Common eye problems may occur when you reach a certain age, especially when you are a senior citizen. Dr Daphne Han, Consultant and Director at Singapore National Eye Centre, gives detailed answers to your questions.
Common eye problems for elderly include:
Age-Related Macular Degeneration
Age-related macular degeneration (AMD) is a major cause of blindness in those over 50 years old. The condition can make it difficult to read or recognise faces, driving and reading.
Glaucoma
Sudden and severe pain in the eyes can signal glaucoma. Glaucoma is an eye disease in which fluid pressure within your eye becomes too high, damaging the delicate fibres of the optic nerve. This damage is irreversible and can lead to blindness.
Cataract
Over 80% of people aged 60 and above have some form of cataract. Do you have a problem seeing due to cloudy vision that even spectacles cannot help? You may have cataract, a cloudy growth on your eye.
Diabetic Retinopathy
Diabetic retinopathy is a disorder of the blood vessels in the retina of patients with diabetes mellitus. It is the leading cause of new blindness in working adults in developed countries, including Singapore.
Dr Daphne Han, Consultant and Director from the Department of Cataract and Ophthalmology Service at Singapore National Eye Centre, gives detailed answers to your questions.
Question by thkhoo
I am a 63+ male. I had my eyes last examined in June 2010.
I have early cataract and floaters.
During the past few months, I have been having transient blurring of vision, especially of the right eye. This feels similar to having normal mucoid debris obstructing vision. Washing of the eyes helps.
During the past few days, I experienced a few flashes, again especially in the right eye.
When there is no blurring, floaters, or flashes, my vision is essentially "normal" for me.
I appreciate your comments. Thank you.
Answered byDr Daphne Han Consultant Cataract and Comprehensive Ophthalmology Service Singapore National Eye Centre
What you described are 2 different problems.
Firstly, the transient blurring that is improved by “washing the eye” is most likely due to dry eyes. This can be managed by using artificial tear supplement eyedrops, There are many over the counter formulae that you can purchase from most pharmacies, for moisturizing dry eyes.
Secondly, the new onset of flashes that you described are likely photopsia ( the medical term for flashes) due to vitreoretinal traction. This is due to liquefaction of the vitreous jelly that occupies the centre of the eyeball, causing a dynamic change that is transmitted to the blood vessels of the retina, hence the flashes. This can precede a new onset of floaters, and can be associated with a retinal tear that can lead to retinal detachment in a small number of patients. It is advisable to seek medical/ophthalmic attention for a precautionary check of the retina, a vital structure of the eye, which is akin to the negative or film in a camera.
Question bychiangdon
Dear Dr Han,
I am 46 years old and I have been diagnosed by a private eye specialist with AMD for my right eye back in 2009. I have short-sightedness of about 900 degrees for both eyes. The condition seems to be stable and I am not taking any medication. I still have a patch of blur in my central vision which improves under bright lighting and I still see wavey lines when looking at MsExcel spreadsheets.
Question #1 : Will it improve or gets worse with time? What can I do to improve or recover?
Question #2 : Occassionally, I get very stinging pain in my eyes, (acidic tears ?) and I need to stop everything and wipe away the tears. This occurs >90% of the time when I eat piping hot or spicy food. I have to abstain from chilli so as not to induce this pain.
What could be the reason and what should I do about it?
Thanks in advance.
Don
Answered by Dr Daphne Han Consultant Cataract and Comprehensive Ophthalmology Service Singapore National Eye Centre
Q1. Macular degeneration in highly short-sighted patients in their forties are more likely due to thinning of the retina at the central “macula” region. This often stays stable as the eyeball is no longer growing any larger at this age. However, if there are any new blood vessels, which can occasionally grow in this area, they can bleed or cause scarring and lead to further reduction of central and near vision. It is advisable to have a dilated eye check regularly, e.g. once a year to monitor the problem.
Q2. Eating hot and spicy food often causes a reflex lacrimation (tearing) due to stimulation of the autonomic nerves supplying the tear glands. This is a normal reflex. However. If your eyes feel painful when you tear, if may be due to perhaps pre-existing dry eyes or even some inflammation of the sebaceous (meibomian) glands of the eyelids. You may need regular artificial tear supplements and cleansing of the eyelids, especially at the level of the lid margin, where the meibomian glands are. Seek medical attention if on doubt.
Question byjaney
I'm in my late forties and recently someone told me that I should have my eyes checked, just in case. Is this really necessary if I have no symptoms of any eye problems, no diabetes, or high blood pressure?
Can you tell me: what would such an eye check entail and what should I ask for? How often should one go for such an eye check, or if it is 'all systems clear' then no more need unless any problem crops up?
Thanks for your time.
Answered byDr Daphne Han Consultant Cataract and Comprehensive Ophthalmology Service Singapore National Eye Centre
At forty-plus years old, most eyes are still pretty healthy. However, several eye diseases may strike even at this age. For instance, it is important to have an eye check especially if there is a family history of glaucoma, an eye disease that may cause blindness if untreated. Ask for a screening eye test at which at least your eye pressure (intra-ocular pressure) and a fundoscopy (with or without dilation) are checked.
If all is well, you could take advantage of some of the free eye screenings that various eye clinics provide for a routine check-up every 3 years or so.
Question bymelvintan407
Dear Dr Han,
Is it possible for one in his mid 40's to have mild cataract ? If yes, what can one do and how to delay the cataract problem and is there any solutions to correct the cataract ? Otherwise, what should one observe during this period. Many Thanks. Plsd to hear from you.
Answered byDr Daphne Han Consultant Cataract and Comprehensive Ophthalmology Service Singapore National Eye Centre
It is indeed possible to have mild cataract even in the mid forties, especially if there is a history of eye trauma, pre-existing diseases such as diabetes or steroid ingestion. Highly myopic patients may also present with mild cataracts at this age. Early cataract may give rise to increasing short-sightedness due to a change in the refractive index of the lens in the eye.
This is a condition we call index myopia. Hence changing glasses may help to improve vision. There is no proven medical treatment for cataract so far. Protecting the eyes from UV light by wearing sunglasses, not smoking and having a balanced diet rich in anti-oxidants will certainly do no harm, but the only definitive treatment for cataract is still surgery, when the vision is affected.
Question bylee
I am just hitting 50 and have been using daily disposable contact lenses for the past few years. For close reading, I can just about read with the lenses or have to take off my glasses for clarity.
I have heard about the latest KAMRA lens for far-sightedness. My question is: Can someone like me do that surgery when I already have myopia, astigmatism and now problem reading anything too close. How safe is the procedure and what are the risks involved?
I don't want to end up with sub-optimal eyesight and end up seeing 'slightly blur' for everything the rest of my life...
Look forward to your objective advise so I can evaluate my best options. Thanks
Answered by Dr Daphne Han Consultant Cataract and Comprehensive Ophthalmology Service Singapore National Eye Centre
KAMRA is not suitable for those who are short-sighted. There are other options for management of presbyopia in a short-sighted person. One of it is a strategy called mono vision, where you undercorrect you non-dominant eye by about 100 degrees by adjusting the power of your contact lenses, for near vision. This eye will then be slightly blurred for far but good for reading.
You could try asking your optometrist regarding this the next time you get your daily disposable contact lenses. There is no surgical risk involved by doing this.
Question by nctptp
Dear DR,
Although my eye symtom may not be related to the above eye diseases,may i ask u about my eye problems!
I have been suffering fasiculation in left upper eyelid (sometimes almost whole day,on and off during these days) since 3 weeks ago. I think i have no lack of sleep and much stress, i am worrying that may lead to drooping eyelid later if this symtom continue.
Please suggest me what should i do for now.
Thanks and best regards.
Phoo
Answered byDr Daphne Han Consultant Cataract and Comprehensive Ophthalmology Service Singapore National Eye Centre
Unilateral eyelid twitching is a common problem, and can be associated with heightened psychological stress or excess caffeine intake. Sometimes, local eye irritation such as dryness, inflammation of the eyelids or eye allergy can contribute to it too.
Try to rest and reduce stress, reduce caffeine intake and see an eye practitioner to check for any local eye problems. The twitching will stop eventually in 9 out of 10 cases. If the eye twitching persists for weeks or months despite these measures, your eye doctor may consider a brain scan looking at causes for facial nerve irritation.
Question byeldercat_17
Hi Doc,
I am 63 years of age, female. So far I have had no problems with my eyes and have not seen any eye doctor. My questions is: Do I need to go for a check up for Glaucoma or any other eye diseases?
Thanks,
Pam
Answered by Dr Daphne Han Consultant Cataract and Comprehensive Ophthalmology Service Singapore National Eye Centre
It is prudent at this age to go for an eye screening in particular for glaucoma and age-related macular degeneration as these are conditions that become more prevalent with age and may possibly lead to irreversible visual loss. It is usually better to treat diseases early rather than late.
Question by hengsp
Hi, Dr Han,
My mother was diagnosed with Normal Tension Glaucoma recently. I would like to enquire if there is any food that will help to prevent the condition from deteriorating? She sleeps less than 5 hrs a hours at night, does that cause the condition to deteriorate?
Thanks,
Soong Phiau
Answered by
Dr Daphne Han Consultant Cataract and Comprehensive Ophthalmology Service Singapore National Eye Centre
No formal studies have found significant benefit for any food therapy in NTG (Normal Tension Glaucoma), but anecdotal evidence is that ginko biloba may help improve blood supply to the optic nerve head, where glaucoma damage occurs. There should be no harm taking it as a health supplement, if there are no contraindications.
There are also some reports of reduced night time blood flow to the optic nerves due to a night time dose of antihypertensive medication (meds for high blood pressure), causing worsening of NTG. If your Mom takes any such medications, you may want to speak to her physician to change them to a day time dosage. Also problems such as snoring when asleep and being in a head down position (e.g. prolonged headstands in the yoga practitioners) were anecdotally implicated, but no harm stopping these.
If your Mom is on treatment for her NTG, the most important thing is to be compliant with her antiglaucoma eyedrops. Please also comply with regular follow-ups by her eye doctor, to monitor her condition.
Question by rachel
I went for an eye check at the optician today, to review my contact lens suitability. As I am already in my mid 40s, the guy told me I had presbyopia of +125 degrees (both eyes). So, he suggested the option of mono-vision contact lenses, where one eye would be for distance viewing, and the other eye would be more for reading.
I tried it and, whilst I could see far and read near, it was not very sharp either way. So, I opted for normal style lenses instead, and to make a pair of reading glasses.
Q: Is this the best / optimal solution? Would mono-vision lenses have been just as good, - and just a matter of 'getting used to it' - or would it negatively affect my eyes in the mid term ( make them worse than they already are)? Any other potential side -effects like headaches, etc?
I would have liked the 'no-spectacles' option if its safe and just as good.
Would the same apply for a lasik mono-vision correction as I have read somewhere?
The guy also did a test to check my 'dominant' eye. To my surprise, it was really true! An object appears moved when my left eye was closed, but not moved when my right eye was closed. ( So, left eye is dominant). Can you explain the science behind this ?
Thanks much
Answered by Dr Daphne Han Consultant Cataract and Comprehensive Ophthalmology Service Singapore National Eye Centre
Monovision for contact lens use in management of myopia is a fairly well-studied strategy in ophthalmology. Ocular or eye dominance arises from the fact that humans have 2 eyes of which one i.e. the dominant eye “takes the lead”. It is conventional to assign the dominant eye for seeing far in monovision, but some studies suggest that it does not matter even if the non-dominant eye is assigned for distance vision, in “crossed monovision”.
A study in 1927 found that 40% of patients have right ocular dominance, 20% left while 40% uncertain. Some studies suggest that people with very strong ocular dominance may not be great candidates for monovision as they are not able to suppress the blurred image (such as the image in your right eye when your left is seeing far).
Personally I think monovision does take a bit of getting used to. A difference of about 125 degrees is fine, and should not cause a huge impact on your stereopsis (binocular vision for depth perception). Higher degrees of difference between the 2 eyes may cause problems for activities that require depth/distance judgement, e.g. going downtairs, and even headaches. If you find it more comfortable being fully corrected by contacts for far while wearing glasses for near, that is perfectly fine. If you are motivated, there is no harm trying monovision with contact lenses again. If you can tolerate monovision with your contacts, you can certainly consider having monovision LASIK, if the usual criteria for LASIK suitability are fulfilled.
Ref: U11
