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How to Keep Older Eyes Sharp

By Marge Dwyer
Beth Israel Deaconess Medical Center correspondent

Air pollution. Wind and sun. Heating and air conditioning. Cigarette smoke. Hair dryers. Long hours peering at the computer. It's no wonder our eyes often feel dry, itchy, irritated and inflamed.

When you think about it, our eyes are one of the few body parts regularly exposed to the elements. It's no wonder that dry eye is one of the most common eye conditions encountered after age 40.

"There have been rapid changes in air quality over the years. The eyes are exposed to trillions of particles from air pollution - everywhere you go," says Dr. Mark C. Kuperwaser, an ophthalmologist in Beth Israel Deaconess Medical Center's Division of Ophthalmology who practices at the Longwood Medical Eye Center in Boston. "People are living longer. We are exposed to more heating and air conditioning, making it difficult for the delicate mechanisms in the eyes to maintain an adequate, moist eye surface."

Tiny glands in the eyelids produce tears, a mixture of water, oils, proteins and other substances that keep the eyes moist and help fight infection. Sometimes the composition of tears gets out of whack or too few tears are produced. Antihistamines, blood pressure medicine, anti-depressants, birth control pills and other medications can contribute to dry eye. It often accompanies diabetes, arthritis, Sjogren's syndrome (an autoimmune disorder) and other conditions.

Problems frequently develop when the tiny oil-producing glands (Meibomian glands) in the eyelids become clogged. Loss of this oily secretion means that there is less protection against tear evaporation. While it may seem like a minor nuisance, chronic dry eye is not to be taken lightly.

"Ninety percent of all eye surface diseases are caused by inadequate oil secretion due to the Meibomian ducts being plugged up," Dr. Kuperwaser says.

When wax and bacteria build up, conditions on the surface of the eye can begin to deteriorate.

Prevention is Key

The good news is that a little prevention can go a long way to avoiding dry eye.

"Like brushing and flossing your teeth, everyone over age 40 should get used to putting a warm compress - a warm damp washcloth - over their eyes once or twice a day. It's low cost, not harmful and usually solves the problem," Dr. Kuperwaser says.

Over-the-counter eye drops help many dry eye sufferers. More severe cases may require prescription drops, ointments or even surgical procedures. But often simple steps can help, like wearing sunglasses; shielding your eyes from wind and dry air; getting adequate nutrition, rest and exercise; using a humidifier indoors, and avoiding rubbing irritated eyes.

Another key tool in protecting yourself against eye problems is having regular, comprehensive eye exams.

"Everyone should be screened by an eye care professional by age 40, especially if you have diabetes, eye diseases in the family, or regularly take steroids," Dr. Kuperwaser says.

If you have family members with eye disease, ask your doctor if you need more frequent eye exams or to start them at a younger age.

Common Eye Disorders As We Age

What are the common eye problems that can result in vision changes as we age? Researchers studying vision among Framingham Heart Study participants have found that four common eye conditions increase in prevalence in those age 40 and over - cataracts, glaucoma, macular degeneration and diabetic retinopathy.


Cataracts, the most common eye disorder in the world, are responsible for about half of the 3.3 million Americans age 40 and over with low vision. It occurs when the lens of the eye thickens and clouds. Cataracts can progress slowly without noticeable symptoms.

"The glare from lights when driving at night often is the first sign that cataracts are developing," Dr. Kuperwaser says.

Over 20.5 million Americans have cataracts; this is projected to rise to more than 30 million by 2020. While cataracts can occur in the young, older people are most at risk. About half of those 65 years or older have some lens clouding. The condition is especially prevalent after age 75.

"Cataracts are a functional problem. People are not seeing clearly and come to us to find out what's wrong," Dr. Kuperwaser says.

He adds that some report needing brighter light to read, seeing halos around lights and/or double vision, and changing eyeglass prescriptions frequently.

The good news is that there are effective surgical solutions for most cataracts. Three to four million operations are done annually in the nation. Most are successful and with few complications.

Can cataracts be prevented?

"I tell patients not to smoke. If they take steroids or have diabetes, they should be regularly screened," Dr. Kuperwaser advises.

A daily multivitamin may be helpful, he adds. Lutein, found in green leafy vegetables and added to many multivitamins, has been found not harmful though it still remains under study. He advises avoiding vitamins and herbal supplements marketed as so-called "eye vitamins" unless your doctor recommends them because little is known about how many of these substances impact the eyes.


A common condition after age 40, glaucoma affects two to four percent of the population and is a leading cause of blindness. African-Americans, Hispanics, Mexican and Asian-Americans are among the groups at higher risk. The older you are, the more important it is to be screened for this silent, sight-robbing condition that usually results from increased eye pressure causing a damaged optic nerve. It's more common among people with a family history, with conditions like diabetes, those who regularly take steroids, and the nearsighted (trouble seeing distant objects).

While the most common type of glaucoma has no symptoms, some notice a slow decrease in side (peripheral) vision, or tunnel vision when the condition is advanced.

"Glaucoma is a heart breaker because it's so treatable and only one-half of the people in the U.S. who have the condition are receiving treatment," Dr. Kuperwaser says.

When detected early by a simple eye pressure test done as part of an eye exam, glaucoma usually can be successfully treated with eye drops, laser and/or surgery.

"It's important to catch this condition early because once it sets in, vision loss is irreversible," he says.

Macular Degeneration

This disease attacks the macula, tissue in the retina on the back wall of your eye that serves central vision. We use central vision when we read, drive and look at peoples' faces. Macular degeneration is a common disease usually found in industrialized nations of the world. By age 70, one out of three people show some signs of the condition. About 90 percent of those impacted will not have serious problems from the condition, but 10 percent will have the more severe form of the disease and suffer vision loss. One million are legally blind from this condition each year; there are 10 percent more cases each year.

Symptoms of macular degeneration include requiring increasingly bright light for close work; difficulty adapting to low light levels; blurred vision; colors appearing less bright; difficulty recognizing faces; having a blind spot in the center of your vision, distortion of vision and reduced clarity of central vision.

Your risk for macular degeneration is increased if you have family members with the condition, you smoke, have cardiovascular disease, are obese, or have light-colored eyes. You are more at risk if you are Caucasian, over age 75 and a woman. Having low blood levels of zinc and antioxidant vitamins (A, C and E) also can increase the odds.

Although treatments are presently limited, prevention is key.

"Numerous studies have shown that lifestyle changes can reduce the risk of getting the condition. By consuming a diet rich in fruits and green leafy vegetables, getting adequate rest, exercising and not smoking, you reduce your risk," Dr. Kuperwaser says.

Diabetic Retinopathy

This complication of diabetes resulting from blood vessel damage to the retina at the back of the eye impacts one in every 12 people with diabetes age 40 and over. There may be no symptoms at first, or perhaps just mild vision problems. But don't be fooled. Diabetic retinopathy is the leading cause of blindness in working age adults in the United States.

Everyone newly diagnosed with either Type 1 or Type 2 diabetes should begin having an annual comprehensive eye exam to track eye problems. This applies to women who are diagnosed with gestational diabetes during pregnancy, and those who take steroids or have kidney or blood vessel (vascular) disease. African-Americans and Hispanics are among the groups particularly at risk. The longer you have diabetes, the greater your odds for developing retinopathy.

There are two types of diabetic retinopathy. Nonproliferative diabetic retinopathy may just require monitoring by your eye specialist, while proliferative diabetic retinopathy requires prompt treatment. Procedures range from laser treatment to a vitrectomy, in which blood and scar tissue is removed from the eye. While surgery can slow or stop progression of retinopathy, it is not a cure. Regular eye checkups are needed to follow the condition and particularly to detect troublesome changes at an early stage when treatment is simpler and more effective.

Symptoms include floaters (spots floating in your vision); blurred or decreased vision; poor night vision, and vision blocked by dark streaks or a red film. Contact your eye doctor right away if you experience sudden vision changes or your vision becomes blurry, spotty or hazy.

How can you protect yourself against eye disease and other complications if you have diabetes? By keeping your blood glucose (sugar), your blood pressure and cholesterol under good control.

"The better your control, the fewer complications you will have," Dr. Kuperwaser says.

To schedule a consultation with the specialists at Beth Israel Deaconess Medical Center's Division of Ophthalmology, call (617) 667-3391.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted July 2012

Contact Information

Division of Gerontology
Department of Medicine
Beth Israel Deaconess Medical Center
Lowry Medical Office Building #1B (West Campus)
110 Francis Street
Boston, MA 02215