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Vision Impairment in Older Adults

Updated: Jul 17, 2023

Vision is one of the senses that connects us with our environment and the people around us. Gradual or instant changes to eyesight are dependent on how well we treat our eyes and how we respond to problems with eyesight when needed. By the time we approach 30 and 40 years we experience changes in the shape of the lens and start holding reading materials closer or farther away.

We also experience changes in peripheral vision as we age. More often older adults will turn their head to the side because of cloudy vision on the periphery. When the eyes become less flexible, it makes it more difficult for older adults to accommodate the changes in light. Some adaptations taken around light are when they decide to stop driving at night, or when they take the extra time to adjust to a dark room after coming in from the sunlight.

Years ago, during a staff training session on understanding the lived experience of diminished or loss of vision among older adults I smeared vaseline around the glass lens leaving the center clear. Next, I covered the whole lens with vaseline, and the staff couldn’t see the words on paper and reached out blindly when they stood up to walk. The surprised reactions from the experiment gave us a better understanding of visual acuity and the leading causes of impaired vision like macular degeneration, blindness, glaucoma, and cataracts.The activity was an eye opener as I observed the staff interaction with the vision impaired adults over the week. They had more empathy and a little more patience as they let older adults adjust longer to the lighting inside and outside the building.

Macular degeneration is age related (AMD) and can be prevented with a combination of injecting medicine and laser treatment. AMD is a disease where the center of the retina (the light sensitive tissue at the back of the eye) becomes blurry, and there is loss of “central vision” and it becomes difficult to see people, drive, read, or do tasks around the house.

Glaucoma can occur at any age but is common among older adults. This can occur in one eye or both eyes when the drainage canal blocks the cells from the back to the front over the cornea and iris. The pressure from this blockage damages the optic nerve. Treatment for glaucoma is by injection and surgery to unblock the drainage canal.

Cataracts are the clouding of the lenses that have become less flexible and less transparent and thicker. The breakdown in fiber and proteins forms clumps that blurs vision. As the clouding becomes larger and denser some of the symptoms are seeing halo around lights, double vision, being sensitive to light and glares, and difficulty with vision at night. Cataracts can develop in one or both eyes and depending on the rate of clumping fibers and proteins

Older adults with vision impairments or near blindness can cope with living a brighter and more independent life by making certain adaptations. These include wearing a wide brim hat and sunglasses outdoors, having shades in windows to block out bright sunlight, having well lit rooms with adequate and even lighting in halls, bedrooms, and bathrooms, painting bright colors to mark stairs, be on the lookout for tearing, swelling, dryness of eyes, and having regular eye exams and glaucoma screenings every 1-2 years.

Many older people have adequate to good vision and a recent study has shown that untreated eye problems can also lead to Limbic-predominant age-related TDP-43 encephalopathy (LATE) with dementia-like symptoms similar to Alzheimer’s. Older adults with vision impairments sometimes place limitations on their activities. Modern medicine and technology along with help from Healthcare professionals can help older adults explore ways to live a normal life with their visual impairments.

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