Detecting Vision Problems That Can Be Hard to See

By Dr. Thomas LaGrelius

When I was 40, I had 20/15 fighter pilot vision, near, far and in between. Today, I wear progressive lenses to correct presbyopia, hyperopia (far-sightedness) and astigmatism, but with those amazing glasses I still have 20/15 vision, everywhere. Vision is precious. Thank you Dr. Al.

There are some vision changes everyone gets with age. Slower darkness adaptation and visual floaters are a couple. Another is “presbyopia” causing most of us to need reading glasses by about age fifty. The lens of the young eye is very flexible and elastic, like clear, soft rubber.

Tiny “Ciliary” muscles attached to that lens can contract and make it “rounds up” like a ball. That bends the light, like a magnifying glass, but as we age the lens gets stiff, like clear, hard plastic. When the older ciliary muscle contracts the lens no longer “rounds up”, so we need an external magnifying lens to see sharp up close. Reading glasses. You can buy them at any drug store for a few dollars. Most of us call them “cheaters”, but prescription reading glasses will often give you MUCH better vision.

Unless you are severely “myopic” (near-sighted) to begin with, everyone eventually needs reading glasses. That happened to me in my 40s, a bit early, because I have the opposite of myopia. I have “hyperopia” (far-sightedness). Many people, like me, with really good distant vision in youth are actually “hyperopic.” Later, they discover this and need complex lenses to see well, and are annoyed because their vision was once near perfect.

By age 55, I was an eyeglass dependent, visually frustrated X-fighter pilot. These changes were expected and inevitable, but I had not expected astigmatism. The cornea eye surface gets a little misshapen, and points of light like the stars in the sky begin to look like short lines. If you have astigmatism you are usually born with it, but it can come later. It does not happen to every senior, just us “lucky” ones.

Macular Degeneration
An all-too common cause of vision loss with age is “macular degeneration.” The small central area of the retina that sees fine detail degenerates and the patient gradually loses critical central vision. Good health habits and perhaps leutine and zeozanthine supplements can cut the risk. Smoking, alcohol use, poor diet, overweight, high blood sugar, high insulin levels and deficiency in some anti-oxidants can increase the risk. Again, vision is precious. Control those risks and get regular eye exams. Macular degeneration is partially preventable and some forms are treatable.

Glaucoma is not simply high eyeball pressure, though most of us think so. It can damage the retina and cause severe vision loss in a short time. It takes as little as three years if severe. Peripheral vision goes first, unlike in macular degeneration, where it is preserved and central vision is lost. The only way to know you have early glaucoma is to have your eye pressure tested AND inspect the retina. Make sure a qualified person does it every year or two. Glaucoma is usually easy to treat and thus prevent vision loss.

Half of seniors have symptomatic cataracts by age 80. Live long enough and you will almost certainly get them. A cataract is a cloudy lens you cannot see well through, like a shade pulled over the eye. Vision slowly dims, bright colors fade to yellow pastel, night vision becomes difficult, bright lights cause glare and halos form around them. Thankfully cataracts are curable with surgery. We remove the lens and put in an artificial one.

There are lots of different lenses that can be implanted. The fancy ones are quite expensive. These special lenses can give you fairly good vision at all distances, but often not perfect vision at any distance. Bad choice for fighter pilots. The simple lenses work best, but you will have to wear glasses too because they are “fixed focus.” I recommend the simple ones and glasses for the distances the implanted lens does not correct. By the way, myopia, hyperopia and astigmatism can all be corrected with a lens implant, if done just right.

Case history:
Over the years, a senior South Bay woman slowly developed cataracts. Eventually they interfered with driving, so she chose surgery. The surgery went perfectly, but when she came back to see her surgeon she was uncharacteristically angry. She told him, “You ruined the colors!”

He looked confused.

She said, “All my life I have loved soft colors and pastels. I have never liked bright colors at all. Now all my furniture, my cloths, my car and everything I own are bright red, bright blue, bright green. It’s hideous! I’ll have to replace everything I own. You ruined the colors!”

The eye surgeon smiled and explained that over the decades as her cataracts had worsened the colors she once saw faded away. As this happened very gradually, she bought brighter things so they would look to her clouded eye the same as they had when her lenses were clear. Then when her yellow shades were removed, all those cloths and furniture suddenly looked the way they actually were, bright and brilliantly colored.

She frowned. She was not buying any of that explanation. She angrily walked out and never came back.

I guess she either learned to like bright colors, or replaced everything she owned. Her anger was the most unexpected complication of cataract surgery we ever saw, but at least she could see to drive her bright vermilion car home and clearly see her hideous belongings.

Live long, be well. (And get your eyes checked.)

Dr. LaGrelius has been a board-certified specialist in family medicine since 1977 and geriatric medicine since 1990. He completed his most recent family medicine board recertification in 2014 and his geriatrics recertification in 2010. Dr. LaGrelius graduated from the University of Washington Medical School in Seattle, serving his internship and residency at the University of Southern California Medical Center. He is a staff member at two hospitals: Torrance Memorial Medical Center, where he served for six terms as chairman of the Department of Family Practice, and on courtesy staff at Little Company of Mary Torrance Hospital.

He is the founder and president of Skypark Preferred Family Care, a concierge primary care/geriatrics practice based in Torrance.

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