How to protect your vision as you age

Our eyes provide us with a window on the world, but that window gets a little foggy and fragile as we age. Close-up vision blurs and cataracts lie ahead for many. Tear ducts function less well, and eyes can get dry and inflamed.

Worse, glaucoma and macular degeneration can pose serious threats to vision, making reading difficult and jeopardizing independent living. Blindness is among the public's top health fears, according to the National Association for Eye and Vision Research, an advocacy organization, consistently up there with cancer and paralysis in polls of health concerns, according to the American Foundation for the Blind, another advocacy group.

As baby boomers age, more people will be confronted with vision problems. Among Americans older than 40, there are an estimated 41 million cases of blindness, low vision or age-related eye disease, according to the patient advocacy organization Prevent Blindness, which predicts that this number will grow to 64 million by 2032.

So what can you do to keep your eyes working? While there's no way to prevent presbyopia - the fuzzy close-up vision that requires reading glasses - doctors say you can do a few things to lower your risk for - or at least slow the progression of - other age-related problems.

By the time they're 80, more than half of all Americans have had cataracts, according to the American Academy of Ophthalmology. "It's a normal part of the aging process, like getting gray hair," says Melanie Buttross, an ophthalmologist with Eye Associates of Washington. As time passes, the eye's lens becomes more opaque and dense, eventually causing blurry vision. This condition is called a cataract.

Just as some people go gray early, some get cataracts early. Daniel Pluznik, an ophthalmologist with Eye Physicians of Washington, says he has "a fair number of patients in their 40s" with cataracts. "The more nearsighted you are, the younger you tend to develop them," he explains. The risk doesn't appear to run in families.

At first the blur can be counteracted with changes in prescription, but if it interferes with daily activities, doctors may recommend surgery - a generally safe, extremely common procedure that often takes less than a half-hour. The surgeon removes the cataract, then inserts a clear artificial lens. The lens can be customized to correct vision. Afterward many patients see better than they have in years.

"I have such good vision now," says Christine Lynn, 74, a psychotherapist in Washington who had been seriously myopic since childhood. After she started to have trouble driving at night, she had cataract surgery in each eye, about two weeks apart. (Insurance usually covers cataract surgery.) That was about two months ago. Lynn says her post-surgical sight is such a dramatic improvement it's actually a little jarring. "I've never seen my face without glasses. Now I see every pore. It's crazy."

Would that there were such a happy-ending fix for glaucoma, a condition involving damage to the optic nerve, whose early stages can be detected only through an eye exam. It is diagnosed by evaluating the optic nerve and measuring the pressure of the fluid in the eye; high pressure can harm the optic nerve.

Prevent Blindness estimates that more than 2.7 million Americans age 40 and older have glaucoma. Most at risk are African-Americans, Mexican-Americans, smokers, diabetics and people who are severely nearsighted or have a family history of glaucoma.

There is no way to prevent glaucoma - or to restore the vision loss it causes - but its progression can be halted with early intervention. That requires regular eye exams. The American Academy of Ophthalmology recommends that adults without the risk factors mentioned above have a baseline exam at age 40, then evaluations every two to four years until 55. From that point on, they should be checked every one to three years, and one to two years once they're 65. Those at risk for glaucoma and other eye diseases should be seen more frequently.

Ignore the guidelines at your peril. "Unfortunately about once a year I have a patient who walks in the door and has lost significant vision, and has no idea he or she has glaucoma," Pluznik says. Since it's irreversible, he adds, "the whole idea is to pick it up early so we can treat it."

And treatment can be extremely effective. Daily eye drops help lower the pressure in the eye, though sometimes ophthalmologists will use lasers or surgery. Once your pressure is stabilized, you should have your eyes checked every four to six months, Buttross says; "otherwise, if the pressure creeps up, you won't know it."

Age-related macular degeneration (AMD) is a disease where the cells in the central part of the retina - the part most important for central vision, called the macula - deteriorate. Though eyesight can be preserved when the disease is caught at an early stage, the Centers for Disease Control and Prevention calls it "the leading cause of permanent impairment of reading and fine or close-up vision among people aged 65 years and older," and says 1.8 million Americans older than 40 have the condition and another 7.3 million are at risk of developing it. Unlike glaucoma, AMD, which runs in families, is a greater risk for whites than for African-Americans.

There are two kinds of AMD, dry and wet. More common is the dry, which can cause loss of central vision - essential for reading and driving - but so gradually that many people have it for decades with no obvious effect. Wet, or neovascular, is more dangerous. Abnormal blood vessels grow into the retina, in some cases leading to bleeding or leaking of fluid. Wet AMD is frightening, Pluznik says, because it may alter vision suddenly: "Patients can wake up one day and just see a central black spot."

Don Albrecht, 85, of Great Falls, Va., was recently diagnosed with dry AMD in his left eye and wet AMD in his right eye. The warning sign came last fall, when he was watching a baseball game on TV and couldn't see certain details on the players' uniforms. He became alarmed and eventually was referred to a retina specialist, who treated his wet AMD with injections that eliminated the intruding blood vessels, a relatively new procedure. "If it had been 10 years ago," he says, "I may have lost my sight."

The National Eye Institute's Age-Related Eye Disease Study (AREDS) found that people with AMD who take certain vitamins and minerals can slow the disease's progression. Those antioxidants include vitamins A and E, beta carotene, lutein, zinc and copper; they are sold over-the-counter in pill form as the AREDS formula. The researchers recently altered the mix by adding lutein and zeaxanthine and eliminating beta carotene. Called AREDS2, this formula is what ophthalmologists often suggest now.

Because these treatments can cause side effects, Buttross recommends checking with a doctor before taking them.

Along with the AREDS2 pills, ophthalmologists suggest a low-fat diet that includes fruits and vegetables, especially leafy greens such as spinach, kale and collard greens, and eating omega-3 fatty acids, which are found in salmon and tuna.

Albrecht says he eats lots of salad and takes AREDS2 supplements. "I feel very lucky," he adds. "I have an eye problem, but it's under control."

Tips to help keep your vision

• Be alert to the early signs of vision problems.

• Protect eyes from ultraviolet light with sunglasses. (Make sure yours offer full UV protection.)

• Get regular comprehensive eye exams.

• Don't smoke.

• Keep weight normal to avoid diabetes.

• Control your blood pressure.

• Eat a diet rich in dark leafy greens and omega-3 fatty acids (found in foods such as salmon, flaxseed and walnuts).