Eye Problems in Elderly: Types, Symptoms and What to Do

Common complaints that the elderly have about their eyes encompass: 

Vision-related

• My vision is not sharp
• I see small shadowy shapes
• Lines look crooked 

Non-vision related

• I feel like there is sand in my eye
• My eyes are itchy and red
• My eyes get wet and teary 

When eye problems occur, the following are important considerations:

• Onset and duration – When did the change occur? Was it sudden or gradual?
• How severe are the symptoms?
• Are there multiple symptoms present? 

“A gradual decline (over months or years) in vision such as in sharpness and clarity is more common, and usually caused by cataracts, presbyopia or refractive error,” Dr Lim said. 

“A sudden, significant drop in vision (within seconds, minutes or hours) is less common. Conditions that can cause this include blood vessel blockage in the retina or optic nerve, retinal detachment or bleeding within the eye,” he added.

1. Cataract

Cataract is a condition when the natural lens in your eye becomes progressively cloudy.

Symptoms of cataract

The most common symptoms of a cataract include:

• Cloudy or blurry vision
• Poor night vision
• Colours seem faded
• Glare and haloes
• Frequent prescription changes in your eyeglasses or contact lenses (“power” keeps changing)

Risk factors for cataract

Aging is the most common cause of cataract with those aged:·

• 60 years and above: Up to 80% have cataract
• Above 70 years: Up to 95% have cataract

Data provided by the Singapore Eye Research Institute (SERI)

Other causes of cataract include:

• Smoking
• UV radiation (sunlight) exposure
• Having poorly-controlled diabetes
• Having high blood pressure (hypertension)
• Taking certain types of medication such as corticosteroid, etc.

Cataract: How to manage

a) Conservative management (for mild cases)In the early stages of a cataract, often a change in glasses or contact lens prescription is sufficient. 

b) Surgery (for more severe cases)If poor vision is still encountered even after changing your lens prescriptions and upon confirmation by your ophthalmologist, cataract surgery may be required. 

About cataract surgery (phacoemulsification)

In phacoemulsification:

• A small opening between 1.8mm and 2.75mm is first created in the periphery of the transparent cornea.
• An ultrasonic device is then introduced through this opening into the eye. This device breaks the cloudy lens up into small pieces and facilitates removal from the eye.
• After the cataract is entirely removed, an artificial lens implant is inserted into the same position

Types of artificial lens implants used in cataract surgery

a) Standard Monofocal Lenses

• Most commonly implanted lenses, with equal power in all regions of the lens
• Provide good overall vision at a specific distance (mainly for distant vision)
• Reading glasses will be required
• Suitable for people who are comfortable wearing reading glasses

b) Multifocal lenses

• Provide good distance and near vision without glasses
• Convenient as both near and intermediate vision (for fixed distances) can be clearer using these lenses
• However, some people may find it difficult to read fine print, especially in dim light and may experience glare and haloes which may be bothersome
• This lens should be used in both eyes
• Suitable for people who want to reduce their dependence on glasses for far and near vision

2. Presbyopia (老花眼)

Presbyopia (老花眼) is an age-related condition in which a person is unable to focus on near objects. This results in you having to hold things (such as a mobile phone and reading materials) further from your eyes to be able to see them properly. 

Presbyopia is a normal natural ageing process of the eye and usually begins at around 40 years old.

Causes for presbyopia

Presbyopia occurs when the natural lens in the eye loses its elasticity and ability to change shape as a person gets older. This makes the lens less able to focus light accurately when looking at near objects. 

Presbyopia: How to manage

A common, non-invasive solution for correcting presbyopia is the use of reading glasses. Surgical procedures include Presby-LASIK, Monovision and Cataract surgery (phacoemulsification).

3. Refractive errors (short sightedness, long sightedness)

Refractive errors are common, treatable eye conditions where the eye's shape prevents light from focusing directly on the retina, causing blurred vision.

The two types of refractive errors are short sightedness or near-sightedness (myopia) and long sightedness (hyperopia).

“Age can sometimes produce different effects in patients with existing refractive errors. Individuals may find their myopia increasing significantly as they grow older. This is often due to the development of cataracts.

Similarly, younger people with long sightedness may be able to cope with it without glasses, however they may find their vision blurry when presbyopia sets in at a later stage,” said Dr Lim. 

Refractive errors: How to manage

Non-invasive solutions for coping with refractive errors include the use of glasses and contact lenses. Invasive procedures include refractive surgery options such as LASIK and Cataract surgery (phacoemulsification).

4. Floaters and flashes

Floaters are dots, lines or circular/oval-shaped shadowy shapes that you may sometimes see moving or floating in your field of vision. They can appear suddenly and more than one.

Flashes is the sensation of seeing flashing lights or lightning streaks in your field of vision. Both floaters and flashes are very common and usually harmless. 

“These (floaters and flashers) occur due to the ageing changes of the vitreous gel in the eye (the gel-like fluid that fills the eye),” Dr Lim explained. “However, infrequently floaters can be associated with more severe conditions such as retinal tears, retinal detachment, as well as bleeding or inflammation of the eye,” he added.

Migraine aura

The seeing of aura caused by a migraine (a type of headache) can sometimes be mistaken for flashes. However, for migraine aura, they:

• Are usually visible in both eyes at the same time.
• Last 15mins to 20mins with constant zig zag or shimmering pattern
• May be followed by headache and nausea or vomiting

5. Visual distortion and missing spots 

“Visual distortion and missing spots in a vision are usually due to retina problems like AMD (age-related macular degeneration) or epiretinal membrane (also called macular pucker). They may also be caused by neurological conditions,” Dr Lim advised. 

AMD (age-related macular degeneration): How to manage

Age-related Macular Degeneration (AMD) occurs in "dry" and "wet" forms (to know more about the difference between the two forms, read this article). 90% of AMD patients suffer from the "dry" form. 

For dry AMD, there is currently no known treatment. Some patients may benefit from the "AREDS2" formulation of supplements and vitamins, in terms of reducing the risk of developing advanced AMD. Do consult your eye doctor on whether these supplements will be beneficial for you. 

Epiretinal membrane (macular pucker): How to manage

Epiretinal membranes do not always require treatment. In many cases, epiretinal membranes are mild and may not affect vision. However, in some cases where the epiretinal membrane is severe, surgery may be required.

6. Dry eyes

Dry eyes or dry eye syndrome occurs when the eye is either unable to produce enough tears (a problem with tear quantity), or when the composition of tears is abnormal and unable to adequately cover the surface of the eye (a problem with tear quality). 

Symptoms of dry eyes

You may have dry eye syndrome if you have:

• Intermittent blurring of vision and tearing
• Eye redness, irritation, or sensitivity to light
• Heaviness or tiredness of the eyelid
• Sensation of having a foreign body or sand sensation in your eyes 

“Dry eyes are often associated with ageing, changes in hormones and can be caused by other medical conditions. Common triggers for (dry eyes) symptoms include use of the air conditioner or fan, prolonged screen time and eyelid disease,” Dr Lim said.  

Dry eyes: How to manage

There is a wide variety of ways to manage dry eyes including the use of:

• Warm compress
• Eyelid cleaners
• Lubricants
• Medications
• Supplements
• Procedures 

For more on coping with dry eyes, see this article.

7. Teary eyes

The opposite of dry eyes is having teary eyes or watery eyes. If you are suffering from prolonged itchiness and excessive watering of the eyes, it may be allergies triggered by dust, pollen, pet hair or other substances in your environment. 

It (teary eyes) can also be commonly caused by irritation from dry eyes or oily, inflamed eyelids. Less frequently, tearing occurs due to tear duct obstruction or a mispositioned eyelash or eyelid.

Although uncomfortable, this condition does not usually result in significant vision loss. 

For tips to manage teary eyes (watery eyes), see this article.  

8. Eye redness

Eyes may become red and swollen due to eye infections caused by viruses and bacteria. 

Conjunctivitis (pink eye) is the most common eye infection. It is an inflammation of the conjunctiva and the inner surface of the eyelids, usually due to a viral or bacterial infection. Sometimes, it can also be due to underlying allergic condition (allergic conjunctivitis).

The other common kind of eye redness can be due to subconjunctival haemorrhage, or ‘bloodshot eyes’.

Subconjunctival haemorrhage (‘bloodshot eyes’) can be caused by trauma or can occur spontaneously when the fine capillaries of the eye burst from sneezing, straining, vomiting or heavy lifting. 

This is caused by a broken vessel in the eye, which appears very red over the underlying white portion of the eye. Bloodshot eyes may be accompanied by discomfort or tearing but is usually painless.

This will usually heal without treatment after a few days to one week. But do consult a doctor if your red eye is accompanied by pain, blurring of vision, persistent un-resolving red eye or trauma. 

For tips to manage red eye, see this article.

Do consult an ophthalmologist immediately if you experience any of the following:

• Sudden, severe blurring or loss of vision
• Painful red eyes with vision blurring
• Sudden appearance of many floaters or continuous flashes
• New, sudden onset of double vision
• Red and swollen eyelids

For more on eye injuries and when to seek help, see this article.

We rely on our eyes to make sense of the world around us and empower us to stay independent. 

To maintain good vision for as long as possible:

• Live healthily (by adopting a balanced diet, exercise regularly and maintain a healthy weight)
• Keep chronic conditions (such as diabetes and high blood pressure) under control
• Wear UV protection
• Do not smoke
• Go for regular eye screening

For more tips on how to keep your eyes healthy, see this article.

Ref: F26

Related articles:
Our Eyes - Our Windows to the World

Glaucoma: How to Prevent and Manage

How to Avoid Blindness Caused by High Myopia

6 Common Eye Problems: Possible Causes and Tips