Caregiver Guide: Vision Problems

Understanding the Problem

Growing older does not always lead to poor vision. However, age can bring about changes that might affect both the eyes and vision. For example, some typical vision problems affecting older people include difficulty seeing well in dim light.  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. And they can also lose the ability to see close objects or to read small print without help from bifocals or reading glasses.

Many things can be done to help with these vision problems.
Better lighting can be very helpful.  As well as using reading glasses, bifocals, or a magnifying glass.  Holding reading material where the bifocal lens focuses on the page is extremely important.
More serious eye conditions or diseases might need to be treated with eye drops or medicines.  Some of the most serious problems could require surgery. A good preventive measure is a yearly checkup by an eye doctor to tell if a vision problem is correctable by prescription glasses, or if the problem needs further help.

Eye diseases in older adults


The lens of the eye is transparent at birth and when people are younger. Cataracts occur when the lens becomes cloudy and keeps light from easily passing through the lens. This causes a decrease in vision.  Cataracts are more likely as people get older.

Removing the lens of the eye and replacing it with a clear plastic lens implant is a safe and effective operation.  It 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 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 their remaining useful vision. Laser surgery might help in some cases and new research suggests that taking certain vitamins and minerals might help prevent developing more advanced disease.

There are many low-vision aids available which can be helpful, that can be suggested during a low-vision evaluation. Consult a local medical or optometry school, or other organizations that help the visually impaired.

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 the older person to go completely blind. People with macular degeneration have to train themselves to use their remaining peripheral vision.


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 importantly, 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.

Diabetic retinopathy

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. Some eye clinics can do home visits.
  • 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, such as hallucinations, are usually related to an overdose of medicine.
  • Make the house brighter and objects more visible and remove obstacles that could cause accidents. Electrical cords, shag carpets, and knick-knacks on the floor should be removed or arranged so as they do not get in the way of walking.

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Last Updated July 2015

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