As I walked along the street my eyes started talking to me.
I don’t mean I was hearing voices, but the message was just as clear … something was wrong, very wrong. My depth perception was disappearing, clarity was not what it should have been – particularly since I’d had successful laser eye surgery - and my vision seemed like I had something in front of me preventing me from seeing well.
Immediately several thoughts ran through my mind: the laser surgery had been messed up, perhaps it was macular degeneration, cataracts, or worse.
A quick appointment with my eye surgeon quickly discovered the issue – a common malady, particularly among older patients. He recommended a specialist who provided vision exercises that corrected the problem, thankfully, within a few weeks.
But, the experience was a wake-up call as to how often we take our eyesight for granted, particularly as we get older.
There are varying estimates of vision impairment among older populations. An article in Geriatric Rehabilitation  suggested a range from approximately 4 percent to 20 percent of adults aged 65 and older experience vision problems.
The U.S. Centers for Disease Control and Prevention’s (CDC) National Health Survey indicates a rate of vision impairment for persons age 65 to 74 are somewhere between 10 and 20 percent.
The CDC reports that more than 3.3 million Americans 40 years and older are either legally blind or have poor vision. The leading causes of blindness and low vision are typically age-related eye diseases such as macular degeneration, cataract, diabetic retinopathy, and glaucoma, among others.Credit: National Eye Institute
The aged are often the least likely to have vision care or insurance to pay for it. By one estimate  persons aged 50 to 59 years were least likely to have eye-care insurance. The percentage of persons who had not had a dilated eye examination or a visit to an eye-care professional in the preceding 12 months decreased as people get older.
Costs in the Trillions
The cost of vision impairment is significant. At the 2012 World Ophthalmology Congress it was reported that global costs related to visual impairment were more than $2.95 trillion in 2010, with North America accounting for $692 billion and Western Europe accounting for $576 billion. The congress projected that the overall figure will balloon to nearly $3.53 trillion by 2020 . For the elder population that cost is also significant. Take for instance cataracts – most prevalent among seniors – the direct medical costs for cataract treatment are estimated by the American Optometric Association (AOA) at $6.8 billion annually . Another study estimated the combined economic impact of age-related macular degeneration (AMD), cataracts, diabetic retinopathy, glaucoma, and refractive error among Americans aged 40 and older costs $35.4 billion ($16.2 billion in direct medical costs, $11.1 billion in other direct costs, and $8 billion in productivity losses, in 2004 dollars). Annually, the U.S. government and state Medicaid agencies pay at least $13.7 billion of these costs .
But the price of age-related vision problems goes far beyond eye issues alone.
Recent research highlights that vision impairment in later life can have profound consequences for the physical functioning, psychological well being, and health service needs of older adults. A study published in 2005 in the American Journal of Geriatric Psychiatry  suggested vision problems/impairment in later life could lead to depression. The CDC says, “Vision loss ranks among the top ten causes of disability in the United States” and “people with vision loss are more likely to report depression, diabetes, hearing impairment, stroke, falls, cognitive decline, and premature death. Decreased ability to see often leads to the inability to drive, read, keep accounts, and travel in unfamiliar places, thus substantially compromising quality of life.”
So the need and desire to maintain healthy eyes and vision are clear. And many among the older population are keenly aware of the issue. A report by the Ocular Nutrition Society  suggests almost as many baby boomers say they worry about losing their vision as those that say they worry about having heart disease or cancer. But, even though they say they are worried about failing vision and/or other eye problems and 78 percent of those surveyed ranked vision as the most important of the five senses, more than half of those surveyed said they don't typically have a recommended annual eye exam.
Steps To Take
Maintaining your eye health is a multi-step process. It starts long before you reach middle or senior age. Here are a few tips:
See your eye doctor regularly
As the Ocular Nutrition Society survey found many people fail to visit their eye care specialist regularly. That’s a bad habit that most likely started long before senior citizenship arrived. So the first step to take in maintaining and/or improving one’s eye health is to have regular exams and checkups by a qualified eye care pro.
Credit: Ocular Nutrition SocietyWhat is a comprehensive eye examination? A qualified and quality eye care professional should perform most if not all of the following: take a complete patient history – not only of your eye health, but your overall health as well; test each eye (the old eye chart) for visual acuity; give you several additional tests such as depth perception, color vision capability, eye muscle movement, side vision tests, and your eye’s responsiveness to light. Additional tests will measure the curvature of your cornea; your refraction (are you nearsighted, farsighted, or have an astigmatism); how well your eyes focus and work together; and more.
Nutrition and Diet
Your eyes are not independent from the rest of your body. What you eat, your exercise regimen and more affect your eyes and eyesight. Many people are not aware of important nutrients that can play a key role in eye health. Experts recommend that disease prevention, including lifestyle changes, attention to dietary intake and vitamin supplements should be a focus of primary vision care. Studies indicate that proper nutrition promotes healthy eyes, however many American diets are found to be deficient of important nutrients that help protect eye health, suggests the Ocular Nutrition Society.
The American Optometric Association (AOA) recommends what they call “eye-friendly nutrients” such as lutein/zeaxanthin, vitamin C, vitamin E, and zinc to reduce the risk of certain eye diseases, including macular degeneration and cataract formation. Foods rich in eye healthy nutrients include tuna, salmon, spinach, kale and broccoli. An Age-Related Eye Disease Study conducted by the National Eye Institute in 2001 enrolled 3640 subjects, age 55 to 80. The study found that taking an antioxidant vitamin or mineral supplement reduced the risk of advanced Age-Related Macular Degeneration progression by about 25 percent and showed a 19 percent reduction in visual acuity loss in some of the subjects in the study.
Despite the evidence the Ocular Nutrition Society reported that only 18 percent of older adults say they take supplements to support their eye health. When considering vitamin supplement specifically formulated for eye health there are a lot to choose from. If you are not sure which might be best for you consult with your eye care specialist.
Just like the rest of your skin, your eyes need protection from the elements as well.
UV or ultraviolet rays (particularly the UV-A and UV-B parts of the UV spectrum) are the primary culprits in skin damage and they are also the bane of your eyes. Conditions such as photokeratitis (often referred to as “sunburn of the eye”) may produce extreme sensitivity to light and excessive tearing but are usually problems of limited duration. However there are long-term problems that can result from over exposure to the sun that may increase the chances of developing cataracts, retina damage, and other problems.
So, if you are out in the sun, make sure you protect yourself by wearing good quality sunglasses, a hat or cap with a wide brim. Sunglasses should ensure they block out 99 to 100 percent of both UV-A and UV-B radiation; screen out 75 to 90 percent of visible light; be perfectly matched in color and free of distortion and imperfection; and have lenses that are gray for proper color recognition, recommends the AOA.
Additionally, certain recreational activities could increase your risk of eye damage. For example, skiing, mountain climbing, time at the beach and other outdoor activities can increase risk of eye damage. Indoor activities like the use of tanning beds or occupations that might involve welding equipment are also risk factors (as is frequent computer use for long durations at a time). Even certain prescription drugs could make your eyes more sensitive to UV radiation. Any one of these factors should be thoroughly discussed with your eye care professional.
Smoking and Other Issues
A British study, among others, found that smoking affects vision. In the British study , researchers found smoking is associated with a two-fold increased risk of developing Age-Related Macular Degeneration.
Exercise is also a critical element in eye health, particularly as you age. Just like the health benefits exercise produces for the rest of your physical and mental condition, exercise is a significant factor in maintaining eye health. There are also eye-specific exercises that can easily be done. But, while exercises for your eyes may help, they’ll do nothing for serious eye problems like glaucoma or macular degeneration. An Internet search will reveal hundreds, if not thousands, of sites touting various eye exercise programs, along with supplements, special classes or the like. Whether or not eye exercises will help you, and what specific types of exercises you should attempt is best left to a discussion with your eye-care professional.
While my eye issues have cleared up, I’m now much better informed and prepared for any eye problems I may experience in the future – which I hope will be few and far between.
 Horowitz, Amy DSW. The Prevalence and Consequences of Vision Impairment in Later Life. Geriatric Rehabilitation. July/August/September 2004 - Volume 20 - Issue 3 - p 185-195
 Bailey RN, Indian RW, Zhang X, Geiss LS, Duenas MR, & Saaddine JB. Visual Impairment and Eye Care Among Older Adults—Five States, 2005. MMWR 2006; 55 (49): 1321–1325.
 World Ophthalmology Congress (WOC) 2012: Abstracts IS-RET-SA 232 (6) and IS-RET-SA 232 (3). Presented February 18, 2012.
 Eye Health Statistics at a Glance - Compiled by American Academy of Ophthalmology (Updated April 2011)
 Rein DB, Zhang P, Wirth KE, et al. The Economic Burden of Major Adult Visual Disorders in the United States. Arch Ophthalmology 2006; 124(12): 1754–1760.
 Horowitz, Amy D.S.W.; Reinhardt, Joann P. Ph.D.; Kennedy, Gary J. M.D. Major and Sub-threshold Depression Among Older Adults Seeking Vision Rehabilitation Services. American Journal of Geriatric Psychiatry: March 2005 - Volume 13 - Issue 3 - p 180-187
 J. R. Evans, A. E. Fletcher, R. P. L. Wormald. 28 000 Cases of Age-related Macular Degeneration Causing Visual Loss in People Aged 75 Years and Above in the United Kingdom May Be Attributable to Smoking. British Journal of Ophthalmology 2005; 89:550-553 doi:10.1136/bjo.2004.049726