of developing cataracts.
• Vitamin E is also an antioxidant, which helps protect your cells.  This may help prevent age-related macular cataracts.
• Lutein and Zeaxanthin.  These are carotenoids which are found in high concentrations in the central retina (the macula). They help protect your eyes from harmful violet and blue light, which is emitted by the sun as well as video screens.
• Omega-3 fatty acids.   The cell membranes of your retina are found to have a high concentration of DHA, which is a particular type of this polyunsaturated fat.  It is also anti-inflammatory.  It can also help with dry eye disease and may be of benefit for age-related macular degeneration.

To ensure that your eyes are always at their best, get them checked regularly by an optometrist or ophthalmologist, so that any problems can be nipped in the bud.