Age-Related Vision and Eye Disorders

January 01, 2015
 Just as physical strength decreases with age, eyes also exhibit a decline in performance. This issue of Better Health talks to Dr. Orathai Suwanpimolkul, a board-certified Geriatric Ophthalmologist, to give readers a better understanding of the possible interventions in common age-related eye disorders.  

Common Age-Related Eye Disorders 

Dry Eyes 

As we age our bodies produce fewer tears, resulting in a chronic lack of sufficient eye lubricant. Dry eyes is a common age-related eye condition. The causes of which include clogged meibomian glands (that reduce oil output), hormonal changes, thyroid disorders, rheumatoid arthritis and certain medications such as antihistamines and drugs for high blood pressure. The eye doctor must perform a thorough investigation to identify the true cause of dry eyes.

“Persistent dryness, itchiness, stinging, burning, and watery eyes are common dry eyes symptoms,” Dr. Orathai says. “Some may question why watery eyes is a symptom of dry eyes. It seems odd, but dryness on the eye's surface stimulates the production of tears, as a protective mechanism. 



Age-related cataracts are the degeneration and clouding of the lens, which diminishes the light passing through, and affects the ability to see clearly. Cataracts are a common eye disorder among aging people, especially those with diabetes. Blurriness, double vision, sensitivity to light, or seeing “halos” around lights are common symptoms.
“The treatment of cataracts is surgery which involves removing an opacified lens and replacing it with a clear artificial one,” explains Dr. Orathai. “Thanks to advances in medical technology, the surgery is generally safe and effective. During the procedure, an ultrasonic device is inserted into the eye. This device emits high frequency ultrasound waves to break up the lens, allowing its removal by suction. The artificial lens is then inserted into the eye. The minimally invasive technique enables a speedy recovery. Extremely advanced cases might require alternative surgical methods. 


Glaucoma is not as common as cataracts, but it still poses a threat to good vision. It involves loss of optic nerves from damage caused mostly by high eye pressure. Glaucoma damages your vision subtly and gradually, so that you may not notice until the disease is at an advanced stage – causing permanent vision loss.
“The most common cause of glaucoma is abnormally high pressure inside the eyes,” says Dr. Orathai. Continual high pressure damages optic nerves over time. Risk factors include family history, race, age, extreme nearsightedness, and medical conditions such as diabetes.”
Glaucoma does not usually have any warning signs and symptoms during the first stage. “An important symptom is a gradual loss of peripheral vision, which usually goes unnoticed until it disturbs daily activities. Frequently bumping into things or diminished side vision while driving are common signs,” adds Dr. Orathai. “Take note that when a loss of peripheral vision becomes noticeable, permanent damage has already occurred.”
The treatment goal for glaucoma is not to reverse the damage, but to conserve the remaining optic nerves. Options include medication, laser treatment, and eye surgery – depending on the type and severity of the glaucoma. 
Dr. Orathai highlights the need for regular eye exams to determine glaucoma risk and early intervention to prevent further progression and irreversible optic nerve damage. “It is highly recommended that all adults – starting at the age of 40 or those with risk factors – have regular glaucoma screening tests,” says the doctor. “The key is to detect the risk factors and glaucoma signs as early as possible, when there are no symptoms. In less common cases, some people may experience acute glaucoma.

Patients will rush to seek medical treatment because of severe symptoms that include intense eye pain, headache, reddened eyes, and sudden blurred vision. However, acute glaucoma is an uncommon condition.”


Age-Related Macular Degeneration (AMD) 

Age-related macular degeneration (AMD) is usually affected in adults starting at 60 years of age or older and results in loss of central vision. “There are two types of age-related macular degeneration, often described as wet or dry,” says Dr. Orathai. “Wet macular degeneration occurs when new blood vessels grow beneath the macula. These abnormal blood vessels are extremely fragile and can lead to bleeding in the macula or leaking of exudate fluid. Patients with wet macular degeneration usually come to the hospital with the symptoms of acute blurred vision or visual distortion. Dry macular degeneration, on the other hand, is not acute. But gradually, dry macular degeneration can also cause permanent vision loss.”
As with the goal of glaucoma treatment, treatment of age-related macular degeneration aims to maintain vision or slow down the progress of vision damage. Most cases of wet macular degeneration are treated by injecting medication into the eyes or using a special laser to prevent abnormal growths of blood vessels in the macula. For the dry form, the doctor may prescribe a specific vitamin formula to reduce the progression.
Patients must visit their doctor for a comprehensive eye diagnosis. “The patient will sometimes not notice the first stage of macular degeneration. An eye dilatation examination can diagnose it,” Dr. Orathai says. “One test can make a big difference.” 

Diabetic Retinopathy

Diabetes is an all-too-common condition among older adults. It affects the blood vessels throughout the body, including those in the eyes. According to Dr. Orathai, patients who have uncontrolled diabetes, or have had it for a long time, risk developing diabetic retinopathy. In some people with diabetic retinopathy, blood vessels may get occluded, swell, and leak fluid and lipid – while some with more advanced stage can have abnormal new blood vessels grow on the surface of the retina. The fragile abnormal blood vessels can leak blood.
Diabetic retinopathy patients may not notice changes in their vision during early stages, since there are only slight changes in the retina,” Dr. Orathai says. “As it progresses, some may have blurred vision because of swelling retinas or acute vision loss caused by bleeding in the retina. The abnormal blood vessels can cause scar tissue to form, which can pull on the retina and cause retinal detachment.” 
Dr. Orathai recommends that newly diagnosed diabetic patients have a specialist perform an eye dilatation examination to diagnose any disorders.


Don’t rely on warning signs

It’s helpful to try and spot the early signs and symptoms. However, for eye disorders (which often have no warning sign at the early stages), it is often too late once symptoms arise. A specialist conducting a comprehensive eye examination with the goal of early detection and treatment can make a big difference. Dr. Orathai recommends that people who are at least 40 years old, have an eye examination in order to evaluate the risk factors and rule out the presenceof possible age-related eyes disorders.

As people age, declining physical performance is inevitable – and usually irreversible. You can be ready if you understand and know the necessary steps to take for early intervention, in ensuring visual health in the years ahead.

Dr. Orathai Suwanpimolkul

“Many eye disorders often have no warning signs in their early stages. A comprehensive eye examination is helpful for early detection.” Dr. Orathai Suwanpimolkul


 What is intraocular pressure? 



Intraocular pressure (IOP) is fluid pressure inside the eye – to keep the shape of the eye. Eye pressure results from the balance between production and dissipation of fluid in the front part of the eye. Blockage of the canal into the eye making it unable to drain causes higher eye pressure, which only a specific tonometry tool can measure. 


Premier Eye Examination


For lifelong eye health, taking the preventive approach is the best policy. Eye screening examinations provide a clear view of your eye health, which enables you to take the vital early steps to prevent vision impairment and vision loss. To this end, Bumrungrad’s Premier Eye Package includes:    
  • Visual acuity test (testing vision clarity and sharpness) by reading numbers or letters                
  • Ishihara test for color blindness screening;
  • Measuring curvature of the anterior surface of the cornea with an auto keratometer to rule out some disorders characterized by abnormal corneal curvature, which may lead to vision loss;       
  • Measuring eye pressure with an air puff tonometer; 
  • Screening for disorders of the retina and the optic nerve, such as glaucoma, diabetic retinopathy, or macular degeneration using the fundus camera;               
  • Examining the shape and appearance of the front of the eye, including the cornea, the anterior (front) chamber of the eye, the iris and the anterior chamber angle of the eye with an Anterior Segment OCT, because certain abnormalities may indicate risk for eye disorders. For example, a closed or narrowed angle of the eye may signify risk of developing acute glaucoma;          
  • Retinal thickness measurement, retinal tissues abnormality, and optic nerves examination with a Spectral Domain OCT;
  • Visual field testing with Frequency Doubling Technology (FDT) to detect decline in peripheral vision during early stages of glaucoma and possible abnormalities in the brain that affect vision.
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