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Sight problems in older people

A guide to common vision problems, related care challenges and where to find more support.

Beware

New eye problems can be a sign of a serious underlying health problem. You should seek urgent medical advice if you are concerned.

Common "potentially serious" problems include:

  • sudden loss of vision or sudden change in vision
  • a red and painful eye
  • a dark curtain or shadow moving across your vision
  • any sudden increase in flashes and/or floaters
  • coloured haloes around lights
  • eye symptoms accompanied by other symptoms such as a headache, nausea or vomiting

Regular eye checks

A lot of eye problems become more common as we get older and any impairment can have a major effect on our quality of life. However, regular check ups and getting the right help can make a difference.

The NHS recommends visiting an optician every 2 years (or more often if advised by your optometrist or eye specialist). Think of it as an “eye health” check to help spot important problems early, rather than just a test of your visual acuity. An eye test can pick up eye conditions such as glaucoma and cataracts as well as general health problems like diabetes and high blood pressure.

Certain groups are entitled to a free NHS sight test and this includes anyone aged over 60, or diagnosed with diabetes or glaucoma, registered as vision-impaired, or if you are aged 40 or over and have a first-degree relative (parent, sibling or child) with glaucoma.

The NHS has more details here.

If you have a disability or illness which makes it difficult for you to leave your house then you may be entitled to a mobile sight test, where an optometrist visits you at your home. This visit might also take place at a day centre or in your residential or care home. If you qualify for a free eye test, you won’t have to pay for a home eye examination either. Ask your usual optician first, as they will hold your previous records. If they can’t help, your local Clinical Commissioning Group (CCG) will keep a list of optometrists who offer this service. This NHS site will help you find the relevant contact details.

Common eye problems in later life

Reduction of close/reading vision due to normal age-related changes in the eye. By the mid-forties, even people who have never worn glasses may start to need them for reading. Inexpensive reading glasses can be bought in some supermarkets and pharmacies but it is still important to have a regular full eye test. Those who already need glasses for distance vision may find that bifocal or varifocal lenses are the solution so that only one pair is needed. The optometrist will advise you.

This is a clouding of the lens of the eye. The commonest type is due to increasing age and up to half of people over age 60 are affected to some degree. Symptoms may include less clear vision, dimming of colours and being dazzled by headlights. New glasses may help to start with but once symptoms are interfering with daily activities, surgery to replace the lens is usually recommended. This is a straightforward procedure and often done under local anaesthetic.

You might find this information from Moorfields NHS eye hospital useful.

Glaucoma refers to a group of conditions where the optic nerve at the back of the eye is damaged, usually by raised pressure inside the eyeball. It affects almost 10% of people over age 75. Glaucoma can lead to loss of peripheral vision (“tunnel vision”) and even to central vision loss if not detected and treated.

There are different causes but the type which is commonest in later life (“open-angle glaucoma”) develops gradually and there may be no symptoms in the early stages, meaning it is often picked up on a routine eye test. You are more at risk if you have a first-degree relative (parent/ sibling/child) with glaucoma, are of Afro-Caribbean ethnicity, are short-sighted, a diabetic or have taken steroids for a long period. Treatment will stop your vision from getting any worse and usually starts with daily eye drops to reduce the pressure. For most people, this is sufficient, but the drops have to be continued for life. Laser treatment or surgery is necessary in some cases.

In rare cases, there is a rapid-onset or acute form of glaucoma (“angle-closure glaucoma”) which is a medical emergency.

Acute glaucoma is a sudden rise in pressure in the eye when the drainage channels in the eye become blocked. Symptoms may include a red and intensely painful eye with blurred vision, a headache, nausea and vomiting. You may see rainbow-coloured rings around bright white lights. Some people feel generally unwell, have a hard, tender eyeball and the cornea may look hazy. Risk factors include smaller eyes, being long-sighted, female sex, Asian and Indian ethnicity and a family history of acute glaucoma.

Glaucoma UK has helpful information.

Flashes of light at the edge of your vision occur when the jelly or “vitreous humour” inside your eye shrinks and tugs on the light-sensitive retina at the back of your eye. An occasional flash may be harmless but new or increasing symptoms may be a warning sign that the retina is tearing and detaching from the back of the eye. This is called a “retinal detachment” and is a medical emergency which needs urgent medical attention.

Floaters appear as spots, threads or cobweb effects when you look at a plain surface or a bright sky and are caused by clumping together of fibres in the clear vitreous humour as it shrinks. Mild floaters, particularly if you have had them for a long time, they have been assessed by your optometrist and they are not changing, are usually harmless and don’t need any treatment. They may persist over time or gradually become less noticeable.

If you notice a sudden shower of new floaters, if floaters and flashes are getting worse or occurring together, if you see a black shadow or curtain effect moving across your vision or experience any sudden change in your vision or loss of vision, seek urgent advice. These can be signs of retinal detachment which can result in permanent sight loss. Urgent treatment to stick the retina back down gives you a better chance of a full recovery. There are several techniques used including laser or freezing (cryotherapy) treatment.

The Association of Optometrists has some helpful advice here.

This is the biggest cause of sight loss in the UK.

The macula is a special area of the central retina which allows you to see fine details clearly. AMD causes gradual loss of central vision (eg the ability to recognise faces and to read) but not blindness, as peripheral vision is preserved. Other symptoms include a distorted or blurred area of vision, less vivid colours or straight lines looking crooked or wavy. Sometimes there are no symptoms and it is picked up on a routine eye test.

About 75% of people have the milder form or “dry AMD”, often with near-normal vision. Less common is “wet AMD”, characterized by abnormal blood vessel formation around the macula which can lead to severe and permanent loss of central vision.
The cause is unknown but it has been linked to factors such as smoking, high blood pressure and having a family history of AMD.

Treatment is only needed for Wet AMD. You can find out more at The Macular Society website.

This is a complication of diabetes which can cause sight loss if left untreated. Please see our information about diabetes.

This is common over age 50. It is usually due to an inefficient lubricating tear film which evaporates too quickly, doesn’t coat the eye well and leaves the surface of the eye dry and irritated. The eye may have a gritty or burning sensation, you might have brief blurring of vision or mild increased sensitivity to light, and sometimes even leads to a watery eye, despite the eye itself being dry. Although uncomfortable, it doesn’t normally cause pain or poor vision. Many factors can make it worse such as central heating/air conditioning, staring at a computer screen, wearing contact lenses, smoking, drinking alcohol and some medications and underlying health conditions. If the eyelids become sore and red, this is called blepharitis.
There are lots of different artificial tear drops and gels which can be used, sometimes with a longer-lasting ointment for use at night. Some people can become sensitive to the preservatives in eye drops and may need a preservative-free preparation. This is advised if drops need to be used more than 4-6 times per day. Ask your optometrist or pharmacist for advice.

Guys and St Thomas hospital has this useful information leaflet.

Visual impairment - registration, aids and driving

Registration is voluntary but can simplify applications for various benefits or services.
There is a growing range of visualise aids which can make life easier
People with visual impairment may be excluded from driving.

Registration as visually-impaired is voluntary but can result in:
– A referral to a specialist low-vision clinic to help you to come to terms with your diagnosis and provide practical support including low-vision aids. (You don’t have to register as visually-impaired to get this service.)
– Social Services will offer you a needs assessment to identify any help you require at home to stay independent or help with mobility/ getting around. (This is also available without registration. Ask your optometrist for a Low Vision Leaflet or contact Social Services directly.)
– Access to a range of benefits. This depends on whether you are sight-impaired or severely sight-impaired but can include Attendance Allowance, Carer’s Allowance, Blue Badge Scheme, a reduction in TV license fee, Council Tax reduction etc.

If your vision has deteriorated to a certain level, you may be eligible to register as “sight-impaired” (previously referred to as “partially sighted”) or “severely sight-impaired” (previously “blind”). Your eye specialist or ophthalmologist will make this decision and complete the paperwork. Copies of the certification then go to you, to your GP and to your local social services department.

The RNIB has more advice about benefits and concessions.

To see clearly, your eyes need 3 times as much light at age 60 as when you were 20, so for all elderly people, make sure the house is well lit, especially around stairs and eliminate any trip-hazards such as loose or heavily-patterned carpets or rugs. Use bright bulbs, light-coloured lampshades and extra floor/table lamps to illuminate tasks. Maximise daylight by avoiding net curtains, tying back curtains and keeping windows clean.

Those with diagnosed visual impairment may benefit from a range of aids including
– Big-button telephones and remote controls
– Talking watches and clocks
– Big-button computer keyboards. Screen-reading software which converts computer text into speech.
– Magnifiers; hand-held, round-the-neck or free-standing, some with built-in lights. Video magnifiers use a camera to transfer text on to a built-in monitor or your own TV screen
– Binoculars and monoculars; small, light-weight telescopes
– Large print publications, e-readers, talking books/newspapers
– Walking aids such as long canes and GPS devices.

The RNIB has plenty more information

If you are diagnosed with a condition that affects your vision in both eyes (or the remaining eye if you have only one) , you have a legal duty to inform the DVLA or face a fine. This doesn’t include being short sighted or long-sighted. On registration as visually-impaired, the DVLA will assume your driving license is no longer valid and you won’t be able to drive. There are occasional exceptions if visual impairment is mild but your doctor will need to inform the DVLA on a special form.

This link will take you to the DVLA rules relating to eyesight and driving.

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October 2020

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