Eldercare at Home: Vision Problems
Caregiving How Tos
Understanding the Problem
Growing older does not always lead to poor vision. However, age can bring about changes that might affect the eyes and vision. For example, some typical vision problems affecting older people include difficulty seeing well in dim light and/or difficulty seeing when going from bright light to dark and vice-versa. Some older adults become more sensitive to glare and bright lights. They also can have difficulty distinguishing colors, seeing close objects or reading small print. Many things can be done to help with these vision problems. Using reading glasses or bifocals, a magnifying glass, and better lighting can be very helpful, and holding reading material where the bifocal lens focuses on the page is extremely important.
More serious eye conditions or diseases may be treated with eye drops or medicines, while some of the most serious problems require surgery. A good preventive measure is a yearly checkup by an eye doctor (description follows) to determine if a vision problem is correctable by prescription glasses, or if the problem needs further workup.
Eye Diseases in Older Adults
Cataracts occur when the lens of the eye, which is transparent at birth and in younger years, becomes cloudy. The development of cataracts reduces the amount of light passing through the lens. This causes a decrease in vision. Removing the lens of the eye and replacing it with a clear plastic lens implant is a safe and effective operation that can be done as an outpatient procedure. Normal activities can be resumed as early as the day following the procedure. There is an immediate and dramatic improvement in vision, even though the eye takes about a month to heal completely. The procedure can be performed on almost anyone regardless of physical and mental status or age and the basic costs of lenses is covered by Medicare and most insurance plans.
Age-Related Macular Degeneration
People with this condition have trouble seeing with their central, or straight-ahead, vision. This happens when the macula, a very small part of the inside of the eye, degenerates. The macula is responsible for seeing fine details in the center of the field of vision. The straight-ahead vision becomes distorted or missing.
Once the vision loss has stabilized, the older person should see a low vision specialist to help maximize the use of his or her remaining useful vision. Laser surgery might help in some cases of macular degeneration.
There are many low-vision aids available which can be beneficial. Consult a local medical or optometry school, or other organizations that help the visually impaired for a low vision evaluation. It is important to remember that macular degeneration affects only the macula and, therefore, only central, straight-ahead vision. This is important to know because the rest of the back of the eye still functions. Macular degeneration will not cause one to go completely blind. People with macular degeneration have to train themselves to use their remaining peripheral vision. There are many aids on the market for people with macular degeneration, such as:
- Magnifying lenses.
- Video enlargement systems.
- Computer display and enlargement systems.
- Large-print items.
- Special papers and writing aids.
- Adaptive appliances.
- Speech software for computer systems
Chronic glaucoma is a disease in which vision is slowly lost because the pressure of the fluid inside the eye becomes too high for that person's eye. This pressure damages the optic nerve, which is like a "telephone wire" that sends information from the back of the eye to the brain. The high pressure of glaucoma can lead to blindness. In the beginning, peripheral vision is lost, with all vision eventually being lost.
The usual treatment is taking medicine eye drops on a regular basis for the rest of the person's life. Surgery is also sometimes performed, but initial treatment is customarily by medicines. Once vision is lost, it cannot be restored. The treatment goal is to prevent further vision loss.
Glaucoma may be hereditary. It is more common among Latinos, African-Americans, people who have had previous eye injuries, and people with diabetes. Early detection is important.
Acute glaucoma is rare, but important, because it can be effectively treated. In this condition pressure in the eye rises suddenly, and is accompanied by redness and pain in the eye, severe headache, nausea, vomiting, blurring of vision, and seeing halos around lights. This is an emergency and needs immediate attention by an eye doctor.
Diabetes is the leading cause of blindness in this country. Diabetes can cause the blood vessels in the back of an eye to leak or get plugged up, resulting in blindness. Regular visits to the eye doctor and monitoring blood sugar will help prevent this treatable condition.
A recent study has shown that better blood sugar control may help prevent or slow the onset of diabetic eye problems and decrease the need for laser treatments. Laser treatment and other types of surgery can improve vision and prevent further vision loss.
Your goals are to:
- Schedule yearly visits to the eye specialist.
- Have the older person's medicines checked regularly for side effects on vision. The most common problem reported is dry and irritated eyes. Severe side effects are usually related to an overdose of medicine.
- Make the house brighter and objects more visible. Electrical cords, shag carpets, and knick-knacks on the floor should be removed or arranged so as they do not hinder walking.
Call the doctor or nurse immediately or go to the emergency room if any of the following symptoms occur.
- Pain in the eye
Pain is a symptom of a possible significant problem, such as infection, severely dry eyes, corneal abrasion, increased eye pressure, and other potentially sight-threatening problems. In acute glaucoma, pain in the eye can be accompanied by headache, nausea, vomiting, or seeing halos around lights.
- Sudden loss of sight
Sudden lost of sight could indicate a hemorrhage inside the eye, retinal detachment, stroke, or other significant problems. A complaint of loss of sight should always be taken seriously.
- Loss of peripheral or side vision
This could be the result of a stroke or other neurological condition.
- An eye that appears suddenly to be crossed or turned out
This may also be the result of a stroke or other neurological problem and may be accompanied by double vision.
- Sudden and acute redness of the eyes with a discharge
The discharge may be either yellow and "goopy" or very watery. This may mean that there is an eye infection.
- The person sees flashes of light or streaks of lightning in his/her vision
This could be a sign that a retinal detachment is developing. This might be accompanied by a sudden increase in the number of "floaters" being seen. (Floaters are normal with aging, and can be more noticeable outdoors and in well-lit rooms. They are the result of aging of the vitreous-jelly-like substance-within the eye.) However, a sudden increase in the number or appearance of floaters should always be taken seriously.
If any of the above signs or symptoms develops, an eye doctor should be consulted immediately. An eye doctor is either an ophthalmologist or an optometrist. An ophthalmologist is a medical doctor (MD) trained as a specialist in the refractive, medical, and surgical care of the eyes and related structures. An optometrist (OD) is trained in the refractive and medical care of the eyes and related structures. Either an ophthalmologist or an optometrist can treat medical conditions of the eye, prescribe eye medicines, glasses, and contact lenses.
Call the doctor or nurse during office hours to discuss the following problems:
- Symptoms that come on gradually, such as blurry vision or itching, reddened, irritated or aching eyes
These symptoms should be reported to the patient's primary care doctor, or can be treated in conjunction with a yearly or routine eye examination. Visiting the eye doctor yearly can result in early detection and prevention of more severe eye conditions.
- Increased sensitivity to glare or bright light, or worsening blurry vision
These might be symptoms of cataract formation or simply the need for an updated prescription for glasses. Cataract formation is a gradual process as is the associated vision loss.
- Redness, itching, burning, or minor discharge from one or both eyes
These may be signs of dry eyes or allergies. Severely dry eyes can become infected if left untreated.
- Eyelid changes
In older persons, the lower eyelids might begin to turn in or out. This can lead to severe irritation, redness, and infection. Occasionally upper lids can droop and obscure vision. Sudden one-sided lid droop should be investigated immediately.
Know the answers to the following questions before calling the doctor:
- What medicines is the person taking?
- Are there problems seeing objects up close or far away?
Is it with glasses on or off?
- Is vision blurry? Did it start suddenly and is it in one eye or both? Is it with glasses on or off?
- Is there a blind or fuzzy spot in the center of the vision?
- Is there extreme sensitivity to light or glare?
- Is there any pain in the eye?
- Does the person see double?
- Is there any leakage or discharge from the eye?
Here is an example of what you might say when calling for help:
"Hello, this is Joanne Paul. I'm calling because my father, John Paul, is squinting when he reads the newspaper. He's been holding it far away from him, too. After reading he has a little headache. He says his vision is fine otherwise. He seems to be able to see far away, like his television. I'd like to have his eyes checked. It's been two years now and he has had diabetes for seven years."
- Remove hazards that could cause tripping.
Make sure the floor is clear and free of clutter. Electrical cords should be routed along the wall. Low furniture (such as foot stools) should be placed away from areas where people usually walk.
- Add brighter lights around the house.
Place lights in stairways and reading areas. A reading light should come from above and behind the person. A 75-watt bulb placed about two feet away is usually good for reading, but experiment with different intensities and arrangements. Try fluorescent and halogen lights. Fluorescent light is bluish while halogen is a whiter light. Halogen bulbs give off 10% more light than incandescent.
- Have nightlights in the hallways, bedrooms, and bathrooms.
Installing motion-sensing lights that turn on automatically when someone walks into a room or hallway might help prevent injuries.
- Use reflector tape or outline stair edges with colored tape so steps are easier to see.
- Cut down on glare.
Minimize glare by avoiding waxed floors, covering shiny surfaces, and using sheer curtains over windows.
- Check that eyeglasses are being worn and are clean.
Make sure the eyeglasses are on when the older person is getting dressed in the morning.
- Check on whether medicines could cause eye problems.
Certain medicines have side effects that interfere with vision and make eyes irritated. Some medicines disturb vision. Check with your pharmacist or doctor about all of the medicines being taken, including over-the-counter medicines, herbal, and alternative therapies. They may be able to suggest other safer options.
- If eyes are dry, use artificial tears during the day and lubricating ointments at night.
Dry eyes burn and itch. If left untreated this can lead to more serious problems. Eyes that are moist are more comfortable and less likely to become infected. Purchase lubricating eye drops or artificial tears at your local drugstore. The preservative-free vials are best for sensitive eyes.
- Discourage the use of sunglasses indoors.
People who have cataracts sometimes use dark glasses indoors to lessen the glare caused by cataracts. However, people with cataracts need more light, not less. If indoor light is creating glare, adjust the light to minimize this problem. If the older person needs sunglasses for outdoor use, he or she should have 100% UV (ultraviolet) protection to reduce glare.
- Use low vision aids.
These include large-print calculators, magnifying glasses, and computers that speak. There are also large-print books, magazines, and newspapers available at your local library. The Complete Directory of Large-Print Books and Serials should be available in the reference section at your library.
- Use contrast to make things easier to see.
Contrast is the difference in color or tone between adjacent parts of objects. For example, black print on white paper is high in contrast which makes black print easier to see. In comparison, red print on gray paper would be low contrast. The difference between red and gray is small so the red print would be more difficult to see. Contrast can be used to help enhance remaining vision by making things easier to see. There are very simple things that can be changed in the home to make everyday activities easier and safer to do.
- Keep the home pattern-free
Patterns often make it difficult to see what is on them. Tablecloths, placemats, bedspreads, rugs, and other objects in the home often have designs that are pretty to look at, but it is hard to see what is on them. Keeping the home as pattern-free as possible makes it easier to see and find objects.
In the Kitchen
- Use two cutting boards: a dark one for cutting light colored foods like potatoes and onions and a light cutting board for cutting dark foods like carrots and green peppers.
- Use light serving bowls and plates for dark foods and dark serving bowls and plates for light colored foods.
- Use a light cup for pouring coffee or tea and a dark cup for milk.
- Use placemats and napkins that are a different color from the plates to make it easier to find the place setting.
- Use contrasting tape around pot handles to make them easier to locate.
- Place bold labels on the controls of appliances like microwaves and stoves.
In the Bathroom
- Drape contrasting towels over the edge of the tub to make it easier to see.
- A contrasting mat in the shower will increase safety and make it easier to see the bottom of the shower.
- Colored soaps are easier to see in a white tub or shower.
- A colored toothbrush or colored toothpaste can help in putting toothpaste on the toothbrush.
- Put items that are used often, like soaps and lotions, on contrasting surfaces or towels to make them easier to see.
- Use carpets of different colors to make an area easier to see.
- Drape contrasting fabric or towels over the backs of chairs so that they stand out and are more easily avoided.
- Installing dark colored switches and outlets on light colored walls may also be beneficial.
- Use writing tablets and paper with bold lines and black felt-tip markers for writing.
- Experiment with your ideas for increasing contrast in the home.
Problems You Might Have Carrying Out Your Plan
"Mom can see fine. She's just confused."
Vision problems can be one of the reasons for confusion. If the person you are caring for has cataracts, carrying out daily tasks might become difficult. This can lead to embarrassment and frustration that you might interpret as confusion. You need to persuade the older person to go to an eye doctor.
"Failing vision is a part of getting old."
The eye does change as a result of aging. But that doesn't mean vision should be poor. It is important to visit the eye doctor on a yearly basis to prevent poor vision and to detect early signs of eye disease.
"I've stopped reading because I want to save my vision."
Don't stop doing the things you enjoy. You don't or can't "use up" your vision. Keep reading, but use a good reading light (one that comes from behind or above and is not too bright).
"My father is 80 years old. He's too old for cataract surgery."
If it's appropriate, it is never too late to have cataract surgery. Cataract removal is a safe and simple procedure that can be performed on people of all ages. It does not require a hospital stay or specialized medical or nursing care.
Think of Other Problems You Might Have Carrying Out Your Plan
What other problems could get in the way of doing the things suggested in this section? For example, will the older person cooperate? Will other people help? How will you explain your needs to other people? Do you have the time and energy to carry out this plan?
Be alert for possible vision problems and take steps to prevent them. Be sure that the environment in which the older person lives is well lighted. Schedule regular appointments with both the primary care doctor and the eye doctor and be sure their recommendations are carried out. Make sure all medicines (prescription, non-prescription, herbal, and other remedies) are reviewed by a doctor at regular intervals.
What to Do If Your Plan Isn't Working
If vision problems seem to be getting worse and are of major concern to the older person, ask the doctor and/or nurse for help. Tell them what you have done and what the results have been.