Seeing your way to better eye health

Maintaining your vision as you age requires a proactive approach.

Published: April, 2021

Did you know that women are more likely than men to have eye conditions that can lead to vision loss, such as age-related macular degeneration, glaucoma, and cataracts? According to the American Academy of Ophthalmology, more than 60% of people with these conditions are women, in part because they live longer, and risk rises with age.

While women may be more at risk for eye disease, you should also know that in many instances, vision loss is not inevitable if you are proactive about your eye health.

With this in mind, we asked Dr. Michael Lin, an instructor in ophthalmology and an ophthalmologist at Massachusetts Eye and Ear, what you should be doing to help keep your eyes healthy. His responses are below.

Q. Are there some common problems women should be aware of as they get older?

A. Yes. There are a few conditions that should definitely be on their radar.

Posterior vitreous detachment. One of the most common reasons people in their 50s and 60s visit our emergency room is seeing flashes or light streaks to the side of their vision or a new cobweb-like haze that floats around in their vision. This happens because the eye is filled with a jelly-like substance, called vitreous. Vitreous is tightly attached to the retina, the part of the eye that acts much like the film in an older-model camera. With time, the vitreous becomes more liquefied and shrinks. In some instances, the vitreous will detach from the retina; that's called a posterior vitreous detachment. As the vitreous contracts, it can tug on the retina, which stimulates the retina cells, triggering them to report to the brain that they are seeing light. It's not actual light that they are seeing, but a visual disturbance caused by the vitreous. The cobweb-like floater that people also commonly report is caused by shadows from the vitreous jiggling around in the eye, because it is no longer firmly attached to the retina.

If people get new flashes and floaters, it is important to come in right away for a dilated eye examination because the vitreous can occasionally pull so hard on the retina that it causes a tear or detachment of the retina, which must be treated quickly before it causes significant vision loss.

Cataract. Most people are born with a clear lens in each eye, but over time that lens becomes cloudier. This cloudy, yellowed lens is called a cataract. Cataracts are part of the aging process. They can make the world appear dim because the cloudy lens blocks light from getting in. Medication is generally ineffective for cataracts, but cataract surgery has come a long way over the past few decades. It is now a relatively quick day surgery performed by an ophthalmologist to remove the cloudy cataract lens and replace it with a clear lens that lets people see much more clearly.

Glaucoma. Glaucoma is a chronic, progressive disease of the optic nerve, which connects the eye to the brain. Glaucoma usually causes a loss of peripheral vision at first, though central vision loss can occur early in some types of glaucoma, or in very advanced glaucoma. Lowering eye pressure is currently the most effective way of treating glaucoma. Possible treatments include medications, laser, and surgery. If a relative has had glaucoma or high pressure in the eye, it is very important to start getting routine eye exams around age 40, because glaucoma is often painless and not noticeable until it is very severe.

Age-related macular degeneration (AMD). AMD is a degeneration of the retina that can cause central vision loss and distortion. An eye doctor can detect this by seeing changes in the retina when examining the back of the eye. Risk factors for AMD are older age, family history, and smoking. AMD is divided into two types: exudative — or "wet" — and non-exudative — or "dry." Treatments for AMD include special vitamin formulations for the dry type and injections of medication for the wet type.

Diabetic retinopathy. Having uncontrolled blood sugar and blood pressure can cause problems in the retina such as blood spots, abnormal blood vessel growth, retina swelling with abnormal fluid, and bleeding into the eye. This can be treated by controlling blood sugar and blood pressure. Your ophthalmologist may also recommend laser treatment, injections of medication, or both.

Dry eyes. Over time, the film of tears that keeps the eye lubricated can become less effective. This can cause the eyes to feel irritated or as if something is in them. Using over-the-counter artificial tears is a good first step, but you should see an eye specialist if you are not getting symptom relief.

Q. What should women know about potential eye changes they may experience as they age?

A. Changes in vision may be part of the typical aging process or due to abnormal eye disease, such as AMD or glaucoma. A yearly eye examination with an optometrist or ophthalmologist is the best way to detect if there is any disease that can or should be treated. In general, vision changes that are slow and chronic can wait for a routine eye examination, but it is important to see an eye doctor as soon as possible for sudden changes in vision, such as blurring or missing parts of vision, new flashes, new floaters, pain, light sensitivity, redness, or any other concerns.

Q. What should preventive eye care look like?

A. Having a regularly scheduled eye examination is one of the best ways to detect any vision problems early and to get timely treatment. At these visits, your care team will check your vision with an eye chart, see if your vision would improve with glasses or contact lenses, and measure the pressure in your eyes. You may also have your eyes examined with a specialized microscope called a slit lamp. It is generally helpful to have your eyes dilated at least once every two years in order to get a complete examination because there are certain parts of the eye that are hard to examine without dilation.

Optician, optometrist, and ophthalmologist: What's the difference?

If you're ready to schedule an eye appointment, you may wonder who you should see: an optician, optometrist, or an ophthalmologist? According to Dr. Michael Lin, an instructor in ophthalmology and an ophthalmologist at Massachusetts Eye and Ear, the professional you need to see really depends on the purpose of your appointment.

Optometrists

Optometrists are eye doctors who received a doctor of optometry (O.D.) degree after attending optometry school for four years. Many people can have their eyes taken care of by an optometrist until they need cataract surgery or have more complex eye problems. Optometrists are qualified to prescribe glasses and contact lenses and can often diagnose and monitor eye disease. Optometrists can perform laser procedures in some states, but they are not trained to do surgery in the eye, such as cataract surgery. For more complex issues requiring treatment with medications or surgery, optometrists will frequently refer patients to ophthalmologists.

Ophthalmologists

Ophthalmologists are eye doctors who have completed a bachelor's degree, a doctor of medicine (M.D.) or doctor of osteopathic medicine (D.O.) degree after attending medical school for four years, and at least another four years of residency training in ophthalmology. Often, they will go on to complete an additional one or two years of fellowship training. Ophthalmologists provide medical and surgical treatment of all eye diseases. The most common surgery they perform is cataract surgery — more than three million in the United States each year.

Opticians

Opticians fit and make eyeglasses. They work with optometrists and ophthalmologists and use the prescriptions those doctors write to customize the right frames and lenses for each patient.

Ophthalmic technicians

Another professional you may encounter is an ophthalmic technician, who may assist optometrists and ophthalmologists during a clinic visit by performing imaging tests, checking vision and eye pressure, and taking a medical history.

Q. Are there any lifestyle changes women can make to help keep their eyes healthy?

A. Living a healthy lifestyle is not only good for your overall health but also good for your eyes. Diet and exercise are important because uncontrolled blood sugar and blood pressure are major risk factors for eye disease, such as diabetic retinopathy. Smoking can also increase the risk of many eye problems. Wearing sunglasses when outside and eye protection when doing home improvement projects can prevent damage from ultraviolet light and accidental flying objects, including projectiles, but also dirt and dust.

Getting a complete eye exam every year is a great way to make sure that the eyes remain healthy, especially if there is a family history of eye disease.

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