news&views Autumn 2020 | Page 48

Your Aging Vision Dr. Jane Thrall As with most things, age changes the way we see the world. Eyes and the visual system are complicated and sensitive. Visual health is affected by many life choices, including what we eat, how much exercise we get, and any bad habits picked up along the way. The most common eye conditions in older people are cataracts, glaucoma, and age‐related macular degeneration (ARMD). Cataracts Cataracts are a clouding of the lens inside the eye, a very common condition in patients over sixty years of age. When the lens clouds, vision becomes distorted and dull. The process is usually so slow that it is barely noticed until road signs are difficult to read and night driving becomes unnerving. Cataract surgery is simple and highly successful with minimal risk. The most common thing I would hear after a patient had their first eye done was, “When can I get the other one done?” During a procedure called phakoemulsification, the surgeon makes a small incision in the eye and inserts a device that breaks up the lens and removes it in tiny pieces. An intraocular lens of the appropriate strength is inserted to replace the natural lens, and sight is restored. New glasses are prescribed if needed, but often patients only require reading glasses. Glaucoma Glaucoma is an eye condition that has few or no symptoms; patients invariably present with no concerns unless they’ve lost nearly all their sight. Historically it was thought that glaucoma was a condition of high pressure in the eye. While there is a strong association between eye pressure (intraocular pressure or IOP) and glaucoma, it turns out that’s not the whole story. Fluid is always flowing into and out of the eye. This aqueous fluid keeps the eye healthy and free from disease. When something goes awry with this process, pressure within the eye builds up. This increased pressure compresses tissue and affects the flow of oxygen and important nutrients to the optic nerve tissue, which conveys sight to the brain. The nerves affected first are the ones associated with peripheral vision, and the last to go are the central nerves from the macula. Peripheral vision is lost one cell at a time, but the pattern, in most cases, is predictable. Special screening tests have been developed to flag those who may be experiencing early changes to their peripheral vision and more in-depth tests can monitor the vision changes. 48 | arta.net