With age, all organs in the human body undergo involutions (reverse development). Age-related degenerative changes also occur in human eyeballs. As a result of this, an aging person gradually loses sight. Considering that with the help of an organ of vision a person receives more than 80% of information about the world around. It is quite natural that people who begin to see poorly, withdraw into themselves, become asocial.
With age, the diameter of the pupil decreases, the visual fields narrow, the contrast of color perception decreases, the surface of the eye becomes dry, the retina becomes thinner and atrophy. All these changes in eye structures inevitably affect the quality of a person’s vision.
The most frequent age-related changes in vision include cataracts, presbyopia, myopia, glaucoma, and various pathologies of the retina, most often of vascular etiology. Is it possible to prevent age-related vision loss and how to deal with the existing changes?
A cataract is a clouding of the lens of the eye. This is the most common age-related change in the structures of the eye. After 50 years, cataracts are found in every tenth patient, after 60 years - in every fifth, and after 75 years - in 90% of ophthalmic patients. It is impossible to avoid this pathology, especially if a person has burdened heredity.
For age-related cataracts, the appearance of lens opacification in its peripheral areas is characteristic, which in the initial stages of the disease does not affect visual acuity. Later, the number of foci of turbidity increases, they merge. Patients notice that they begin to see worse, there is a fog, a veil before their eyes. With further development, clouding affects the entire lens: the eye loses its ability to distinguish colors, see details on objects, read or examine small objects.
At the initial stages of development of senile cataract, conservative treatment is possible based on stopping the progression of pathology (eye drops, systemic vitamin complexes). However, this treatment does not solve the problem of turbidity. The only radical method of treatment of senile cataract is surgery - phacoemulsification with the implantation of an intraocular lens. This is an outpatient operation, consisting in the destruction of the contents of the lens and the introduction of its folding lens inside.
Ophthalmologists call this condition presbyopia (translated from Greek and Latin - "old eye"). Presbyopia develops due to a decrease in the ability of the lens to change its curvature. As a result, the lens in people in old age is always in a relaxed state, and after 60 years, it completely loses the ability to accommodate.
The first signs of presbyopia appear already at the age of 40-45 years. It becomes difficult for a person to read printed text, it is especially difficult to recognize it at dusk or in poor light. Moreover, such changes appear even for those who have never worn glasses before.
Unbeknownst to himself, a person, reading a magazine or newspaper with small text, tries to keep it away, and while doing some small work (handicrafts, sewing, knitting), lean back to focus. The eyes of an aging person get tired quickly, and prolonged stress provokes headaches, annoys him, which in some cases causes rejection of reading, handicraft or other minor work.
It is impossible to avoid age-sightedness, but modern ophthalmology has learned to deal with this pathology. Ophthalmologists offer conservative and surgical treatments for presbyopia. Conservative methods include glasses and contact lenses that correct vision. They are used in most cases for reading or watching TV.
For surgery in front of presbyopia, low-impact laser microsurgery is used.
The main microsurgical treatments for presbyopia are:
- LASIK (laser keratomileusis) is an operation to correct the refractive properties of the cornea, during which the corneal microlayer is cut with a laser;
- PRK (photorefractive keratectomy) is an operation during which evaporation is carried out with the help of an excimer laser of the upper layer of the cornea;
- implantation of an intraocular lens is an intervention in which the natural lens is replaced with an artificial intraocular lens.
The latter method is also a treatment for senile cataract, which often accompanies presbyopia.
Glaucoma is a group of eye diseases characterized by persistent increase in intraocular pressure, which leads to irreversible pathological changes in the optic nerve and retina. The outcome of untreated glaucoma is blindness.
Senile glaucoma develops for two groups of reasons:
- general (burdened heredity, systemic cardiovascular diseases, endocrine pathologies);
- local (pathology of intraocular vessels, violation of the drainage system of the eye).
As a result of violation of the outflow of intraocular fluid inside the eye, pressure builds up, which puts pressure on the retina and optic nerve. With a long course of the disease or a short-term, but frequent, sharp increase in pressure in the eye, the retina atrophies, and the optic nerve dies. Senile glaucoma is manifested by specific symptoms:
- blurred vision;
- narrowing of the visual fields;
- the appearance of halos around light sources;
- feeling of pressure, heaviness, cutting inside the eyes;
- pain in the temporal and superciliary areas;
- the deterioration of twilight, and later day vision.
In severe cases, possible attacks of glaucoma, which are accompanied by nausea, severe headaches, deterioration of general well-being. If such a patient is not treated in time, severe glaucoma attacks may end in blindness.
According to the mechanism of development, ophthalmologists distinguish between open-angle and angle-closure glaucoma, the treatment of which is radically different. The open-angle form of the disease arises as a result of a decrease in the gaps between the partitions of the comb ligament, and therefore the outflow of intraocular fluid worsens. The closed-angle form of senile glaucoma arises due to the age-related relaxation of the lens. The enlarged lens prevents the passage of fluid into the anterior chamber of the eye (the so-called "pupillary block").
Age glaucoma is treated conservatively, and with the ineffectiveness of conservative therapy - promptly. The tactics of treatment depends on the form of pathology (open or closed angle), severity of the disease (acute attack or chronic course) and its stage. Most often, patients are prescribed complex treatment, when surgery is supplemented by local drug therapy.
Conservative treatment includes prescribing drugs for:
- reducing intraocular pressure by improving outflow or reducing the production of intraocular fluid;
- improve the microcirculatory blood supply to the membranes of the eye and optic nerve;
- normalization of metabolic disorders in the tissues of the eye.
The main methods of surgical intervention in senile glaucoma include peripheral iridotomy (excision of the iris in its peripheral areas to restore outflow of fluid) and trabeculoplasty (artificial destruction of the walls of the comb ligaments). These operations can be performed microsurgically or with a laser.
Doctors-ophthalmologists call retinopathies the pathologies of the inner sensitive eye shell (retina). The retina is responsible for converting the light signal into a nerve impulse. With age in the retina, involutive changes occur: its thickness decreases, the vessels narrow, thrombose, atrophy. The accompanying pathologies (arterial hypertension, atherosclerosis, diabetes mellitus) aggravate and accelerate involutive processes in the retina.
The most common age-related pathologies of the retina include:
- retinal detachment;
- hemorrhage into it.
Senile retinitis (inflammatory pathology of the retina) is not clinically different from retinitis that occurs at a different age. Inflammation of the retina can be infectious and non-infectious (allergic, physical, chemical) nature, but the cause of the inflammation has no effect on the symptoms of the disease. The main symptoms of retinitis are a decrease in visual acuity, a change in the boundaries of the visual fields, a violation of color sensation, a distortion of the outlines of objects and a display of their movement.
Treatment of retinitis is conservative and consists of prescribing systemic etiotropic therapy (antibacterial, antiviral), anti-inflammatory drugs, vasodilators, antispasmodic, metabolic agents, as well as topical medication (eye drops, subconjunctival injections).
Retinal hemorrhages can occur against the background of severe diabetes, cardiovascular pathologies, and diseases of the blood system. Stressful situations, hypertensive crisis, cardiac arrhythmia, injury to the eye or head can be a provocation for the appearance of detachment.
Retinal hemorrhage can be acute or chronic, limited or massive. Depending on the size of the hemorrhage focus, patients may be prescribed conservative therapy (corticosteroids, anti-inflammatory, hemostatic, angioprotectors, antihistamines) or surgery (laser coagulation, vitrectomy).
Retinal detachment is usually preceded by its rupture. At the point of rupture, intraocular fluid begins to leak under the retina, separating it from the choroid. The causes of this pathology are similar to the causes of retinal hemorrhage. Clinically, retinal detachment is characterized by a decrease in visual acuity, the appearance of "flies", fog, blurred vision, sudden loss of lateral vision, deformation of visible objects.
Treatment of retinal detachment complex (surgical and conservative). The goal of treatment is the adjoining of the retina to the choroid with its subsequent strengthening.
From surgical interventions in case of detachment, extrascleral ballooning (filling), laser coagulation, vitrectomy (partial or complete removal of the vitreous body) are used.
Age-related pathologies of the retina are difficult to treat. Full recovery of vision after the treatment does not occur, because the retina is atrophied (visual cones and rods partially killed).
The best way to avoid senile blindness is to regularly visit an ophthalmologist. After 40 years, doctors recommend monitoring the condition of the eyes at least once a year, even in the absence of signs of deterioration of vision. When the first signs of visual impairment appear, the approach to an ophthalmologist cannot be postponed: adequate treatment will help to avoid progression and severe complications of eye diseases.