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Eye Problems Among Elderly

Introduction

Having a good eye sight is valuable compared to other things. It is unfortunate if an elder having a poor eye sight, one will stop from enjoying an active lifestyle. For instance;

“Before this, I still able to read at near without holding the reading materials further away from me in order to read clearly”

“Last time, I remember that I still can see clear at far, but recently I noticed that my vision getting blur and cloudy”

“Nowadays, I’m having difficulty to drive confidently at night because I feel glaring from the oncoming car lights”

“Last time, I can drive safely but now I’m afraid that I’m not aware if other vehicles come from the side. I was nearly involved in an accident”

“Sadly, I also bumped into things frequently and hurt myself”

“Recently, I feel uncomfortable, irritate, watery and sandy sensation on my eyes which I’ve never experienced before”

Epidemiology

A research stated that, Malaysian population is estimated to reach up to 33.7 million in 2020 whereby 3.8 million (11.8%) from the total population is elderly. There was a study done in Malaysia on common Age Related Diseases and condition occurred among elderly as described in Table 1.

Table 1: Age Related Diseases And The Explanation

No Age Related Diseases / Conditions Explanations
1

Changes in Refractive Error

Causes:

  1. Presbyopia: Aging in crystalline lens causes it to become inflexible and resulting difficulty to focus at near.
  2. Second sight: Ability to see clearly at near without This is a sign of presence of an early cataract. This condition occurs temporarily. It is recommended to get a comprehensive eye examinations including refractive assessment from Optometrist or ocular assessment from an Ophthalmologist.
2

Cataract

Lens become opaque and causing poor vision.

In Malaysia, cataract usually occur at age of 60 to 70 years old.

Globally, cataract related to aging, contribute up to 48% of the cause of blindness and this is account for about 18 million people in the world.

This reversible blindness can be treated by Ophthalmologist with cataract surgery.

A matured cataract can lead to secondary glaucoma.

It is recommended to have an eye check with an Optometrist or an Ophthalmologist as soon as possible if having cataract.

 3

 Glaucoma

 

Is a chronic, progressive optic neuropathy with increase in Intra Ocular Pressure (IOP) as a risk factor and mostly painless.

It is known as silent vision thief. Particularly elder’s age of 60 years and above are at risk. It is highly suggested to have an eye assessment with Optometrist or Ophthalmologist as soon as possible if having visual field defect as in pictures below:

Normal

Mild

Chronic

Final Stage

For patient diagnosed with glaucoma, one should comply with medication that being given and followed up appointment as scheduled.

 4

 Watery Eyes

Causes:

  • Obstructions in drainage system
  • Droopy of lower eyelid
  • Over sensitive to light, wind and changes in surrounding temperature

It is advisable to have an eye assessment with Optometrist or Ophthalmologist. Ophthalmologist able to treat any obstruction or blockage in drainage system.

The droopy of lower lid can be treated with plastic surgery by Ophthalmologist.

Wearing on sunglasses with the ultra violet (UV) protection can help in reducing one sensitivity to exposure of bright light.

 5

Dry Eyes

Tears production reduced with increasing age.

Patient’s eye easily gets tired, irritate and feeling sandy sensation.

One way to treat dry eyes is by instillation an Artificial Tears which can easily buy from any pharmacy outlet.

It is advisable to get an eye examination with an Ophthalmologist

 6

Age Related Macular Degeneration (ARMD)

 

“Black dot” at the central vision

 

Wording becomes crooked, distorted and wavy

ARMD is the main leading vision problem among elderly with age 65 years old and above.

ARMD is caused by degeneration of macular (the most sensitive area in the eye) that allows one to see clearly and in details.

Symptoms of Wet ARMD

  • ‘Black dot/area’ at central vision
  • Blurring of vision especially when reading
  • Vision problems (straight line become crooked and distorted)
  • Colour become faded

Risk in elderly age 60 years old and above  

It is recommended to get a comprehensive eye examination with Optometrist and Ophthalmologist.   

There are 2 types of ARMD: Dry and Wet as listed in Table 2.

Table 2: The Differences Between Dry ARMD and Wet ARMD

Dry ARMD Wet ARMD
90% of ARMD cases  10 % of ARMD cases
Gradual loss of central vision  Rapid progression. Occurs within weeks or a month
 Usually not leading severe vision loss.  Damage at macular permanently causing a severe vision loss.

 Cells and blood vessel beneath the macular rupture

and accumulate. This accumulation known as “Drusen”

Usually occur after Dry ARMD.

Abnormal blood vessel growth and leak at macular area causes changes in macular structure and result in distorted vision.

 7  Eyelid Problems

Such as:

  1. Trichiasis: inwards growth of the eyelashes
  2. Entropion: inward turning of the eyelid
  3. Blepharospasm: Muscle spasm of the eyelid
  4. Dermatochalasis: excess of the skin in the upper or lower. This condition effect visual field (constricted)

Eyelid problems such as Entropion and Dermatochalasis can be treated with cosmetic eye surgery/ oculoplasty.

It is suggested to elderly who have eyelid problems to get advice and treatment from Ophthalmologist.

Before treatment

After 7 days operation

 8  Floaters

Jelly-like structure (Vitreous) inside the eye becomes liquefied with increasing age.

This liquified gel clumps together and floating inside the eye thus resulting in floaters and can lead to vision problems.

Small number of floaters is considered as normal.

If the floaters suddenly increase in number and size, it is a sign of early retinal detachment and need to see Ophthalmologist urgently.

9 Retinal Detachment

It is a condition whereby the retinal layer (layer that sensitive to the light) detached from the layer underneath it.

Symptoms:

  • Increase in numbers of floaters
  • Seeing flashes of light
  • Shadows or dark curtain appeared in visual field

Conclusion

Common Age Related Eye Diseases and conditions among elderly as highlighted in Table 1 is preventable and can be treated. Hence, a comprehensive eye screening is important among elderly in order to detect any eye problems earlier.

References

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  10. http://hubpages.com/hub/The_Five_Most_Common_Eye_Problems_in_Adults
  11. Panduan untuk penjaga warga emas. Bahagian Pembangunan Kesihatan Keluarga.Kementerian Kesihatan Malaysia. Jun 2008
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  14. Rosniza A.R. Mata Kering. Portal Myhealth. Jan 2015.
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Last Reviewed : 30 October 2017
Writer : Nurul Hafizah Binti Mohd Norizan
Translator : Nurul Hafizah Binti Mohd Norizan
Accreditor : Hjh. Nor’Aini Binti Hj. Anuar