Our eyesight ages just like the rest of our body. Over time, our vision may deteriorate and we may need glasses to see clearly. In addition, serious eye diseases can develop and threaten our sight. Professor Robert Rejdak explains why regular ophthalmological examinations after the age of 40 are so important.
Anna Piątkowska-Borek, WP abcZdrowie: People who have turned 40 often say that their eyesight suddenly begins to deteriorate.
Professor Robert Rejdak, MD, PhD, ophthalmologist, President of SCOP and Head of the Department and Clinic of General and Paediatric Ophthalmology at the Medical University of Lublin: There is a general rule in ophthalmology that once a person reaches the age of 40, everyone should undergo a routine ophthalmological examination because of the risk of various age-related diseases. As ophthalmologists, we encourage all patients to have these examinations and emphasise their importance. We also remind general practitioners that people over 40 should be referred for routine eye examinations.
Why is the age of 40 such an important threshold?
After the age of 40, the early stages of glaucoma may begin to appear. Glaucoma is a silent thief of sight that causes slowly progressive damage to visual function. This manifests itself in characteristic changes in the visual field as well as morphological changes in the optic nerve head. Elevated intraocular pressure is, of course, an important predisposing factor.
Some people are predisposed to glaucoma simply because of the anatomical structure of their eye, which causes intraocular pressure to increase. As they age, they may develop glaucoma. An ophthalmologist can identify the early stages of the disease if a patient comes for an examination after the age of 40.
But glaucoma is probably not the only threat after 40?
Another disease that may begin to manifest itself after the age of 40 is cataract, which is a clouding of the lens. Most commonly, this change is idiopathic, meaning that it is age-related, but lens clouding can also be accelerated by conditions such as diabetes.
It is important to emphasise that diabetes has a destructive effect on eyesight. It can also lead to diabetic retinopathy or diabetic macular oedema. We should therefore remember the close relationship between diabetes and eye diseases.Ageing can also lead to diseases of the macula. The most serious of these is age-related macular degeneration, affecting the central part of the retina, commonly referred to as AMD.
It can occur in two forms: dry, or atrophic, and wet, or exudative. Dry AMD, which accounts for the vast majority of cases, is characterised by slow progression and gradual deterioration of vision, sometimes over several years. It damages central vision but progresses much more slowly than wet AMD, which can have a very severe and rapidly progressing course. The exudative form is particularly dangerous because, if left untreated, it can cause significant damage to central vision within a short period of time.
Fortunately, effective treatment is available. This involves intravitreal injections of anti-VEGF agents. The medication is administered directly into the eye and is intended to inhibit the development of abnormal blood vessels. In Poland, we have a dedicated drug programme for the treatment of the exudative form of age-related macular degeneration.
Along with the diseases you have mentioned, another characteristic sign of ageing is holding a book or phone farther and farther away in order to “bring it into focus.”
The fundamental age-related change is what we call presbyopia, which is the gradual loss of the ability to see clearly at close range. After the age of 40, we all begin to need reading glasses. This is part of human physiology and is associated with the gradual weakening and loss of accommodation. As a result, with each year after 40, we tend to need more plus power for near vision and reading.
Of course, depending on the refractive status of the eye, presbyopia may develop differently in different people. Ultimately, presbyopia most commonly reaches around +2.5 dioptres. At that point, people who previously did not need glasses usually begin to require them for reading.
Can myopia also develop after the age of 40?
Myopia usually progresses during adolescence. The first wave often occurs when children start school, and it may continue to worsen after the age of 20. This is what we refer to as juvenile-onset myopia. However, myopia that develops later in life may already be associated with the early stages of cataract. As the lens becomes harder and more opaque, vision deteriorates. Depending on the degree of lens opacity, this refractive error can be corrected surgically.
Can hyperopia also be corrected surgically?
We should remember that there is a whole range of refractive surgery procedures that can correct refractive errors such as myopia, hyperopia and astigmatism. Young people undergo these procedures to become independent of glasses. At an older age, however, we usually wait until the first signs of cataract appear and then correct refractive errors as part of lens surgery.
Dry eye syndrome also often becomes more severe with age. How can it be treated?
There are many causes of dry eye and ocular surface disease in general. When we diagnose the condition and identify impaired tear production, the patient needs treatment aimed at moisturising and lubricating the surface of the eye.
There are many different preparations available for this purpose, commonly known as artificial tears, which can provide relief. We can also use silicone punctal plugs to prevent tears from draining away from the surface of the eye. In this way, we block tear drainage through the lacrimal system.
A third, more radical method of treating dry eye is cauterisation of the lacrimal drainage system. This is a surgical procedure involving permanent closure of the lacrimal puncta, thereby reducing tear drainage. Of course, dry eye syndrome may sometimes be associated with autoimmune diseases. In such cases, we treat the underlying disease responsible for reduced tear production.
That makes me think that the older a person gets, the less they cry. Is that taking the conclusion too far?
You could put it that way, although it should of course be emphasised that this is related to the occurrence of dry eye syndrome.
Listening to you, I am beginning to worry that you have not yet exhausted the list of ophthalmological problems affecting people in their forties.
Unfortunately, I have not. The truth is that various age-related disorders become more common over time, including laxity of the protective structures surrounding the eye and of the eyelids. Initially, these are mainly aesthetic problems, but over time they may become medical problems that interfere with vision. We may see increasing drooping of the eyelids, outward or inward turning of the eyelids, as well as wrinkles and folds around the eyes. At this stage, these changes can be treated surgically, and many patients undergo oculoplastic procedures, which combine elements of plastic surgery and ophthalmology.
Finally, let us summarise. What should we do to keep our eyes healthy for as long as possible? How can we delay the ageing of our eyesight?
We certainly need to start with maintaining good overall health, which means treating systemic and lifestyle-related diseases such as diabetes and hypertension. This is the first step and an absolute foundation. It is also important to detect autoimmune diseases at an early stage and treat them appropriately. Different diseases affect the eyes in different ways.
Another essential measure is regular eye examinations, which after the age of 40 should become a permanent item in our calendar. These examinations allow us to detect diseases at a very early stage and begin effective treatment. We must remember that this is a race against time—the earlier we start treatment, the greater the chances of success.
In addition, eye injuries can occur at any age. They may happen while carrying out various jobs around the home, such as sawing or grinding materials including wood and metal, mowing the lawn or pruning branches. We strongly encourage people always to wear protective eyewear while performing such tasks. This is the best way to prevent injuries and, consequently, serious vision problems. As a surgeon, I treat many patients with eye injuries that could have been avoided.
Interview by Anna Piątkowska-Borek, WP abcZdrowie
The content is intended for informational and educational purposes and does not replace medical consultation. Before making decisions concerning your health, consult an appropriate healthcare professional.
Published as part of the “Science Without Borders” series.
